Don’t quit while ahead but invest to build on HIV prevention successes
In two years, investment in community based HIV prevention decreased by over a third in London. This coincided with significant Government cuts to the public health grant. In the same period, there has been reduction in HIV diagnoses amongst MSM in some parts of the city. So, do the funding cuts to prevention matter? If we want to sustain and build on our success, then yes, they matter a lot.
A 32% decrease in HIV diagnoses amongst MSM in London was recorded across five clinics between October 2015 and September 2016 and analysis shows that it reflects a genuine reduction in HIV transmission in this group. This is wonderful. But so far, it is also localised.
Cuts in HIV prevention spending in London are not a response to changing needs in the city, still less the reduction in diagnoses amongst MSM. They are a direct result of the Government’s year-on-year disinvestment in the public health grant. The HIV diagnoses data from London does not justify such cuts. In fact it will take time before we can see the impact of these cuts on our HIV prevention efforts.
We know that combination HIV prevention works – if you increase awareness through health promotion, increase testing, get people on treatment, and increase access to PrEP, you can reduce HIV incidence. Now, in London for 2015/16 this effect is documented. The funding put into community health promotion has meant that many MSM are increasingly aware of their risks and thus are testing more regularly and taking other steps to protect themselves. Cutting back those services that have led to this effect, threatens their long-term success.
The drop in HIV diagnoses is relatively confined to MSM in five London clinics. Elsewhere diagnoses continue at significant rates. There is no evidence to suggest that our combined prevention strategy should change to address this at the moment. But funding for HIV prevention outside London fell by 10% between 2015/16 and 2016/17, and by 13% in those areas with a high prevalence of HIV, limiting our capability to transfer the results in London elsewhere.
Furthermore, cuts are undermining our ability to tackle HIV in other groups where this effect is not yet being seen. NAT’s research found a disproportionate squeeze in funding for BME specialist services in recent years, in London and beyond. We may see deepening inequalities in HIV if services fail to meet the needs of all those affected.
Nothing would be worse than to quit while we’re ahead. To know that we have tools that work to stop people from getting HIV and then to disinvest in them is both nonsensical and unethical. Not only does government need to invest to sustain the outcomes we have in London, it needs to do so to replicate them in other places, and in other groups.