HIV prevention in England is underfunded and deprioritised, says the National AIDS Trust (NAT). Whereas £55 million was allocated to local activities in 2001-02, the figure for high-prevalence areas in 2014-15 was just over £10 million – which works out as just 70p (US$1) per person, per year. The charity says that this level of spending is unlikely to have any impact on the rate of new infections.
While NAT only analysed spending on local activities, it has also become clear that England's national HIV prevention programme’s budget will be cut. This programme is HIV Prevention England (HPE), funded by central government, with activities carried out by Terrence Higgins Trust and several dozen partner organisations, including NAM.
Speaking at the HPE conference last week, Rosemary Gillespie of Terrence Higgins Trust confirmed that the programme’s £2.4 million annual budget would be halved to £1.2 million. While protests against news of the cut appear to have pushed the government into committing itself to maintaining £2.4 million as the total budget for national HIV prevention activities, only half of this sum will go to the HIV Prevention England programme in 2015-16.
There is no clarity over what the remaining money will be spent on, whether new activities will be supported or when the decision will be announced. Kay Orton of the Department of Health told the conference that it has yet to be decided how the overall funding will be used.
Returning to the local situation, NAT’s report focused on the 58 local authorities with a high prevalence of HIV (where there are two or more people living with diagnosed HIV per 1000 people). Spending in the 94 lower prevalence areas was not counted, but is unlikely to be substantial.
Public health officials were asked for information on spending on health promotion services targeting people who are HIV negative (‘primary HIV prevention’) and which are delivered outside sexual health clinics. They were also asked for information on HIV testing services provided outside sexual health clinics. As well as funding by local authorities themselves, when the HIV Prevention England programme funded locally delivered activities (such as outreach or community testing), this was included. Of note, spending was not counted on STI or HIV treatment services, harm reduction services for people who use drugs, generic condom distribution programmes or support services for people with HIV.
Gathering the data was difficult. Some local authorities gave very full accounts of their HIV prevention work, while others provided very little information or could not separate their HIV prevention budget from those of other activities.
Results for 2014-15
A total of £10,317,312 is being spent on HIV prevention in these high-prevalence local authorities. This is less than 0.1% of the local authority public health allocation for these areas. Moreover, the NHS spends 55 times more on HIV treatment and care in these areas than is spent on HIV prevention.
The £10 million figure can be contrasted with estimated spending of £55 million in 2001-02 and £38 million in 2007-08. The historical figures do include spending in lower prevalence areas but haven’t been adjusted for inflation or recent rises in the prevalence of HIV.
Spending is a little higher in London than elsewhere. Looking at the spending per adult each year, this amounts to 87p in London – 68p is spent by local authority commissioners, 15p by the London HIV Prevention Programme and 4p on local delivery by HIV Prevention England.
In high-prevalence areas outside London, a total of 59p is spent – 55p by local authority commissioners and 3p on local delivery by HIV Prevention England.
The amount spent varied considerably from one area to another and the correlation between the local HIV prevalence and spending was weak. While some local authorities are investing in HIV prevention and developing innovative projects, others with high prevalence of HIV are spending little or nothing on HIV prevention.
In particular, while reducing late diagnosis of HIV is a public health priority and creating new opportunities to test is a responsibility of local authorities, 35 of 58 local authorities surveyed were not investing anything in HIV testing outside sexual health clinics.
“There are massive inconstancies between regions and areas, creating a postcode lottery of HIV provision,” commented NAT’s chief executive Deborah Gold. She also noted that when ring-fencing of the public health budget is lifted in April 2016, the situation could get worse. “In the current climate of cuts and pressure on budgets we are extremely worried this money will be used to shore up other areas of council spend. This would be a disaster for public health in this country.”
National AIDS Trust. HIV prevention in England’s high prevalence local authorities: 2013/14 and 2014/15.
Highlights from the report can also be seen in this video presentation.