“No Decision About Me
without Me” was the strapline for the first conference of people living with
HIV in the UK
since Positive
Action in 2008.
One
hundred and thirty people living with HIV came together in London on 24 September to talk about the
issues facing us as a patient group and as members of society. Issues which
stood out included: changes to the NHS and social care; HIV and ageing; HIV and
young people; HIV prevention for positive people; advances in treatment; and
the use of new media in activism.
It’s
interesting comparing discussions here with the ones back in 2008 and realising
how much our world has changed.
The two most
prominent issues at the 2011 conference weren’t predicted in 2008: the
wholesale reform of the NHS and of public health and the related cuts to HIV
health care, social care and prevention.
The Chair
of the All-Party Parliamentary Group on AIDS, Pamela Nash MP, opened the
conference. She said that late diagnosis remained one of the greatest
challenges to HIV health care and saw it as largely being caused by stigma: as
a gesture against stigma, she was about to take an HIV test herself and would announce
the result on World AIDS Day. She also emphasised that opportunities for
diagnosis are still being missed. Budget-cutting not only means loss of
services but loss of a generation’s expertise.
Stigma and poverty blight the
lives of too many. Jonathan Grimshaw
Jonathan
Grimshaw MBE, one of the first people diagnosed in the UK, gave a plenary speech. Asking
what ‘activism’ was, he named six overlapping components: mutual peer support;
advocating for treatment; self-empowerment; involvement in decisions; asserting
human rights; and combating stigma.
The
biggest challenge to the continuing empowerment of people with HIV was that the
current model of HIV care was unsustainable, he said. “Because treatments are
successful, there are now 100,000 of us, and we are seeing some social care and
even some treatments withdrawn or restricted. Stigma and poverty blight the
lives of too many.” The ageing of the HIV-positive population and how to
resource their future medical and social care needs was also problematic.
Not all
the HIV-positive population is older: a member of the Children’s HIV
Association’s youth committee spoke about her own nervousness about being an
activist. “I don’t feel like a ‘vigorous campaigner for a cause’; I just want
to make a change,” she said. “The challenge is to get young people involved
without scaring them off.”
Neil
Beasley, a Terrence Higgins Trust (THT) board member, mapped out the health and
social care landscape of the next few years. One challenge is money: THT had a
25% cut in statutory income this year and it expects next year to be worse.
Another
challenge is that HIV services will be commissioned by two very different ends
of the health spectrum. Under the Health
and Social Care Bill (due to be discussed in the House of Lords in October),
HIV health care and treatments in England will be commissioned by the NHS
Commissioning Board, a new non-departmental public body (previously known as quangos);
on the other hand HIV testing, STI services and HIV prevention services will no
longer be run by the NHS but by local authorities, as part of an expanded
public health remit.
The
dangers of fragmentation are obvious, as is the striking lack of primary care
and GP involvement – an opposite pattern to other chronic health conditions
such as diabetes.
A workshop
on health and social care uncovered a number of opportunities for patient power
within the new structures. From this month, local authority prevention and
testing services in England
are being overseen by health and wellbeing boards whose job is to co-ordinate
services. They will include councillors, GPs and the local directors of public health
and social work but must also have patient representatives.
Another
opportunity to get involved in England
is through HealthWatch, local authority ‘consumer forums’ that are part of the
Care Quality Commission and will replace the current LINks (Local Involvement Networks)
from October 2012.
How to get
involved at the ‘top end’ and influence the NHS Commissioning Board is more
problematic, but one opportunity may be provided by NICE, the National
Institute for Health and Clinical Excellence. NICE’s Evidence Accreditation Criteria
are now applied to the production of BHIVA guidelines – not only on HIV testing
and prevention, but also the next set of treatment guidelines – to ensure patient
involvement in their production as well as assuring the quality of evidence
used.
On the
local level, HIV Forum Link, up till now an ad
hoc federation of clinic patient groups, is seeking voluntary organisation
status and may provide a more co-ordinated patient voice in the future
alongside the UK Community Advisory Board.
At the end
of the day, Jonathan Grimshaw remarked on the constructive and engaged
atmosphere at the conference and the lack of over-strident demands. Although people
with HIV may face a straitened existence in the future in terms of benefits and
treatments, the system is not automatically loaded against us and the
opportunities to have your voice heard are, if anything, better than ever.
Slides
from the day are available on the Positively UK website: www.positivelyuk.org/conference.php
For the
report from Positive Action in 2008 see the National AIDS Trust website: www.nat.org.uk/Living-with-HIV/Tell-us-your-issues.aspx or download a PDF of the conference summary report: http://bit.ly/p2D8Py