In April 2002 the protected status of HIV prevention funding, known as 'ring-fenced' monies was terminated. HIV prevention funding became mainstreamed. This occurred at the same time as some of the most substantial organisational changes in the NHS in its history.

The mainstreaming places HIV firmly within a sexual health policy agenda. In England, from the old Health Authorities, Primary Care Trusts (PCTs) were created. Since April 2002, PCTs have been responsible for commissioning local services. In Wales, Local Health Groups will begin commissioning services this year (2003).

Over the past year there has been anxiety within the HIV sector that these changes could facilitate widespread disinvestment in local HIV prevention services since HIV will be forced to compete with a range of other health areas for the same funding.

Some anxieties have not been borne out in most areas. After an initial period of confusion PCTs in urban areas like London and Manchester formed consortia to purchase and allocate HIV services regionally, though inequalities of service still exist elsewhere.

Of greater concern is the relentless increase in HIV prevalence in the UK. This has led to a soaring HIV treatment budget with increases in HIV prevention, community care and funding for other STIs not keeping pace.

Of even more importance is the decision by the government to exclude HIV and sexual health from the system of National Service Frameworks (NSFs) which were devised at the time of the PCT reorganisation. NSFs bind PCTs to achieve tight targets in dealing with cancer, coronary heart disease, diabetes, mental health and several other areas. Some organisations like the Terrence Higgins Trust have attributed the lack of an NSF for sexual health for the increase in HIV among gay men and the considerable increases in STIs among both gay men and young people in general. A target to get every person seeking care at a GUM clinic within 48 hours has failed to be achieved for the fourth year in a row, with no discernible progress being made towards the target.

A sexual health and HIV commissioning toolkit, designed to support the implementation and development of PCT plans from April 2003 was published in January 2003. It advises on partnership models; how to undertake local needs assessments; include examples of good practice in providing information to the public, and to people with HIV specifically, on sexual health and HIV.