Fighting funds

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