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The government must follow the science to achieve HIV justice


The scientific advances on HIV have been nothing short of miraculous. Over the last 40 years we’ve seen the identification of the HIV virus itself, the development of effective medications, self-tests, the discovery that people on effective treatment can’t pass HIV on, prevention tools like PEP and PrEP, and the recent emergence of long-acting injectable treatments. While we have yet to develop a cure or vaccine, we already have all the tools we need to stop HIV transmissions and make the lives of those living with HIV immeasurably better.

In the weeks since I returned from the AIDS 2022 conference, I’ve found myself reflecting on the conference theme, ‘follow the science’, and the many ways in which we fail to do that on HIV policy at the cost of progress. What good is HIV testing if those most at risk don’t, or can’t, access it? How limited is the impact of HIV treatment if out of 9.7m people internationally, 25% of all those living with HIV, weren’t able to access it last year?[1] Can we possibly think that PrEP is as effective as it should be in England when it took two court cases and a three-year trial for people to access it on the NHS? Even now, women and those from minoritised communities aren’t easily able to get PrEP. It is the system that is letting them down. The evidence showing the challenges people who are not white gay males face when it comes to accessing this vital prevention drug has been around for years, yet we’ve seen very little action taken to address this by government. And new data now shows that in England, following the COVID-19 pandemic, up to ten percent of those diagnosed were not on treatment or were lost to follow up having not attended an appointment within two years.[2]

Our inability to effectively ‘follow the science’ goes further than this though. The COVID-19 pandemic, and the current Monkeypox pandemic, illustrate that public health is always an international problem with international solutions. Yet we make the same mistakes over and over again. With so many millions of people still unable to access HIV medication, the world also failed to ensure equitable access to the Covid-19 vaccine, with damaging results. Despite recognising this, as the Monkeypox epidemic grows internationally disproportionately affecting people living with HIV, and vaccine supply remains severely limited, no international approach has been developed. Instead richer countries have purchased limited supply, in turn driving up the cost for others.

Failure to follow science also plays out in the way in which discrimination based on HIV is often partially rooted in out-of-date, even disproven, understandings of HIV.  One example is the current law blocking access to fertility treatment in the UK for many people living with HIV, based on misplaced concern about risk of HIV transmission despite there being zero risk to anyone involved. Yet another example is the problematic law in the UK that criminalizes ‘reckless transmission’ of HIV, which goes against international consensus on the evidence - that this feeds HIV stigma and acts to discourage people from accessing treatment and support[3].

Migration policy is another area where prejudice often outweighs evidence. Our recent publication on HIV and migration underlined in stark detail the barriers migrants in the UK face accessing testing, treatment and care, yet migration policy and immigration detention add to the issues rather than solve them, with devastating consequences like people being denied life-saving medication.

If we are ever to make the progress in HIV that is not just possible but tantalizingly close, we need to shift our attention to how we implement the science. We must pay as much attention to growing access to medication as we do to developing new medications. We must devote as many resources to combatting inequality and stigma as we do to building innovations in the HIV pipeline. And we must change the laws and policies that are not backed up by science and that hold us back, here and around the world. Without this renewed focus, all the science in the world will never get us where we need to be. This is the government's responsibility. We have the tools to end HIV and improve the lives of people living with HIV, we just need action to make it happen.

Sep 5, 2022 By santi.agra