We have the tools to stop the spread of HIV in England. So why is it on the rise?
Deborah Gold/ The Guardian:
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 services 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.