Piece for World AIDS Day 2012. Originally appeared here --
Smarter HIV prevention in the UK
World AIDS Day. For many it will conjure image of young men in the 1980s dying helpless, horrible deaths in hospital wards. Many old enough to have been there will still be able to recall the raw panic that enveloped the early years of the epidemic.
In truth, though, while such imagery unquestionably helps us remember, and to raise money, they are not terribly useful for understanding the reality of HIV in 2012 – or for informing HIV prevention policy. Which is not to say HIV is longer an issue – last year saw the highest number of new HIV diagnoses among gay men in the UK on record. But rather that the epidemic here has moved on. And we desperately need to take heed of this if you’re going to bring down rates of HIV infection.
For one thing, thanks to treatment, if diagnosed early someone with HIV can expect to enjoy a near-normal life expectancy. Second, and most importantly, that treatment can reduce infectiousness by up to 96 per cent – making it extremely unlikely they will pass it on to others.
Quite obviously, though, this is only the case if the individual is diagnosed early. And it’s this which is the great challenge of HIV today. Late diagnosis explains the vast majority of people who die or develop AIDS. What’s more, crucially, it’s the undiagnosed who are now driving our epidemic. Fifty per cent of people with HIV in the UK are diagnosed late (CD4 count of under 350), 20 per cent very late (under 200). Twenty-five per cent of the 100,000 people with HIV don’t know they have it.
Earlier diagnosis through more regular testing thus becomes not only beneficial for personal health, but vital for public health and stopping the spread of the epidemic.
Clearly, conventional HIV prevention such as condom promotion and sex education remain crucial. But they must be coupled with a range of interventions aimed at increasing testing. Just throwing more money at community groups alone will not solve the problem. In short, we need a smarter approach to HIV prevention.
So what are the building blocks of this? Well-funded HIV services and a universal public healthcare system are pivotal. Sadly, both are being undermined by this government.
Beyond that, there are a range of steps the government need to take if they are serious about doing more to reduce rates of HIV. These include:
• Political commitment. The UK has no HIV strategy. The last one, introduced by Labour, expired in 2010, and has not been replaced by this government. This leaves us as one of the few countries in the world without a national HIV strategy.
• More proactive testing by health services. At the moment, testing is conducted on an ‘opt-in’ basis – it requires voluntary commitment by the patient. We need to move towards an ‘opt-out’ system – where your consent to be tested is implied unless you explicitly withdraw it. In high-prevalence areas, all GP surgeries should routinely test all new patients for HIV, while hospitals should do the same for every patient who walks through their doors. The last government commissioned a report which found that this was was feasible, cost-effective and highly successful in reducing rates of undiagnosed HIV. This government has made no real effort to back or implement this.
• In general, testing needs to move outside of just the GUM clinic into GP surgeries, hospitals, communities, saunas and clubs.
• Better HIV partner notification. Telling your recent hook-up when you’ve been diagnosed with HIV is a surefire way of getting them to go for a test. It’s really effective as a means of diagnosing people earlier. But it’s difficult. Services within GUM to support it are patchy at best, and need to be improved.
• An ‘annual testing’ message for Africans living in Britain. It exists for gay men – why shouldn’t it for Africans too? After all, they make up nearly half of the UK’s new HIV diagnoses.
Such steps are not as sexy as high-profile national prevention campaigns. But they would be as effective, if not more so, in stopping the spread of HIV in this country today. So let’s use this World AIDS Day to give money and remember those lost, but also to renew and update our public conversation about HIV and the steps we take to stop what is still, after all this time, a profoundly preventable condition.