With time running out to meet the Government’s target of ending HIV transmission in the UK by 2030, Richard Angell, Chief Executive of Terrence Higgins Trust, and Dr Claire Dewsnap, Chair of the British Association for Sexual Health & HIV, highlight the remarkable progress made in preventing, testing, and treating HIV, and stress the importance of redoubling efforts as this important deadline looms.
The very idea of ending new HIV cases in the UK by 2030 would’ve been unthinkable just adecade ago. This virus has killed nearly 40 million people globally over the last 40 years and we’re still without a vaccine or cure. But, thanks to incredible medical progress to prevent transmission, that life-changing goal really is achievable and must be achieved by the end of this decade. Because not doing so, when we have all the tools necessary to make it happen, would be indefensible.
Strong progress has been made towards that 2030 goal, thanks to the highly effective ways we now have to prevent, test, and treat HIV. However, we now need to redouble our efforts so everyone who needs to can benefit from each one. Because the clock is ticking, and we won’t get there by accident or drift over the finish line by simply doing what we’re currently doing. And time is of the essence, with interim targets for 2025 laid out in the Government’s HIV Action Plan – an 80 per cent reduction in cases from 2019 – needing to be hit in just over a year’s time.
What needs to happen
The reason the Government committed to 2030 is because we know what needs to happen to get the job done – the HIV Commission gave a blueprint for being the first country to end the epidemic. Now, the Government has laid out its own HIV Action Plan. But, unfortunately, while most of what we need is in there, it’s not all happening, and if it is, it’s not at scale.
Opt-out HIV testing in A&E departments in areas classed as having ‘very high’ HIV prevalence – where you test for HIV whenever blood is taken (unless someone opts out) – was announced alongside the Action Plan’s publication, with £20 million funding attached. Just over a year since its rollout, this approach is already having a remarkable impact, with almost one new HIV diagnosis made every day in those select emergency departments. Every other day, the system finds someone previously diagnosed but not currently taking their medication. Those diagnosed in A&Es are more likely to be women, heterosexual, and of Black ethnicity than those testing positive in sexual health departments. This success story must now be replicated in the next tier of need, with its expansion to the 43 A&Es in high HIV prevalence areas, including the West Midlands, Portsmouth, and Leeds. As 2030 gets closer every day, there is no room for complacency.
PrEP is a highly effective way of preventing HIV and is such a brilliant tool for those who know about it (and can access it) to protect themselves. But unfortunately, the prevention pill is being severely under-utilised. While it is commonly used by gay and bisexual men, its use among women and other communities remains very low. Our latest research found no local authority had more than five women accessing PrEP and everyone had on average 12-week waits. A clear way to overcome this would be to make it available in other settings, including an online portal, in pharmacies, and in GP surgeries, like the contraceptive pill. Because we know that some people will never step foot in a sexual health clinic, which is currently the only place PrEP is available.
The final crucial piece of the puzzle when it comes to ending new HIV cases is the fact that people living with HIV and on effective treatment can’t pass it on to partners. This means those who are diagnosed and taking their daily medication are playing a crucial role in HIV prevention. But the reality is that a growing number of people who know they’re living with HIV are not engaged with a clinic or taking treatment. UK Health Security Agency estimates this could be up to 22,670 people. This is far higher than the number of people living with undiagnosed HIV in the UK, so its crucial investment is made in re-engaging these thousands of people. Ending HIV cases is about so much more than prevention – it’s about supporting people living with HIV, including after that 2030 deadline.
The country’s sexual health services play a crucial part in HIV prevention and diagnosis, but they are over-stretched and under strain. In fact, last year’s mpox outbreak laid bare how precarious services are, with clinics having to scale back core work around STI testing and the provision of PrEP and long-acting reversible contraception to respond (brilliantly) to this new health threat without increased funding or resource. Our new research, using a ‘mystery shopper’ methodology, found an average wait time of 13 days across England, Scotland, and Wales for a face-to-face sexual health appointment. To put it clearly: sexual health services need to be properly funded. That means the Public Health Grant must be increased in line with inflation plus one per cent, alongside a long-term settlement. We also urgently need to see the Government set out its vision and ambition around sexual health via a comprehensive new national strategy, in the same way that’s happened for HIV. Despite a commitment from the Government in 2019 to do just this, we are still waiting to see any meaningful progress. All the while, STIs increased by 24 per cent last year in England, with more than 1,000 infections being diagnosed every day, and with new cases of gonorrhoea at their highest-ever levels since records began. Something has to change.
The General Election
The next parliamentary term is the last chance to act to make 2030 a reality and it will play an absolutely crucial part in making the UK the first in the world to end new HIV cases by the end of the decade, or not. That’s why all eyes are now on the next General Election and the health and equality priorities set out in manifestos. If urgent action isn’t taken, the life-changing goal will be missed, and we will all be responsible.
We can’t hang around for the next 12 months, waiting for action and biding our time. This means making a decision on the expansion of opt-out testing in more A&Es in light of the incredible results in the first 18 months in London, Brighton, Blackpool, and Manchester. Hospitals across the country are crying out for the intervention to be introduced. And it’s clear to see why when data from one hospital in London showed the average stay for a newly diagnosed HIV patient has dropped from 34.9 days to just 2.4 following two years of opt-out testing.
The UK could be the very first country in the world to end new HIV cases by 2030. This will change people’s lives for the better and tackle health disparities. That’s why inaction isn’t an option in the weeks and months ahead, as well as in the crucial next Parliament. The question is: will political parties stand with people affected by HIV and poor sexual health? Will they leave a lasting public health legacy? The answer must be an emphatic yes. We know exactly what needs to be done, so let’s not waste time and let’s make a life-changing goal a life-changing reality.