Six key areas of HIV treatment, prevention and service planning in the UK have been identified in a new report as priorities for improving HIV prevention, treatment and care in England by the Independent Advisory Group (IAG) on Sexual Health and HIV.
Their report, Building on Progress: Enhancing the Response to HIV in England, notes the considerable achievements in the delivery of HIV treatment, care and prevention, but highlights how the evolving nature of the epidemic is creating new challenges.
Four important facts about the HIV epidemic in the UK are highlighted by the report’s authors:
- Continued HIV transmissions amongst gay men, and high levels of HIV diagnoses amongst black Africans.
- Undiagnosed HIV infections account for a quarter of all those in the UK.
- Increasing numbers of older patients.
- Support and funding networks are at risk.
The evolving nature of the UK’s HIV epidemic was explored at a number of workshops organised by the IAG. Two specialist reports, one by NAM's Senior Editor Keith Alcorn on the potential impact of antiretroviral therapies and new prevention technologies on HIV prevention, were also commissioned by the group.
Recommendations are made in six key areas.
National cross-governmental overview of HIV
The Department of Health should build a cross-governmental forum as a way of reviewing the UK’s HIV-related policies.
This should be chaired by a senior individual in the field and also involve those involved in the delivery of HIV services as well as people living with the virus.
Meeting at least once annually, the forum should consider how the medical and social needs of an ageing HIV population can best be met.
Guidance on needs of people living with HIV
Working with organisations including NAM, Terrence Higgins Trust (THT), and the National AIDS Trust (NAT), as well as people with HIV, the Department of Health should develop guidance for primary healthcare trusts (PCTs) about needs of people with HIV.
Individuals with HIV should also be involved in the preparation of this guidance, and PCTs should consult those living with the virus about the development of services.
Prevention, testing and health improvement
There should be concerted efforts at all levels to reduce levels of late HIV diagnosis and promote prevention activities.
Moreover, the UK government should back and promote recently developed HIV testing guidance.
Using best evidence
HIV is a very fast-moving area of medicine, and a research and development strategy should be put in place by the Department of Health, with a central point of reference for all involved in the HIV sector.
Stigma and discrimination
HIV remains a stigmatised condition and individuals living with or affected by the virus often encounter discrimination.
A cross-governmental panel should consider how policy and practice can help address these issues.
An urgent priority should be to review how criminal prosecutions for HIV transmission reinforce stigma.
Services
Of the 52,000 individuals accessing HIV care at the end of 2007, 15% were over 50. The success of HIV treatment means that large proportions of individuals with HIV can expect to live well into old age.
Services need to be in place to address the needs of the ageing HIV population. The ring-fenced AIDS Support Grant, which funds HIV-specific social services provided by local authorities, should remain in place.
Independent Advisory Group on Sexual Health and HIV. Building on Progress: Enhancing the Response to HIV in England. November, 2009.