We have the tools to stop the spread of HIV in England. So why is it on the rise? | Deborah Gold

A wildly successful new NHS scheme shows how easy this could be. But a lack of funding and resources is holding us back

  • Deborah Gold is chief executive of the National Aids Trust

Today is World Aids Day: a time to show solidarity with people living with HIV/Aids across the world, and remember those we have lost. But solidarity and remembrance have limited purpose if they’re not combined with a meaningful commitment to fighting this epidemic. Earlier today, the government published new data that shows it’s not on track to meet its long-term commitment to end new HIV transmissions by 2030. This goal should be entirely achievable– yet without immediate action, it risks slipping even further out of reach.

For years the numbers of new diagnoses of HIV have been steadily declining. But in 2021, HIV cases increased for the first time since 2014. This won’t come as a surprise to anyone who works in the sector. Sexual health services are funded by local authorities, which have been hit by years of austerity-driven public health cuts (the sector has had its funding cut by 24% in real terms since 2015). This period of chronic underinvestment has been made much worse by the impact of the Covid pandemic.

This is now affecting clinics’ ability to provide basic services. Many people are encouraged to attend sexual health services for an HIV test because they’ve been notified that they might be at risk of acquiring HIV after sexual contact with someone recently diagnosed with it. This is similar to contact-tracing for Covid-19.

Last year, the number of people who attended a sexual health service after being alerted in this way was less than half that in 2019. The proportion of those diagnosed with late-stage infection rose from 35% in 2019 to 40% in 2021. These people are more likely to already have been unwell at the time of diagnosis and to experience worse long-term health. Having not been on treatment, they would have been more likely to pass on HIV, unknowingly, over a longer period of time. Most troubling of all, there has also been a sharp increase in the number of people who have already been diagnosed with HIV but have not stayed in the healthcare system. This could pose severe consequences to their health.

The data shows that existing inequalities are deepening even further. Distance and travel time to sexual health clinics is far greater outside London, and access to testing, treatment and PrEP is more difficult. And while HIV is likely to be falling among gay and bisexual men, there is no such reduction for heterosexual adults. Altogether, this is a disturbing outlook. If we want to end new transmissions, testing and effective treatment are essential tools. But lack of funding and resources are holding us back. These figures are from 2021. In 2022, the problems caused by the Covid pandemic were further compounded by the mpox (monkeypox) outbreak, when sexual health clinics were forced to deliver diagnosis and treatment with no additional resources, and to undertake a severely underfunded ongoing vaccination campaign. This means the current situation is likely to be even worse, with a long backlog building up, no capacity to manage it, and even fewer resources to go around.

Our other most effective prevention tool is PrEP; a preventive medicine that, when taken properly, is almost 100% successful at preventing transmission. But as it stands, PrEP is failing to reach its potential. According to a report we co-authored earlier this year, almost two thirds of people trying to access PrEP found themselves unable to do so. And this data applies to people who are already trying to access PrEP. There are significant numbers of people who would benefit from the treatment but are simply not aware of its existence. Here, significant racial and gender disparities come into play. Not a single local service we spoke to reported more than a handful of women using PrEP, for instance, despite the fact that women – and particularly women from ethnic minority backgrounds – account for a growing number of new HIV diagnoses.

The 2030 goal is not a pipe dream. There’s still time to change course, and plenty of reasons to be optimistic. This week NHS England published the wildly successful results of its new scheme (launched as part of the HIV Action Plan) to test for HIV on an opt-out basis in hospital emergency departments. The scheme is available in the areas of highest HIV prevalence (London, Manchester, Brighton and Blackpool), and offers an HIV test to every single person who had a blood test for any reason at an A&E department. In the space of just 100 days, 128 people were diagnosed with HIV, reaching people who had been living with the virus without realising it.

These people will now be able to access treatment for themselves, and will avoid passing the virus on to others. A further 65 people were found who had previously been diagnosed with HIV but had slipped through the cracks of the healthcare system. This represents a significant opportunity to re-engage people with treatment. The demographics of people identified through the scheme are those less likely to come forward for testing at sexual health clinics and who may not realise they are at risk.

This scheme has been an unambiguous success. It should be available more widely. Areas such as Birmingham, Coventry and Bristol face similarly high levels of HIV, but lack of funding prevents the programme from being made available. There are no downsides to scaling up opt-out testing and PrEP: not only will it improve countless people’s lives but, at the risk of making a more cynical argument, it will save the NHS money in the long run if people are engaged in treatment more quickly or prevented from acquiring HIV in the first place.

So, while this latest data is disappointing and enormously frustrating, it only strengthens the moral imperative to do better this World Aids Day. More than 40 years after it started, we have the power to end new HIV transmissions in Britain within this decade. So many of us have lost friends and family members over the last 40 years. With this opportunity in front of us, it would be unforgivable to let it slip through our fingers. We have the tools to ensure nobody else acquires an avoidable infection or dies an avoidable death. We have the tools, and we know exactly what to do. It remains only to do it.

  • Deborah Gold is chief executive of the National Aids Trust


Deborah Gold

The GuardianTramp

Related Content

Article image
Stop pretending we can’t afford the NHS: that’s the message of our march today | Larry Sanders
We won’t stand by and watch this government dismantle public healthcare – and if Theresa May really means her promise to ‘work for all’, she’ll listen

Larry Sanders

04, Mar, 2017 @10:00 AM

Article image
My prescription for dejected doctors? Stop harking back to a golden age that never was | Clare Gerada
Medicine’s a tough career and professionals are demoralised. But the good old days had their dark side too, writes Clare Gerada, a former chair of the Royal College of General Practitioners

Clare Gerada

24, Nov, 2017 @6:00 AM

Article image
What price human life? Overworked NHS staff have to answer this every day | Rachel Clarke
Politicians turn a blind eye to the Covid-ravaged NHS, but as winter hits, we’re forced to ask how many deaths are acceptable, says palliative care doctor Rachel Clarke

Rachel Clarke

26, Oct, 2021 @3:00 PM

Article image
Britain’s use of contaminated blood was no ‘tragedy’ – it was a scandal | Simon Hattenstone
The latest inquiry must discover how thousands of people contracted HIV or hepatitis C from blood products, and why it was covered up for so long, writes Guardian journalist Simon Hattenstone

Simon Hattenstone

17, Apr, 2018 @8:00 AM

Article image
My dad might have had a fighting chance if the NHS he loved had not been undermined | Youssef El-Gingihy
After a lifetime’s advocacy for the public model of healthcare and a career as an NHS psychiatrist, he died alone in hospital, says GP Youssef El-Gingihy

Youssef El-Gingihy

30, Jan, 2021 @12:00 PM

Article image
Crisis, what NHS crisis? Theresa May must stop this denial | Jan Filochowski
I’ve turned around three failing hospitals, and I believe the NHS will keel over unless ministers start to address its problems and stop blaming GPs and patients

Jan Filochowski

15, Jan, 2017 @7:38 PM

Article image
I’ve grown old with HIV. I don’t fear the virus any more, I fear the stigma | Michael Penn
New cases among gay men in London have fallen for the first time. We’re turning a corner, but there’s a lot to do to bring attitudes and awareness up to date

Michael Penn

27, Jun, 2017 @8:00 AM

Article image
England's bungled response to Covid-19 leaves it vulnerable to more outbreaks | Rowland Kao
Scotland’s combination of clear messaging and caution looks to have been a better model, says professor of veterinary epidemiology Rowland Kao

Rowland Kao

03, Aug, 2020 @12:00 PM

Article image
Simply throwing money at the NHS won’t solve all its problems | Simon Jenkins
Billions will be wasted as long as the health service is hyper-centralised and disconnected from local authorities, says Guardian columnist Simon Jenkins

Simon Jenkins

26, Oct, 2021 @9:00 AM

Article image
Tory austerity caused misery – and now they want to make it worse | Polly Toynbee
Even though the human cost of a cruel policy has been confirmed, expect another turn of the screw next week, says Guardian columnist Polly Toynbee

Polly Toynbee

15, Oct, 2021 @2:16 PM