To mark this year’s World Aids Day , Curiaโs Chief Executive Ben Howlett sat down with Lloyd Russell-Moyle and Deborah Golf to discuss how the last 12 months have gone from an HIV care perspective.
Lloyd is the Treasurer of the All Party Parliamentary Group on HIV and AIDS, a group that works to ensure those living with HIV have access to affordable medicines and a good quality of life. Meanwhile, Deborah is the Chief Executive of the National AIDS Trust, a charity that defends the rights of everyone living with, affected by or at risk of HIV.
AIDS: Whatโs gone well in the past year
The last time Ben caught up with Lloyd and Deborah ahead of 2021โs World Aids Day, an action plan had been submitted by the HIV Commission, outlining some key recommendations and objectives to the government.
Deborah believes that the standout achievement over the past year has been the rollout of opt-out testing in many parts of the United Kingdom, including London, Manchester and Brighton. This was one of the key recommendations on the plan and now means that all patients who are admitted to an emergency department are routinely tested for HIV unless they specifically ask for that not to happen.
Deborah said:
โItโs been a huge year. The good news is that the government have taken on board some of our high-level recommendations, so we can expect them to report back on their progress this December.
โTheyโve accepted the challenging interim targets that weโve set as part of the process and they accept the recommendation on rolling out the opt-out testing scheme in emergency departments.โ
โThrough this rollout, we have been able to identify a high number of new diagnoses alongside a high number of people who maybe knew that they had HIV but who had fallen out of care. This programme has been overwhelmingly positive.โ
What challenges are we still facing?
While the rollout of the opt-out scheme in emergency departments has seen fantastic results, sexual health clinics are still operating an opt-in policy. This means that patients who visit these clinics have to specifically ask for a blood test to check for HIV. This isnโt the only challenge for sexual health services, though, as Lloyd explains:
โWe have seen a crisis in sexual health which isnโt just because of monkeypox. We look at PrEP (a medicine for HIV-negative people taken before sex) rollout and because thatโs a pre-intervention measure, itโs paid for by local councils.
Well, at the moment there is a real funding crisis with local councils which is having a knock-on effect on the administration of PrEP. If youโre taking PrEP then you need to be going into a clinic at least once a year to test your blood and receive new prescriptions. However, clinics are just too overwhelmed to accommodate that at the moment and itโs a real problem.
To hit the 2030 target of eradicating HIV transmission in England by 2030, we need preventative measures such as PrEP so itโs going to be difficult.โ
The mpox outbreak
Earlier this year there was an outbreak of mpox in the United Kingdom. The infection was being transmitted between individuals who were sexually active with each other, making it a time of real struggle for sexual health clinics up and down the country. Fortunately, cases are now on the decline and an end to the endemic is in sight.
While neither Lloyd nor Deborah want mpox to be used as an excuse for the struggles sexual health clinics have faced, they concede it was far from ideal. Deborah said:
โDuring that period of time when monkeypox was spreading quite rapidly, we had thousands of people making appointments at sexual health clinics to get tested. Thatโs a significant amount of extra appointments which diverted attention away from everything else that sexual health clinics do which has created a massive backlog.
Local authorities didnโt fund the extra work that came as a result of monkeypox, but for clinics to be able to successfully work through this backlog they absolutely need more funding.
Lloyd believes that some important lessons can be learned from monkeypox, both in how the government responded to the outbreak and the communication around it. He said:
โThese outbreaks are going to become more common and sexual transmission is going to be a flashpoint with each wave.
The governmentโs lack of action on monkeypox was alarming because it took four months for them to get their heads around it – in that time it had exploded in a very predictable way. We need to be able to build resilience to these diseases so we can tackle them effectively.
We also need to improve how we communicate the issue. People werenโt comfortable saying that it was targeting a certain community because of the sensitivity around not wanting to seem homophobic.
However, there needs to be confidence to come out and say that it is spreading in certain communities so that these communities have all the information early on in relation to how they can protect themselves.โ
Funding cut to the Global Fund
Earlier this month, the government announced that they would be sending ยฃ1 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. While this may seem like a lot, it is a ยฃ400 million cut on what they pledged in 2019.
Deborah believes that this cut will result in โpeople overseas dying of AIDSโ while Lloyd believes itโs a โbite your nose off to spite your faceโ cut. Deborah added:
โSomething we should have learned from the Covid pandemic is that If you donโt solve HIV or any other pandemic globally you will never solve it in the UK.
That shouldnโt be the reason to not cut the funding to this area, but if you want a UK-first, Brexit-ready reason then there it is.โ
Final thought
Itโs unquestionably been a tough year for sexual health and the battle to eradicate HIV transmissions in England by 2030. While monkeypox didnโt help, the governmentโs funding cuts to local authorities and the global fund indicate that perhaps this issue is no longer near the top of their priority list.