The Department of Health’s 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 partners.
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”.
Since the government’s reorganisation of English health services, the primary responsibility for public health belongs to local authorities. But in many areas – even those with a high prevalence of HIV – the local authority does not actually provide or fund any HIV prevention work. Research by NAT found that that less than 0.1% of the public health allocation in high HIV prevalence areas is spent on primary HIV prevention.
Local services have long been supplemented by national HIV prevention programmes, which have played a particular role in developing social marketing campaigns for the two groups at greatest risk of HIV – gay men and African people. However, central government funding for national HIV prevention programmes has been progressively reduced in recent years.
The current national programme, HIV Prevention England, began in 2012 with an annual budget of £2.4 million. This was less than the combined budgets of the previous prevention programmes, NAHIP and CHAPS. The programme is led by Terrence Higgins Trust, with NAM, MBARC, BHA, Sigma Research (London School of Hygiene & Tropical Medicine), Yorkshire MESMAC and around three dozen local organisations as partners. Promoting the uptake of HIV testing has been a particular focus of activities including a social marketing campaign for gay men and African people, the creation of National HIV Testing Week and the promotion of a home sampling service.
A government minister, Earl Howe, told parliament on December 1 that support for the programme would be “pared back” because of the funding constraints. It has now become clear the funding will be cut by 50%, leaving a budget of £1.2million for 2015-16 – and no commitment to funding in future years.
“This decision is simply staggering,” commented Deborah Gold, chief executive of NAT. “HIV transmission shows no signs of decline, with the highest number of diagnoses among gay and bisexual men ever last year. Public knowledge of HIV is far too low, and myths about HIV are on the increase. We are at serious risk of going backwards on HIV if national-level investment is not made in HIV prevention. We urge the Government to think again.”
NAT notes that 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.
Cuts in prevention spending appear to directly contradict ministers and health officials’ statements about the importance – and financial necessity – of improving prevention and public health services. While the government has prioritised a reduction in undiagnosed HIV as a goal of public health programmes, the reduced funding may undermine realisation of this.
Last year, over 6000 people were diagnosed with HIV and there are no signs of a slowdown in transmissions among gay men. One quarter of people living with HIV are unaware of their infection and this remains a key driver of the epidemic. In the general public, understanding of basic facts about HIV is diminishing.
NAT has launched a campaign urging people living in England to write to the Public Health Minister, Jane Ellison. They urge the government to revise its decision and to commit to continue funding the national HIV prevention programme for England at current levels for a further three years (2015-2018).
NAT’s briefing on national HIV prevention funding can be read here. Their page with details of how to contact the Public Health Minister is here.