Minister's empty words on HIV will not fill financial void

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Data released today by Public Health England showing HIV diagnoses have fallen for the second year in a row provide some welcome cause for cautious optimism on this issue.

They show there were 4,363 new diagnoses in 2017, a 17% decrease on 2016 which brings them down to the lowest level since 2000.

The figures show a continued downward trend since 2015, with Public Health England saying the decline has been driven by a reduction in new diagnoses among gay and bisexual men, which have fallen by 31% over the period, due to a high uptake of testing.

The use of pre-exposure prophylaxis (PrEP) drugs has also made a significant contribution.

While new diagnoses of black African and Caribbean heterosexuals have been in steady decline over the past 10 years, there has for the first time been a national fall in new diagnoses of heterosexuals from other ethnicities too. Having previously remained stable at around 1,000 a year, there was a 20% drop in this group in 2017.

Public health minister Steve Brine, perhaps rather optimistically, claims the figures show the country is well on its way to eradicating HIV “once and for all”.

However, a failure to reduce late diagnoses shows there is much more to do and a closer analysis of regional data in England appears to reinforce that the challenge remains significant.

There has been a decrease of about 34% in diagnoses in both London and the south of England since 2015, while the Midlands and East of England combined have experienced a 23% fall. However, the north of England has seen a fall of just 7% over the same period.

In the previous three years (2012-15) London was the only area to register a decline (3%), while other regions experienced a small rise, the largest of which was in the south of England (8%).

While it is impossible to reach any firm conclusions about the reasons for this without further data, including measures of dedicated capacity and figures for specific cities for example, it suggests there is a degree of inconsistency in provision of preventative and testing services across the country.

London has led the way with investment and innovations to raise awareness and provide services for those most at risk. Earlier this year the capital became one of the first cities in the world to meet the United Nation’s HIV diagnosis and treatment targets.

These efforts have led to a critical mass of services, with people living relatively close to the capital likely to travel in to benefit from these.

Councils in the capital have played a central role. The London HIV Prevention Programme established joint commissioning of HIV prevention services by all 33 London boroughs in 2015.

The Do It London campaign, which is delivered by Lambeth LBC and won a 2018 LGC award for campaign of the year, has included 27,000 awareness adverts on the underground and buses, as well as an extensive social media campaign.

The launching of these initiatives has coincided with the accelerated downward trend in HIV diagnoses in the capital.

However, Mr Brine’s optimism should be curbed by the reality that his government’s public health grant fell from £3.3bn in 2017-18 to 3.2bn this year, as part of planned cuts to dedicated funding of £600m by 2020-21.

The Local Government Association has warned that councils’ public health budgets cannot cope with a current surge in pressure on sexual health clinics.

The latest figures show a 13% rise in attendances at clinics between 2013 and 2017, while tests for sexually transmitted infections has grown by 18% over the period.

This increased demand at a time diminishing funding is placing severe strain on council budgets, leading to some people being turned away from clinics.

Progress made in treating and supporting people with HIV, as well as notable reductions in diagnoses, is a significant achievement but an ongoing challenge.

But the scale of the cuts to public health funding raises questions over what more could have been done up until now and whether the current encouraging performance can be maintained.

Mr Brine’s claim he has “not an ounce of complacency” over reducing the prevalence of HIV still further will look like empty words until his government demonstrates a firm financial commitment to saving and transforming lives.

Jon Bunn, senior reporter