Services for people with HIV: special report
Government commitment to tackling HIV is questioned this week by the National Aids Trust in a new report.
Funds for HIV prevention have declined since the late 1990s, while the number of people living with HIV in the UK has more than doubled, says the trust.
In 2005, 7,750 people were diagnosed with HIV, the highest number ever, but political will to address the issue is lacking, according to the trust’s chief executive Deborah Jack.
Over 42,000 people are receiving HIV treatment and care in the UK, latest statistics show. In 1997, just over 16,000 people were accessing services.
The total number of people living with HIV is estimated at 60,000, with one third undiagnosed.
The National Aids Trust believes funds are being diverted away from HIV prevention work. It is also concerned about the treatment of vulnerable groups such as prisoners and African migrants.
Lack of political commitment
New Labour is renowned for its targets and strategic plans – but not when it comes to HIV, says NAT. Its report states there is no Department of Health target specifically related to HIV and that neither Tony Blair nor any senior ministers have given speeches on HIV in the last two years. The national strategy for sexual health and HIV has not been updated since 2001, it says.
A Department of Health spokesperson said: “Whilst we acknowledge that there is still a lot to do to tackle the rate of HIV and other STI infections in England, we do not accept that the government has shown insufficient commitment to this important area of public health.”
Indeed, Lisa Power, head of policy at the Terrence Higgins Trust praised the government for making sexual health one of six key priorities in the NHS this year, including granting extra funds for services. However, national initiatives are not turning into local action, she says. HIV prevention money is not ring-fenced and is being diverted locally into other services by primary care trusts, according to Power.
Seventy five per cent of new HIV infections in the UK are in gay and bisexual men, says the NAT report.
It also states that African migrants, who are mainly infected before arriving in the UK, now account for about 75 per cent of new heterosexual diagnoses here.
Among African communities in the UK, undiagnosed infection and late presentation for testing and treatment are an issue, the report finds.
HIV services must be “freshly designed” to meet the needs of African people, it says.
The Department of Health spokesperson said: “On HIV we have long acknowledged that the two groups most at risk are gay men and people from African communities living in England. That is why we allocate significant resources annually to targeted work programmes for HIV prevention for these groups, channelled through the Terrence Higgins Trust and the African HIV Policy Network, respectively.”
The issues of HIV stigma and discrimination, “which are especially acute within African communities,” are also currently being discussed, added the DH spokesperson.
Manchester HIV charity George House http://www.ght.org.uk/ght/index.php has many African clients and chief executive Michelle Reid says numbers accessing services have grown hugely in recent years, with no corresponding rise in funding.
Reid is concerned at the treatment of HIV positive asylum seekers whose claims have failed and migrants with no permanent residency rights. Issues include deportation of vulnerable people to countries where there is no access to HIV treatment and denial of free HIV care on the NHS, she says.
The NAT report claims best practice in HIV prevention is being ignored for certain groups including prisoners and migrants.
“Coercive, retributive or moralising responses are replacing actions based on public health and human rights,” it says.
For the government, other issues are taking priority over public health concerns, argues Power at the Terrence Higgins Trust.
“It is not a vote winner to allow HIV positive illegal immigrants to stay in the UK,” says Reid at George House.
It is true that recent government policy and speeches by the prime minister and home secretaries have promoted a “get tough” message on asylum seekers, foreign prisoners and illegal immigrants. Little concern for their human rights or health is evident.
Injecting drug users
HIV among injecting drug users has risen from one in 110 in 2002 to one in 62.
The figures are the worst for 15 years, says Louise Inman, substance misuse policy officer at social care charity Turning Point.
Previously a “concerted harm reduction approach” succeeded in reducing rates of infection among injecting drug users, says the NAT report.
However “strategic action” is now needed to cut infection rates in this marginalised group, it concludes.
Inman says substance misuse services need to adapt to changes in drug use.
People using crack need more needles so extra exchange schemes are vital, she explains. Inman believes the substance misuse sector is “more complacent” about HIV than previously and new service users are “less aware” than before.
Inman points to the idea of clean safe drug consumption rooms for users
recently highlighted by the Joseph Rowntree Foundation http://www.jrf.org.uk/bookshop/details.asp?pubID=785 as a harm reduction strategy worth considering
It is also extremely concerning that a third of prisons have no HIV policy and well over half have no sexual health strategy, according to a 2005 survey http://www.nat.org.uk/HIV_Testing_&_Care/Prisons_&_detention
by the Prison Reform Trust and the National Aids Trust, says Inman.
The same survey found that the HIV rate in prison for men is 15 times higher than the rate outside.
For HIV campaigners, the harsh fact is that HIV and Aids are no longer widely discussed and debated. Momentum has slipped, even though HIV infections are at an all-time high.
Lisa Power at Terrence Higgins points out there has been no national advertising campaign on HIV and AIDS for 20 years. Today’s teenagers weren’t born when TV adverts about AIDS featuring tombstones scared the nation.
“People were more worried about HIV when far less people were getting infected,” she says.
Find out more:-
Mapping the Issues
HIV and other Sexually Transmitted Infections in the United Kingdom: 2005
Health Protection Agency report