No Increase in HIV Prevention Spend Despite Massive Increase in Need Over Last Ten Years

The results of a survey by the National AIDS Trust suggest that investment in HIV prevention in England has stagnated, and probably decreased, over the last ten years, despite the fact that the potential for HIV transmission in the UK is greater than it has ever previously been.

With a massive increase in the last ten years in the numbers living with HIV, significant increases also in the size of both gay and African communities in the UK, and evidence of increased risk taking behaviour, there is an urgent need for HIV prevention to be a priority for the NHS and effectively funded.

Instead, the survey of Primary Care Trusts (PCTs) across England, carried out by the National AIDS Trust with support from the Health Protection Agency, found considerable uncertainty as to the amounts being spent on HIV prevention.  The data which was available, if extrapolated, would mean that overall HIV prevention expenditure in England was approximately £38 million in 2005/06.  This figure in real terms is less than was being spent ten years ago, despite the increasing level of need. 

The results of the survey also present worrying evidence that HIV prevention is being deprioritised by PCTs, even in areas with the highest prevalence of HIV.  Overall, only 55% of PCTs had HIV prevention as a priority in their Local Delivery Plans, and the PCTs which had the highest numbers living with diagnosed HIV were no more likely to have HIV prevention as an agreed priority than those with the lowest numbers.  Even fewer specifically mentioned the HIV prevention needs of gay men (23%) and black African communities (17%) in their Local Delivery Plans, even though these are the groups most at risk.

Deborah Jack, Chief Executive of the National AIDS Trust, comments:

"This survey has revealed shocking complacency around HIV prevention in England today.

With numbers living with HIV at an all-time high, now is not a time for HIV prevention to be ignored and for funding to be reduced.  HIV prevention needs to be a public health priority and more investment is urgently needed to stop many thousands more people in England becoming needlessly infected with HIV in the next ten years."

Most of the respondents to the survey had incomplete or inaccurate understanding of their local population and its HIV-prevention needs, even though they were responsible for the commissioning of HIV prevention services.  Many for example were unable to correctly say how many people were currently accessing HIV care in their PCT and more than half (57%) had not carried out a local health needs assessment relating to HIV prevention or were unable to respond to this question.

A significant number of respondents to the survey said that they needed better resources, training and evaluation if they were to be able to judge whether the HIV prevention strategies they were commissioning were effective or not.

Dr Valerie Delpech, of the Health Protection Agency, comments:

"Knowledge of the local number and characteristics of persons infected and of those at greatest risk of HIV infection are essential to inform and monitor health promotion and other prevention activities."

The National AIDS Trust today calls for:

• Primary Care Trusts to increase investment and resources in HIV prevention programmes and to clearly indicate how much is spent on HIV prevention each year
• The Department of Health to provide training and resources which will give commissioners the information and expertise needed to commission effective HIV prevention services.
• New and measurable HIV prevention targets to be identified and adopted at both national and local levels. 

The full report of the survey is available to download at www.nat.org.uk.

Notes to the Editor:

• 137 English PCTs were sent questionnaires by the National AIDS Trust (NAT) in September 2006 and the report is based on the responses of 80 of these PCTs.
• The Health Protection Agency (HPA) assisted with the methodology and analysis.
• The National AIDS Trust is the UK's leading independent policy and campaigning voice on HIV and AIDS. It aims to prevent the spread of HIV, encourage early diagnosis, ensure people living with HIV have access to treatment and care, and eradicate HIV-related stigma and discrimination.
• The HPA is an independent body that protects the health and well-being of the population. The Agency plays a critical role in protecting people from infectious diseases and in preventing harm when hazards involving chemicals, poisons or radiation occur.