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HIV prevalence rose by 17 per cent last year in London, while services to help people with the virus are under threat. Natalie Valios reports.

Seven out of 10 people with HIV in the UK live, or are being treated for the disease, in London. According to the latest official figures from the Public Health Laboratory Service, there were 1,949 people with HIV in the capital in 2001.1 However, final figures for the year are expected to show a 17 per cent rise in the prevalence rate in London between 2000.¹

The rise is mainly to be found among the heterosexual community and African communities. By contrast, the numbers of gay people being diagnosed with HIV has remained static. In view of the rising levels of infection, you might expect funding to be guaranteed. However, social care services for people with HIV have been squeezed over the last eight years, even though the cost of drugs is also escalating.

The Naz Project London is a charity providing sexual health services for south Asian, middle eastern, north African and Latin American communities. Funding is all based on PHLS data, says its client services co-ordinator Parminder Sekhon, so if a community isn’t represented in those figures or is lumped together with another black minority ethnic category, it becomes invisible. Would-be funders can then use this as a justification for not putting any money into services.

”It’s our job to ensure that the needs of black minority ethnic communities donÕt fall off the mainstream agenda as unfortunately they have in some areas,” says Sekhon.

Historically, London has experienced an unco-ordinated and fairly incoherent commissioning process of HIV services by health and local authorities, says Grainne Morby, director of London services at Terrence Higgins Trust & Lighthouse. The wide variety of HIV services across the capital operate on a mixed pan-London, sub-regional, or local basis.

Under the government’s plans to devolve powers locally, the 16 London health authorities are being replaced by five strategic health authorities Ð south west, south east, north central, north east and north west. The problem, then, may be getting all primary care trusts in one of the five areas to synchronise commissioning, says Morby.

And a new funding regime being introduced this April will see 75 per cent of health authority money being directed to PCTs. Again, the fear is that the emergence of PCTs may hinder a co-ordinated commissioning approach.

”What we don’t know yet is whether there will be a pull by individual PCTs to commission at a very local level. We would argue that to provide a co-ordinated approach across the capital we need it to happen on either a pan-London or sectoral basis.”

Of even greater concern, says Morby, is the news that from April the government is abolishing ringfenced monies which went to health authorities specifically for HIV treatment, care and provision.

Local authorities, too, have always had specific HIV money in the form of an AIDS support grant. The government is reviewing this, but Morby’s expectation is that it will be abolished next year. Consequently, there will be no specific allocations for health and local authorities or PCTs. “HIV will have to fight its corner along with all the other diseases and core categories,” she adds.

Voluntary organisations hope that the government’s national strategy for sexual health and HIV, which went out for consultation last year, will keep the issue at the forefront of statutory authorities’ service planning.

Among its aims, the strategy hopes to reduce the transmission of HIV and sexually-transmitted infections; reduce the prevalence of undiagnosed HIV and STIs; and improve health and social care for people living with HIV. Over the next two years the government will invest £47.5m to support the range of initiatives outlined in the strategy.

Stemming from the national strategy, health and local authorities and the voluntary sector in London worked together to develop an HIV strategy for the capital. It will provide a framework for implementing the national strategy in London and is currently out for consultation.

Another challenge for services providers will be to ensure that HIV and sexual health remains high enough up the PCT agenda, difficult given all the other issues that will demand their attention. And as HIV has slipped down the public agenda over the last six years, despite the rise in figures, this may prove difficult to do. LF

¹ Public Health Laboratory Service, “Aids/HIV Quarterly Surveillance Tables: Data to end December 2001”, 2002