House of Lords report: UK HIV strategy is ‘woefully inadequate’

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A major report on HIV and AIDS says the government is not doing enough to tackle the issue and that the priority given to prevention efforts is “woefully inadequate”.

The House of Lords report, released to coincide with the 25th anniversary of 1986’s ‘Don’t Die of Ignorance’ campaign, says HIV remains one of the most serious public health issues facing the government.

It is released on the same day as Health Protection Agency figures which show that 3,000 gay and bisexual men were diagnosed with HIV last year – the highest number recorded.

The key recommendations:

  • A nationwide campaign on a similar scale to those of the 1980s
  • More work to tackle risky sexual behaviour
  • More spending on prevention work
  • Testing all new patients at GPs’ surgeries
  • Lifting the ban on home HIV testing kits
  • More research into pre-exposure prophylaxis
  • Specialist HIV training for medical staff
  • More than 100,000 people are expected to be living with HIV by next year, at an annual treatment cost of almost £1 billion. In 2010, 45 per cent of those diagnosed were gay or bisexual men. Twenty-six per cent identified as black African.

    More than a quarter of those who have HIV are unaware of their status. Of those who died because of HIV during 2009, 73 per cent had been diagnosed late.

    A Lords select committee, chaired by Lord Fowler, who ran the 1986 campaign, spent eight months examining the issue. The report, ‘No vaccine, no cure: HIV and AIDS in the United Kingdom’, was published today.

    Lord Fowler said: “In the last 25 years the development of new drugs has dramatically reduced the death toll but that should not encourage a false sense of security. Acquiring HIV is not remotely consequence-free.

    “People can now live with HIV but all of those infected would prefer to be without a disease which can cut short life and cast a shadow over their everyday living. Prevention must be the key policy.

    “One essential message remains the same as in the 1980s: the more the partners, the greater the risk. Protect yourself. Use a condom.“

    According to the report, the government has failed to recognise the scale of the HIV problem in the UK and is not doing enough to counter the “steadily growing risk to public health”.

    The document continues: “The numbers of those accessing [HIV] care have trebled since 2000. It remains one of the most serious public health issues confronting the government at the start of the 21st century.”

    It adds: “At present, the priority given to prevention at national and local levels is woefully inadequate.”

    Citing a funding cut for London’s local HIV prevention scheme, the report says: “This is illustrative of a trend towards disinvestment in local HIV prevention.”

    While it says that more funding is needed, the document adds that more must be done to counter risky sexual behaviour, as anecdotal evidence from HIV clinics suggests this is increasing.

    Intensive workshops and one-to-one counselling were found to be the most effective way of decreasing HIV rates, although the report notes that these strategies do not reach large numbers of people.

    More research is needed in a number of areas, the report says. These include finding a vaccine, although it should be assumed that one will not be discovered in the next decade; and and research into pre-exposure prophylaxis (PrEP), which uses medication to decrease the risk of transmission before sex.

    However, the document cautions that there are concerns that PrEP may come to be seen as an “easy solution” and “dilute” safe sex messages.

    The report noted that two recent major safe sex campaigns by the Department of Health (2009’s Sex: Worth Talking About and 2006’s Condom: Essential Wear) did not mention HIV.

    It calls for a new, nationwide HIV prevention campaign, aimed at all of the general population. Research suggests that some groups at highest risk of HIV – men who have sex with men but are not out, and young people – have been missed by targeted campaigns.

    Other recommendations include lifting the ban on home HIV testing kits, which the report says is “unsustainable”; widening routine HIV testing in GPs’ surgeries; and increasing specialist training for medical staff.

    On stigma and discrimination around HIV, the report says that people living with HIV should be encouraged to become advocates for others with the condition and calls on the government to enlist support from faith groups to pass on accurate messages around the issue.

    Currently, it is mandatory for the secondary school science curriculum to include HIV and AIDS, although this is only a “strongly recommended” part of sex and relationship education (SRE). However, one study found that a quarter of young people had not learnt about the issue.

    A government review of SRE is underway and the Lords report calls for teaching on the biological and social aspects of HIV and AIDS to be included in lessons, as well as improved training for teachers on the issue.

    The National AIDS Trust called the report “an important milestone” in the UK’s response to HIV.

    Chief executive Deborah Jack said: “An increased emphasis on HIV prevention in the UK needs to be matched by improved offer and take-up of HIV testing so NAT welcomes the range of recommendations within the report which will make this happen.

    “Crucially, this report identifies late diagnosis of HIV as a serious issue and makes the case for a national public health indicator on late diagnosis – something NAT has been calling for.

    “The report covers more than 50 recommendations for action and it’s important for the government to act on these – not in a piecemeal fashion – but with a cohesive strategy for HIV which brings all these elements together.”