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National HIV prevention - grateful for small mercies?

Yusef Azad

Some readers will recall the campaign NAT led at the end of 2014 to prevent national HIV prevention spending being cut by 50%. We were successful – and last year in 2015/16 the overall amount spent by central government remained more or less stable at £2.4 million. But what now are the plans for the current year, 2016/17? NAT wrote to Public Health England (PHE) to find out. One thing is clear… not enough is being done in England to prevent HIV transmissions.

We are failing to prevent HIV transmission

For a decade new infections amongst gay men stood obstinately at about 2,600 a year, but by 2014 they had risen to 2,800.[1] The challenges in prevention are not restricted to gay men, indeed heterosexual transmission remains significant and consistent, at about 1,500 new diagnoses a year.[2] 

How can it be that despite the vast majority of people diagnosed with HIV being on treatment and non-infectious we are actually seeing an increase in HIV transmissions? Put simply, we are failing in our efforts to promote safer sex.

There is much that could be said about the changing nature of risk, and the content and quality of our interventions, but there is a simpler and more urgent point – you get what you pay for.

Two years ago NAT found that for every £55 spent on HIV treatment only £1 is spent on HIV prevention.[3] We estimated that, at best, spend across England was around £15 million. Compare this with a budget for HIV prevention spending in 2001/02 of £55 million. Over the last 15 years we have witnessed a relentless disinvestment from HIV prevention. The result at first was that HIV transmissions did not go down. The result now is that HIV transmissions are going up.

And spending even less on HIV prevention nationally

PHE’s national work on HIV prevention is not meant to substitute for activities commissioned by local authorities. It is there to catalyse, support, promote, and do what is better done nationally rather than locally. The amount of funding for national HIV prevention has always been modest but vital. It is also a barometer of Government commitment to preventing HIV.  In a letter to NAT, responding to our request for information, PHE announced what it plans to spend nationally on HIV prevention in 2016/17:[4]

  • The national HIV prevention programme (HIV Prevention England, managed by Terrence Higgins Trust) is funded at £1.2 million;
  • The HIV Prevention Innovation Fund (an initiative repeated from last year) is funded at £0.6 million;
  • The national HIV self-sampling service is funded at £0.2 million; and
  • Monitoring and evaluation of the HIV Prevention and Sexual Health Promotion Programme is funded at £0.25 million. 

This amounts to £2.25 million in total and more or less replicates spending from the previous year.  But it is £150,000 short of the £2.4 million in 2015/16 - a 6.25% cut. 

PHE also includes in its own analysis its funding for sexual health promotion through the £250,000 information contract retained by FPA.  This work is of course vitally important, but given the content and intended audience we don’t accept that it is focused on HIV prevention. 

Should we be grateful for small mercies?

Let’s be realistic. All government departments are experiencing massive cuts and Public Health England is no exception. In that context, to contain a cut to just under 7% is an achievement. Credit should be given to all those in PHE who have worked long and hard to make the case for HIV prevention. That commitment to HIV was shared by the outgoing Public Health Minister, Jane Ellison. 

So should we be grateful for small mercies? That the cuts weren’t far worse?  Appreciation of the efforts of PHE to contain the damage cannot blind us to the overall picture of the scandalous underfunding of HIV prevention and the irresponsible neglect of the health of communities at risk of HIV - gay men, African-born men and women, other migrant communities. 

Government cuts to public health, both in the local authority public health grant and nationally, mean an increase in HIV transmissions. It is that simple.  We will not see a turnaround in HIV transmissions until the Government starts valuing our health and spends significantly more. Yes we are grateful for mercies… but they are pitifully small, and that should make us angry.

[1] ‘HIV in the UK – situation report 2015’ Public Health England

[2] ‘HIV in the United Kingdom 2014 report’ Public Health England

[3] NAT surveyed all high prevalence local authorities in England and collated this with spending data from the London HIV Prevention Programme and National HIV Prevention Programme.  The results can be found in ‘HIV prevention and testing in England’s high prevalence local authorities

[4] Read the letter from Professor Kevin Fenton here

NAT Topic

Sep 7, 2016 By hugo