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Dramatic cuts to HIV Prevention England funding
The government has announced that funding for HIV Prevention
England, the national HIV prevention programme in England, will be cut by 50%
from April 2015. This will have a significant impact on local prevention and
testing services and on the dozens of organisations that act as local delivery
NAT (National AIDS Trust) has described the decision as
“outrageous, given the ongoing high rates of HIV transmission in England and
significant gaps in public understanding about HIV”.
Central government funding for national HIV prevention
programmes has been progressively reduced in recent years. HIV Prevention
England began in 2012 with an annual budget of £2.4 million (less than the
combined budgets of the previous prevention programmes, NAHIP and CHAPS).
The Government will now only allocate £1.2 million for the
year beginning in April – and has made no commitment to continuing this in 2016.
Even in areas of high HIV prevalence, many local
authorities’ spending on HIV prevention is inadequate. In some areas, the only
prevention activity taking place is commissioned through the national
The estimated lifetime cost of treating someone with HIV is
£360,777. This means that even if the £2.4 million programme only prevented
seven new transmissions a year, it would save the NHS money.
However, there is a total of around 1.2 million men who have
sex with men and black African adults living in England. A budget of £1.2
million means that the national programme only has £1 to spend a year for each
person in its target audience.
urging people living in England to write to the Public Health Minister,
Jane Ellison, and ask for funding to be continued at least at current levels for the next three years.
NHS urgently needs to make PrEP available
Following the highly encouraging results of two studies of pre-exposure
prophylaxis (PrEP) in the UK and France, a coalition of community organisations
working on HIV prevention has come
together to call for the NHS to speed up its processes and make PrEP
available to those at the highest risk of acquiring HIV. The organisations
point to the continued high rate of new infections and say there is an urgent
need to improve HIV prevention.
Although an NHS England process to evaluate PrEP is
underway, any decision to provide PrEP will probably not be implemented until
early 2017, which the statement says is too long to wait: “We are calling for
earlier access to PrEP. The NHS must speed up its evaluation process and make
PrEP available as soon as possible. Furthermore, we call for interim
arrangements to be agreed now for provision of PrEP to those at the highest
risk of acquiring HIV.”
Over 1000 organisations and individuals have already signed
the statement. Among those supporting earlier access to PrEP are HIV Prevention
England, NAM, Terrence Higgins Trust, Yorkshire MESMAC, National AIDS Trust,
GMFA, the Lesbian and Gay Foundation, Positively UK, Metro Centre, UK-CAB, HIV
i-Base, HIV Justice Network, Naz Project and Act Up.
Which gay men are passing on HIV?
modelling study based on the UK’s HIV epidemic in gay men suggests that the majority of HIV transmissions come from men who are not taking treatment and are not aware of their HIV
status. They tend to be younger, have relatively high levels of sexual
activity and are often in a relationship.
The model aimed to estimate the contribution of various
behavioural and biological factors to HIV transmission between men who have sex
with men. This could help with the design and targeting of HIV prevention and
- Although only one in five gay men living with
HIV are undiagnosed, around 63% of transmissions come from undiagnosed men.
- Although only a third of gay men living with HIV
are not taking HIV treatment (and most of them are undiagnosed), around 85% of
HIV transmissions come from men who are not on treatment.
- Although the majority of men living with HIV are
somewhat older, around 62% of HIV transmissions originate in men aged 15 to 34.
- While many gay men have less sex than this,
around 80% of HIV transmissions originate in men who have at least two new
sexual partners each year.
- Around 90% of HIV infections occur in repeat
sexual partnerships – this includes both ongoing romantic relationships and
- Around 10% of HIV transmissions come from men
who have primary HIV infection (i.e. acquired HIV very recently). This is
considerably lower than some other estimates.
The findings should be used to improve the design and
targeting of HIV prevention and testing interventions. In particular, they
show that younger gay men with high levels of sexual activity are a priority
for HIV testing services, especially services which facilitate regular testing.
The large number of transmissions occurring within some sort of ongoing
relationship suggest the value of interventions for men in relationships.
Quick facts: female condoms
These figures come from 753 heterosexual African men and
women living in England who took part in the recent African Health and
“Female condoms are an effective means of preventing HIV
transmission which could be an alternative if people have trouble using male
condoms,” says Adam Bourne of Sigma Research. Given the very low rates of
awareness and usage, “future interventions may wish to emphasise the benefits
of Femidom use and explain where they
can be obtained.”
“It’s about taking them out, raising awareness and getting
women to try them out and be comfortable using them,” says Celia Fisher of
LASS. The first time a woman tries a female condom, this should not be for sex
– it often works better if she can try it on her own, to get used to the fit
and feel. While the appearance of a female condom out of the packet may be
discouraging, many women say that they feel different when it’s inserted. “When
people have the confidence to try them out, they find out that actually it’s
nothing like the bag that it seems on the outside,” says Celia.
While LASS continues to distribute far more male
condoms (36,000) than female condoms (1000) each year, the demand is growing
with women coming back for more at venues such as hair salons, African
nightclubs and the British Red Cross.
Drugs work should focus on pleasure and practicalities
reduction interventions often fail to engage people who inject drugs because
they over-emphasise infection and risk, according to UK research. While
people who inject drugs frequently adopt safer injecting practices, they tend
to be motivated by a desire to have a quick, pleasurable hit – not by concerns
about blood-borne viruses.
The researchers made particular efforts to talk to people
who had used drugs for many years but had managed to remain free of hepatitis
C. Maybe health programmes can learn from these individuals.
Several avoided re-using needles because a blunt needle
would be painful, take a long time to use, damage veins (making future
injections harder) and risked leaving ‘track marks’ that publicly identified
the person as a drug user. Others insisted on preparing their own drugs, rather
than allowing a friend to do it. This reduced the risk of shared equipment but
was mostly motivated by a desire to avoid badly prepared mixtures.
Harm reduction programmes may be more effective if they
focus on the issues that matter to people who inject drugs – having a pleasurable
hit and maintaining usable veins – rather than the risk of blood-borne viruses.
The researchers noted that whereas some HIV prevention
materials for gay men acknowledge the pleasure of sex (for example, slogans
like ‘have fun safely’), materials for drug users tend to be much more
negative. The themes identified in the research could be reflected in harm
reduction messaging, perhaps with slogans like ‘Don’t use used works,
it hurts’ or ‘New kit – better hit’.
Case study: mentor mothers
Women living with HIV who wish to have a child face a
complex set of choices at each stage, from conception to delivery and infant
feeding. Positively UK’s ‘mentor mothers’ programme aims to empower women to
navigate these complexities and to challenge the stigma that women living with
HIV face. As with the rest of Positively UK’s work, peer support is at the
heart of the project – all the volunteers providing one-to-one emotional and
practical support have had children since their own diagnosis. “Someone who has
lived that life and has walked that journey can better anticipate what the
person needs,” says Angelina Namiba of Positively UK. A careful selection
process and training programme ensures that the mentors have the skills needed
to provide peer support.
Moreover, the mentor mothers provide living proof that it is
possible to have HIV and give birth to an HIV-negative child. They demonstrate
that the challenges of HIV and pregnancy are not insurmountable and normalise
the idea of living with HIV.
Women are referred to the project by midwives, clinicians
and voluntary organisations. The women who receive support tend to be recently
diagnosed (often during pregnancy), have disclosed their HIV status to very few
people and are socially isolated. The volunteer mentor mothers have often had
similar experiences in the past and want to help other women avoid having as
tough a time as they had themselves. Kay Francis, lead HIV midwife at the North
Middlesex University Hospital is involved in training the mentors. She
emphasises the “motherly aspect” of the volunteer role and the strong bonds
that the mentors and mentees forge. Peer support complements that provided by
clinicians, midwives and other professionals, she says.
The mentor mothers also help deliver workshops to people
living with HIV, have produced a booklet based on the questions they are most
often asked, and have taken part in videos on HIV and pregnancy. (These resources are available on
Positively UK’s website).
Other recent news headlines
HIV diagnoses have increased by 80% in the European region
since 2004, and three quarters of new HIV diagnoses in the European region are
occurring in Eastern Europe, yet the scale and targeting of HIV prevention,
testing and treatment in Eastern Europe are inadequate, a European meeting on
standards of care for HIV and co-infections in Europe heard last week in Rome,
“Without scale-up, the AIDS epidemic will continue to outrun
the response, increasing the long-term need for HIV treatment and increasing
future costs.” These are among the opening words of the 2014 “Fast Track”
report issued by UNAIDS, the Joint UN Programme on HIV and AIDS, explaining the
thinking behind their campaign for an ambitious ‘90/90/90’ target, previewed at
the International AIDS Conference in Melbourne this July. Read
The largest cohort study ever to look at CD4 count and viral
loads in HIV-positive people around the time of diagnosis has found evidence
that HIV, at least in Europe, has become more virulent over time. The average
time taken to reach a CD4 count below 350 cells/mm3 has halved over the last 25
years, researchers calculate. Read
A US study presented
at last month’s HIV Research for Prevention conference found generally positive
responses among a selection of participants and clinic staff to a trial that
used $70 gift tokens as an incentive for people with HIV to maintain an
undetectable viral load. Read
Editors' picks from other sources
from NAT press release
than half (45%) of the British public understand how HIV is and isn’t
transmitted, new research reveals today. NAT (National AIDS Trust)
research commissioned from Ipsos MORI also reveals an increase in myths
and misunderstanding about HIV.
Why are some gay men hesitant about preventing HIV with a pill? A few thoughts.
from Pink News
actor Kieron Richardson says his character’s upcoming HIV-related
storyline is not a stereotype but based on modern-day reality.
from The Guardian
the reins to the Department of Health might seem a liberal-minded
approach, but it could mean less is spent on treatment. Drug use simply
doesn’t cause as much ill-health as other risky behaviours, so isn't
prioritised by health officials. But it is seen as a major cause of
from The Conversation
years ago, the “beginning of the end” of AIDS was announced. It
included the promise of reducing HIV transmission by reducing the amount
of infectious virus in the population. But disease control will fail
unless we understand and plan for its translation within complex and
adaptive systems. People take up technologies and use them in
unanticipated ways. Cultures develop resistance in the same way that
bacteria do. We will only ever approach the beginning of the end of AIDS
if and when we bear these things in mind.