HIV Action Plan: We can’t allow positive findings to disguise the very real challenges we face
By Deborah Gold
We’re delighted with the encouraging updates in the HIV Action Plan annual report, which detail how the country is performing toward our shared target to end new HIV transmissions in England by 2030. It’s no small achievement, and we should spend time properly celebrating the progress that has been made, and the effort of many to get us to this point. But celebration should not come at the expense of a renewed focus on what is left to do. Because underneath the positive progress are the very real challenges that face the sector to support people living with HIV and those at risk of acquiring it.
The HIV Action Plan, launched by the Government in 2021, is a comprehensive strategy aimed at tackling the HIV epidemic within the country. It focuses on four key areas: prevention, testing and diagnosis, treatment and care, and reducing stigma, and sets out the Government’s commitment to achieving zero new HIV infections, AIDS and HIV-related deaths in England by 2030.
The annual report shows that between 2019, when the HIV Action Plan first launched, and 2021 the number of new HIV diagnoses first made in England has fallen by 32%. In that same period, the number of people diagnosed with AIDS fell by 21%. These figures are testament to the collective effort across our voluntary and community sector, the health system and the government in improving access and reducing barriers to HIV prevention methods, testing and treatment.
But this progress is not equal. As part of the Action Plan, hospital emergency departments in London, Brighton, Blackpool and Manchester are testing people for HIV and this programme has identified people living with HIV from groups who are less likely to routinely test, including women, heterosexuals and those of Black ethnicities. Many of these people are experiencing poorer health outcomes due to late diagnoses.
The opt-out testing figures also show hundreds of people who are being identified with HIV but are not currently engaged with treatment. This is simply not good enough. The longer people living with HIV go without medication and support, the sicker they can become, while still be able to transmit the virus to others. People are not able to engage in medical care for their HIV for a whole variety of reasons, but in each of those, more must be done to empower and support vulnerable people to access life-saving treatment, meeting their individual needs. People should not be dying in the UK because of their HIV in 2023.
Opt-out testing works and the time to expand the programme to more hospital emergency departments across the country is now. Any further delay from the Government on expanding opt-out testing will mean missing the chance to diagnose hundreds more people across England. Everyone must have an equal chance of being diagnosed and accessing treatment.
The report mentions one of the key priorities of the following year is to develop a roadmap to improve PrEP access and equity. Our joint 2022 report Not PrEPared found that only 35% of people who tried to access PrEP on the NHS were able to. We also found unmet needs for PrEP within heterosexual, trans, Black African, Black Caribbean, and other ethnic minority communities.
Our report includes several recommendations which we hope to find in the HIV Action Plan’s PrEP roadmap. The Government must make PrEP available beyond sexual health services, to increase access to PrEP more widely amongst underrepresented, at-risk demographics. This should include GPs and community pharmacies and online routes. The impact of COVID-19 and mpox on our sexual health services cannot be understated. Keeping PrEP access confined solely in our underfunded and overstretched sexual health services will only exacerbate unmet needs.
Data released earlier this week from UKHSA showed record levels of gonorrhoea and syphilis diagnoses. This proves what can happen when an endemically underfunded public health system is overwhelmed and unable to deliver prevention, testing and treatment interventions that reach everyone they need to. If we don’t get things right, we could face similarly devastating challenges with HIV, not least because higher rates of other STIs are linked to increased risk of HIV.
Our hope is that the positive news from the HIV Action Plan galvanises the Government to go further with their HIV interventions and funding. Our 2030 goals are achievable but by no means guaranteed.