The tackling of HIV is one rare area of government performance in England that it can genuinely claim to be, if not world-leading, certainly doing fairly well in.
For the key internationally recognised measure of percentage of people diagnosed, treated, and infected but with an undetectable viral load, the World Health Organization target is 90-90-90. The UK figures are 94-98-97.
The annual level of new infections is down 34 per cent since 2014, although still 42 per cent of cases are diagnosed late – a figure that rises worryingly in people aged over 65 to 59 per cent.
Some of the progress has been attributed to routine testing in maternity units. The level of testing is now 99 per cent, and has been considered a real success story.
So, on this year’s World Aids Day, there was some cause for modest self-congratulation about progress. The UK has also set the target of no new infections by 2030 – the same as the global goal.
But there was, during a series of questions on HIV in the House of Lords, cause for significant concern about maintaining progress, and on the capacity with current resources to reach that 2030 goal.
One of the key areas, asked about by Lib Dem Baroness Tyler of Enfield, is funding for local authorities, which since 2013 have been mostly responsible for sexual health services.
The public health budget has fallen by £700 million in real terms since 2015 and there’s been a 25 per cent cut in funding of those crucial sexual health services. That’s not just an issue for HIV, but much more broadly. Antibiotic-resistant gonorrhoea is a particular area of concern.
The King’s Fund has calculated that an extra £1 billion in funding is needed for local authorities to restore services to the previous level. In this year’s Spending Review, Health Minister Lord Bethell confirmed “maintenance” of public health funding. That’s simply maintaining the austerity cut.
To make further progress, and to identify as many as possible of the estimated 5,000 people living with HIV who do not know they are infected, a key focus is expanding routine blood testing – to make opt-out rather than opt-in the standard in a wide range of settings when tests are needed for other reasons, following the maternity unit model.
It is widely agreed that to hit the 2030 target, transmission must be cut by 80 per cent by 2025, as the last 20 per cent of cases will require the most resources and attention – a key issue in the now-overdue HIV Action Plan.
In 2019, there were more than half a million missed opportunities for conducting blood tests in sexual health clinics. Forty-six per cent of patients were not even offered a test. NICE guidelines recommend that GPs in areas of high prevalence offer tests to new patients as a standard procedure, but this is not being offered to most.
Another area of concern is the limited availability of Pre-exposure Prophylaxis (PrEP) in England, unlike in Scotland and Wales, where provision has been uncapped since 2017. In Wales, there have been no reports of infection among people receiving PrEP. By contrast, campaigners say provision in England is now worse than at any time since 2017.
The Government was asked about extending availability beyond sexual health clinics to maternity clinics, GPs or pharmacies. There was a promise of news to come in this area.
During the same series of questions in the House of Lords, I asked about equity of access: Does the government collect data on who is accessing it and would it commit to publish it? This is something campaign groups are keen to establish.
I was asked to write to the minister to specify how that might be done. I’ll be doing that.
There’s also the global perspective. A number of questions were pointedly, and rightly, directed towards the Government’s plans to slash international aid.
As with all diseases, as Covid-19 has illustrated so clearly, no one is safe from an infectious disease until everyone in the world is safe.