Alastair Duncan – the co-chair of the BDA HIV Care Specialist Group – is the UK’s first Consultant Dietitian working in HIV. He tells us how he progressed to the role.
Who you are and what is your dietetic role and specialism?
I’m Dr Alastair Duncan but everyone calls me Al. Technically my job title is Consultant Dietitian for Obesity and HIV, although I tend to lose the descriptive bits and stick to Consultant Dietitian. I guess my work is split 50:50 between the two areas.
Additionally I lead on audit and research for the dietetic dept at Guy’s & St Thomas’, and I work one day per week as a Dietetics Lecturer at King’s College London (KCL). I’m passionate about addressing health inequalities and the central role dietitians can have in this space.
How did you become an HIV dietetic consultant?
I was awarded an NIHR clinical doctoral research fellowship to investigate why so many people living with HIV were developing diabetes. After my PhD I continued to research into the complexities of HIV care.
Guy’s is part of the King’s Health Partners Academic Health Sciences Centre, with an organisational ethos of clinical research being central to our work. Within this environment, our Head of Dietetics, Rhys White, had a vision to create consultant dietitian roles to lead our large dietetics department in terms of research and audit, and myself and Dr Danni Bear were appointed.
What has been your career progression from newly qualified dietitian to consultant?
My first degree was in biological sciences, and I worked as a Government scientist for a while before taking a radical departure to work as a chef. I met a dietitian specialising in HIV care, and thought, ‘that’s what I want to do!’
I volunteered in the dietetics department at The Chelsea and Westminster Hospital to find out more about being a dietitian. After completing an MSc in Nutrition I studied dietetics at King’s College London, and then after a short spell of general dietetics was appointed as HIV specialist dietitian at Guy’s in 1998. I was Deputy to the Head of Dietetics from 2005 until 2012, and then was awarded the NIHR research fellowship.
What does your role entail?
There are four pillars of practice. In the Clinical pillar, I lead the dietetic services for HIV and for obesity. In HIV, I developed the Living Well service to support people living with HIV as they get older. I lead an multidisciplinary team (MDT) of 32 people delivering a range of weight management interventions across south-east London.
The second pillar is Education – I work one day per week as a dietetics lecturer at KCL, and teach clinical colleagues at Guy’s and across the country.
The third pillar is Research and Innovation. Service development is at the heart of my role, as is audit and research. I am chief investigator for a study exploring perceptions of weight management services, from both a patient and clinician point of view. I also support everyone in the dietetics department at Guy’s to be more involved in audit and research.
In the fourth pillar – Leadership – I am Chair of the BDA HIV Care Specialist Group, and represent Dietetics on the SE London Diabetes, Endocrinology and Obesity board.
What advice do you have for anyone thinking of applying for dietetic roles in HIV?
People living with HIV experience so much stigma. I feel privileged to support people living with HIV and help them deal with this stigma. If you are thinking of working in HIV care, put yourself in the patient’s shoes, and think about how you might support them.
