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Even when someone is known to have HIV infection, cognitive impairment can sometimes be difficult to diagnose.

This is because the symptoms are similar to those of other conditions, such as depression.

As the inclusion of ‘mission’ in its name suggests, Mildmay has Christian roots.

It is part of the charity Mildmay, which dates back to 1866 when the Reverend William Pennefather and his wife Catherine started working to tackle the cholera epidemic in the east end of London. As a cottage hospital, Mildmay became part of the NHS in 1948, but under Margaret Thatcher’s government it was forced to close in 1982 when these hospitals were deemed uneconomical.

In its factsheet on rarer causes of dementia Alzheimer’s Society explains HIV-associated neurocognitive disorder (HAND) and names Mildmay Hospital as an organisation that works with people affected by this condition.

It says: Neurocognitive disorders in people with HIV may be caused by the virus directly damaging the brain.

The result, she says, is a shift of resource away from specialist treatment, specialist nurses and social work teams, diminishing knowledge and experienced-based specialisms of those who understand the complexities of HIV from a medical and social perspective.

“You have to know HIV from a medical perspective to be able to look at the possible trajectory of the disease and therefore its implications on any one individual,” she adds.

Beverley Nelson, one of Mildmay’s two social workers, lives locally and can still clearly remember the furore about “AIDS people” caused by the reopening.“HIV is not a one size fits all, especially in the area of cognitive impairment which can produce such varied responses in patients.” Advances in antiretroviral drugs has led Mildmay to change its focus from end-of-life care to specialised rehabilitation.It is now Europe’s only centre dedicated to rehabilitating people living with HIV-associated neurocognitive disorder (see box).Although it was a bold campaign that got people talking about HIV/AIDS and almost certainly saved lives, it also generated a backlash of fear and stigma, leading to myths that HIV could be ‘caught’ by sitting on a public toilet seat or shaking someone’s hand.It was Princess Diana who, arguably, brokered one of the biggest changes in public opinion when she began visiting HIV organisations and hospital wards, shaking the hands of people who were dying of AIDS-related illness without wearing gloves.

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Where there is no CNS, CCG commissioners can request an admission.

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