Understanding of HIV in the UK is in decline, yet the virus has not gone away. Indeed, 25 per cent of people now being diagnosed with HIV acquired in the UK are from the wider population, rather than the two groups most affected, gay men and African communities.
Campaigners fear that amid the relentless public spending cuts of austerity Britain, people living with HIV and prevention strategies will be overlooked.
While new HIV diagnoses remain stubbornly high but stable overall, this disguises a continuing upward trend in HIV infections, which have been acquired in the UK as opposed to overseas.
Last year saw a record number of new diagnoses among gay and bisexual men. In addition, the Health Protection Agency now estimates that a higher proportion, than previously thought, of HIV diagnoses among Africans in the UK were UK-acquired infections.
“We have yet to see significant reverses in rates of HIV infection in the UK,” warns Deborah Jack, chief executive of NAT (National Aids Trust).
“Over the last decade there has been a significant decline in public knowledge and understanding of HIV – 20 per cent are unaware you can get HIV from heterosexual intercourse without a condom.
“HIV is taught very poorly, if at all, in schools. There is no plan to address the HIV-information needs of the wider sexually active population, and tackle the stigma which, to this day, limits open and honest discussion about HIV.
“The government must continue to target resources at the communities most at risk, but has an obligation to ensure all people in the UK know the basic facts about HIV, and how to protect themselves and others from infection. It is an obligation the government is conspicuously failing to meet, which is why we have pushed the need for a national strategy on HIV.”
Under new NHS and public health arrangements, responsibility for HIV prevention is transferred, along with the rest of public health, to local councils. But will councils prioritise and invest in HIV prevention work among those at risk?
“Or will this issue – less ‘popular’ than others perhaps – be at the bottom of local councillors’ agendas and therefore be neglected?” asks Ms Jack.
Increasingly people are looking to HIV treatment drugs, which have been so successful in giving a healthy, normal lifespan to those who are diagnosed in time and access them, as a solution to HIV transmission.
We have yet to see significant reverses in rates of HIV infection in the UK
An HIV-positive person on HIV treatment and with a suppressed viral load – the term for the amount of virus in the body – is effectively non-infectious. However, most HIV is passed on by people who don’t know they have it.
HIV testing is, therefore, central to stemming the spread of the virus. More than a quarter of people in the UK who have HIV are undiagnosed and don’t know they have it. High percentages of people with HIV see healthcare professionals with HIV-related illness, but it is not picked up and no HIV test is recommended.
NAT’s Ms Jack sees two major challenges for the newly restructured NHS. “Commissioning of HIV testing is now the responsibility of at least three different bodies in any area, rather than just one,” she says. “There are real risks, just when we need to upscale and improve HIV testing, that this fragmentation undermines an effective response.
“And doctors are now recommending that every person diagnosed with HIV is told about the preventive benefits of being on treatment so they can, if they wish, start treatment immediately, rather than wait until they have to for their own personal health.
“There is, however, currently doubt over whether the NHS will pay – we need to ensure people with HIV, who want to start treatment early to prevent transmission, can do so.”