- But as we reduce HIV rates, things will get harder not easier, says National AIDS Trust’s Deborah Gold.
Public Health England has released its latest report showing the UK’s progress against the HIV epidemic. What did we see? A continued decline in HIV transmissions across all affected groups.
That decline is most pronounced among gay and bi men in London – particularly younger white ones. But there’s progress to be seen everywhere.
Our challenge to the government, the public, and you: let’s not be complacent. Let’s end HIV transmissions in the UK by 2030.
Here at NAT (National AIDS Trust), we fight to protect the rights of people living with and at risk of HIV.
We took NHS England to court to ensure the provision of PrEP in 2016. We fought to ensure that the Equality Act 2010 made HIV discrimination illegal.
Along with Terence Higgins Trust, we’ve recently set up the HIV Commission It will make independent recommendations to government on how to end HIV transmissions in England by 2030.
This is why we’re delighted that new HIV transmissions are down by almost 30% compared with 2014.
Why HIV rates are now falling at last
Why the change? We can put it down to the combination of prevention methods we’ve been able to benefit from these past few years.
Back in 2014, we knew that people on effective HIV treatment cannot pass the virus on sexually. Despite this, it was still not policy to treat people as soon as they’d been diagnosed.
We now have even more evidence that this is true. So now clinics diagnose and treat people swiftly. It helps their own health and it prevents onward transmission.
In 2014 barely anyone was talking about or taking PrEP, a pill you can take to prevent acquiring HIV. Now it’s partially available on the NHS in England. And it is available for all who need it everywhere else in the UK.
Overall, thousands have decided PrEP is the right prevention method for them (whether through the NHS or by self-sourcing).
Sexual health clinics facing cuts
However, it’s not all cause for celebration. People are sometimes struggling to access the PrEP trial in England.
We know that dozens have gone on to acquire the virus after being unable to access the prevention option they need.
Sexual health services are at the heart of the effort to tackle HIV. But they are bursting at the seams due to never-ending funding cuts.
The same Public Health England report which praises the decline in HIV transmissions notes that not nearly enough people are routinely tested for HIV when they go to sexual health services.
We’re missing valuable opportunities to test and treat HIV.
Just last week, we read the heartbreaking news of Ross Scott, a young man from Scotland who died from AIDS-related illness after living with undiagnosed HIV for years.
This is a fate no one should face in an era where HIV treatment means you can live as long and healthy a life as the rest of the population.
As we get HIV down, getting budgets will be harder
So, while we can look at these figures with optimism, we must remember that every single HIV transmission and every single HIV-related death is preventable.
We’ll only cheer once we succeed in making that a reality and genuinely preventing new transmissions and deaths.
In fact, as things get better across the board, our job of ending HIV transmissions by 2030 gets harder not easier.
Think of it like building a flatpack from IKEA. It’s easy to feel satisfied after getting the first few things right. But putting your feet up is a bad idea. The next steps are only going to be more intricate.
As fewer people test positive for HIV, we make fewer savings from testing and treating the virus. That means it gets harder for us to make the case for widely available testing to a government closely guarding its purse-strings.
Yes, we’ve made great headway among gay and bi men. But we’re not moving as quickly with other groups. In some cases, we’re not moving at all.
A case in point is the stubbornly high proportion of heterosexual people living with HIV who are diagnosed late. This means they’re less likely to be one of the many people whose HIV does not affect their long-term health.
Time for a new policy on drugs
Progress is not inevitable, and the HIV epidemic does not look the same everywhere.
For many years, the UK was successful in minimising the impact of HIV among people who inject drugs.
But look to Glasgow. Since 2015, 162 people who inject drugs have been diagnosed with the virus. That compares with around 10 annually among that group in the city in the years before.
Most of those diagnosed face severe multiple deprivations, including homelessness and addiction.
That requires a different type of intervention. We need to reach them in their communities, rather than trying to accommodate them in a service designed for people with radically different lives.
It requires us to be bold about harm reduction policies. It’s time to acknowledge people who use drugs should be able to use them in settings which minimise the risk to their health. Yet the government consistently pushes back on the growing cross-party, cross-society, call for a harm reduction approach to drug policy.
Working together to end HIV
There is no one-size-fits-all solution to any of this. There’s only hard work, well-funded services fit for the communities they are made to serve, and innovative thinking that tackles this issue from every angle.
This is why National AIDS Trust and Terence Higgins Trust set up the independent HIV Commission. It brings together leaders from business, sport, Parliament, and people living with HIV.
We then jointly produce recommendations to government on how to end HIV transmissions by 2030.
Whether you’re an individual with a personal story to share about how HIV affects your life, or an organisation with ideas on how we can keep tackling HIV, you can submit to the commission’s evidence-gathering session here.
Do it by 31 January 2020 and be part of our collective fight to end HIV transmissions by 2030.