HIV – getting new cases down to zero

To mark World Aids Day (1st December 2018), Marc Thompson of the Terrence Higgins Trust talks about progress on reducing new cases of HIV in the UK.

‘We have come a long way to achieving our aspiration of getting down to zero new cases of HIV in the UK although we haven’t got there yet. We also have to remember that there are around 90,000 people in this country who are already living with HIV. For them, this virus may be manageable and under control and they can’t pass it on with the right therapy, but they will continue to live with HIV.

Good news is that there has been a significant drop in the number of new diagnoses of HIV among men who have sex with men, both in London and elsewhere. In 2016, five London clinics reported a decline in new cases of 21 per cent, from 2810 in 2016 to 3570 cases in 2015.

This is partly explained by high levels of HIV testing, including frequent testing of men at high risk of HIV and rapid treatment when someone is diagnosed with the infection.

This observed decline has also been seen among black African heterosexual men and women where numbers almost halved from 4060 in 2007 and 2110 in 2016. This has been partly driven by successful outreach projects which are bringing HIV testing into the community and helping to reduce stigma surrounding HIV.

While we still advocate condom use in the communities which are more vulnerable to HIV infection, there are other interventions which are having a huge impact on infection rates. Very importantly, 13,000 people are now enrolled on the Impact trial in England where they are able to use drug Pre-exposure prophylaxis (PrEP) which is already freely available on the NHS in Scotland, Wales and Northern Ireland. Of course, Terrence Higgins Trust would like PrEP to be available to everyone who needs it in England as soon as possible, but the trial is not due to conclude until 2020. We are pushing for NHS England to bring this forward to April 2019 since we have already heard of cases where people who were unable to access PrEP via the trial have gone on to be diagnosed HIV positive.

Although we have been through a period of austerity and NHS budget cuts, preventing HIV from occurring is far more cost effective than paying for someone to receive a lifetime of retroviral drugs and support once they have acquired HIV.

We also question the wisdom of closing GU clinics and sexual health clinics at a time when we are so close to achieving our goal of reducing HIV infections to close to zero. In England, demand has risen by 13% while the budget is being cut by a quarter. Austerity is having a direct impact on the potential to end HIV. Terrence Higgins Trust is here to do what it does best – important work that can be done in the community, but it can’t be effective if it is trying to plug gaps which should be filled by the NHS and public health.

We still live in a world where HIV is highly stigmatised and there is lots of work to be done to change attitudes and normalise HIV testing, but we are well on the way, with the right support from health commissioners and government.’