By Joe Parry

To this day HIV activism works in tandem with ambition and innovation in the medical profession and science to achieve what was almost unimaginable 40 years ago – HIV is now a manageable long-term condition, and we have a wide range of effective prevention tools at our disposal. With the theme of LGBT+ History Month 2024, Medicine – #UnderTheScope, we have an opportunity to reflect on the intertwined histories of HIV, as a medical and social issue, and LGBT+ community activism.

HIV history is LGBT+ history

We can’t discuss the history of HIV without discussing homophobia. This prejudice prevented initial progress for the predominantly gay men who were affected by HIV when the virus first emerged in the 1980s; it silenced many from speaking out in public. But throughout this era, a bond between dedicated clinicians and activists formed, which is still very much alive today. 

In the early days of the pandemic, pressure groups including ACT UP and Treatment Action Group worked to persuade the political and medical establishment to take action to protect the lives of people living with HIV and communities affected. Those communities had to become experts in their own healthcare and health promotion. Activists demanded increased research funding, accelerated drug approval processes, and a more inclusive approach to clinical trials. As a result, groundbreaking medications like antiretroviral therapy were developed, transforming HIV to a manageable chronic condition. The HIV workforce, often deeply affected by their work, was always a part of the movement. Clinicians including the Chair of National AIDS Trust, Professor Jane Anderson, still speak of the impact and remain committed to change.  

The alliance continues to this day. Without allies working in healthcare combining forces with LGBT+ and other activists, the current landscape for HIV in the UK would be very different. The Government’s recent commitment to change fertility laws that discriminate against LGBT+ people living with HIV would not have happened without the two-pronged attack of scientific data and expert medical insight from our colleagues at BHIVA, alongside collective action. The HIV prevention drug PrEP would not be available if it weren’t for advocates from inside the NHS working with activists and charities to build the evidence base and demand free access to the game-changing blue pill.  

Progress is not being felt equally

Challenges persist; sadly we know that advancements are not felt equally. Recent UKHSA data showed that while HIV diagnoses among gay, bisexual and other men who have sex with men (GBMSM) decreased in 2022 compared to 2021 overall, diagnoses increased among those of Asian and mixed or other ethnicity. We also know that 74.6% of those accessing PrEP in England in 2022 were white GBMSM, further highlighting huge ethnicity and gender disparities.  

UKHSA’s Positive Voices survey further spotlights worrying inequalities which exist for more marginalised LGBT+ communities. Trans and non-binary people living with HIV report far lower life satisfaction, health-related quality of life, and resilience outcomes compared to other groups, in addition to increased stigma.  

These clear imbalances call for the focus for both healthcare professionals and community activists to be renewed solidarity with all people across the intersections of the LGBT+ community. 

A call for renewed solidarity

Our allies across health systems must recognise that unless marginalised communities are part of conversations about their own healthcare, and without tailored support and interventions, inequalities will deepen. This is why projects such as Unheard Voices, which aims to end structural inequalities experienced by Black communities living with or at risk of HIV, are vital in ensuring no-one is left behind in the fight against HIV. This is also why representation and inclusion in healthcare is so important and should be celebrated, helping to increase competent services that are truly accessible to those who are still too often marginalised.

This LGBT+ History Month, we must recognise the indelible connection between HIV activism and medicine and the need to raise our voices through ongoing collaboration and solidarity. By addressing the challenges of access within marginalised communities, we can pave the way for a future which ensures the lessons learned from the past contribute to a more equitable world for all people living with HIV.