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By Hannah Ward

This year marks 40 years since the start of the HIV epidemic in the UK. Over that period, we have lost far too many of our friends and family and as we remember and celebrate their lives today, we also mark the progress made in HIV treatment over this time. HIV is now not a life-ending condition, but a completely treatable health condition. Those on successful treatment can live long lives and cannot pass on the virus. PrEP, the HIV prevention drug, also means that those taking this daily pill are protected from getting the virus too.

Today on World AIDS Day, the UK Government has released its HIV Action Plan for England, including the first significant new funding for HIV testing in nearly a decade. The important new commitments, to fund opt-out HIV tests in hospitals in the highest prevalence areas, to explore making PrEP more widely available outside of sexual health services, to improve NHS training to tackle HIV stigma and to report annually on progress towards 2025 and 2030 targets are all a substantial step in the right direction.

However, today’s HIV data is a stark reminder that the challenge of ending HIV transmissions is not an easy one. COVID has greatly impacted services. There have been big decreases in HIV testing and fewer people living with HIV are accessing the treatment they need to live long healthy lives. The number of late diagnoses of HIV is increasing, and take-up of the HIV prevention drug PrEP is not increasing quickly enough in all communities. There are also wide regional disparities.

We urgently need investment in sexual health and HIV services, to ensure they can rebuild capacity, increase access to tests, and ensure that the big uplift in demand for online testing can be met. A commitment to make online HIV testing available year-round, in all areas, is a real no brainer.

Local authorities, who have responsibility for HIV prevention, are chronically underfunded, and the recent disappointing settlement on public health funding means that they will struggle to play their crucial role.

And ongoing health inequalities must be tackled if we are to have any chance of end HIV transmissions. Too many communities are being left behind by poor access to PrEP, a lack of quality and accessible information, and a lack of support to access treatment and care. It is telling that 96% of those accessing PrEP are gay and bisexual men, and are overwhelmingly white. And while overall HIV diagnoses have fallen across the board, the rate of decline is slower in BAME groups.

It is clear that this plan won’t be enough on its own to get us to our shared goal. The Government must deliver the commitments quickly and push forward on tackling HIV stigma across our society, scaling up testing across the NHS and ensuring everyone with HIV is supported to access HIV treatment. National AIDS Trust will be closely monitoring progress and ensuring that reduced transmissions are a reality for all communities affected by HIV.

This World AIDS Day we're asking you to join is in the fight against HIV to end transmissions and stigma once and for all. Sign up here.

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Key highlights from the HIV Action Plan

The Department for Health and Social Care today launch its Action Plan. This is available in full here.

The plan has committed to ambitious targets for 2025 -

1. to reduce the number of people first diagnosed in England from 2,860 in 2019, to under 600 in 2025.
2. to reduce the number of people diagnosed with AIDS within 3 months of HIV diagnosis from 219 to under 110.
3. To reduce deaths from HIV/AIDS in England from 230 in 2019 to under 115.

The plan includes key commitments such as:

• £20m of new investment over three years, to expand opt-out testing in emergency departments in the highest prevalence local authority areas, a proven effective way to identify new cases.
• Continue the National HIV Prevention Programme in England over 2021 to 2024 with £3,500,00 for this period.
• Develop a plan to drive innovation in PrEP delivery to improve access for key groups including provision in settings outside of sexual and reproductive health services.
• Work with areas not providing home/postal HIV testing to make sure 100% of areas do.
• Scale up capacity and capability for effective partner notification (PN) for people diagnosed with HIV.
• A new standard for sexual health services to achieve a 90% HIV testing offer rate to first time attendees, with monitoring and reporting on progress.
• A review of late diagnosis protocols, identifying opportunities to strengthen these and roll out nationally.
• Work to include information on HIV transmission and U=U as an element of every healthcare worker’s standard induction and regular mandatory training.
• A national HIV Action Plan Implementation Steering Group to drive forward progress.
• Parliament will be updated annually on progress by the Secretary of State.
• A set of indicators and targets to assess progress against the Action Plan will be published in 2022.

Key highlights from 2020 HIV and sexual health data

• Last year’s data shows that the number of people living with HIV has increased to 106,890 in the UK.
• Worryingly, the number of people being tested for HIV at sexual health clinics decreased 30% in 2020. This was particularly high for heterosexual people and Black African communities, which is particularly concerning as rates of undiagnosed HIV and late HIV diagnosis remain stubbornly high amongst this group.
• Almost half of people testing did so online – showing significant increased demand for online testing services and making the case for year-round access to online testing in all areas.
• There has been an increase in the rates of late HIV diagnosis in England to 42%  of all diagnoses, up from 35% in 2019.
• Fewer people accessed HIV care in 2020 – with double the number not receiving HIV care who needed in in 2020 compared to 2019. 
• From 2017 to 2020 24,000 people had access to the HIV prevention drug PrEP in England through the Impact Trial. However, access was low amongst many groups. 96% accessing the drug were gay and bisexual men, 76% were white and the median age 33 years. More action is needed to reach all communities.

The data report can be read in full here.

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