It’s possible that within this decade, we could achieve something remarkable: stopping the onward transmission of a virus without a vaccine or cure, for the first time in history. Even twenty years ago, that possibility would have been unthinkable. Thanks to recent medical advances it’s within reach. Quick and easy HIV testing, the pill PrEP which stops you from acquiring HIV and treatment that means a person living with HIV can’t pass it on. These developments are some of the great successes of modern medicine.
Unfortunately, though, the science can only take us so far. Before parliament, I worked for National AIDS Trust, a fantastic HIV rights charity. There I saw firsthand: that every day we are missing opportunities to test, to get prevention to people and to ensure everyone living with HIV is getting the care that they need. My first project in that job was working to launch the report of the HIV Commission. It was an independent project, established by National AIDS Trust, Terrence Higgins Trust and Elton John AIDS Foundation to make recommendations on how England could end new HIV cases by 2030. Amongst the independent commissioners was a young Labour backbencher with a keen interest in HIV, but who no one predicted might one day sit in Cabinet overseeing it. Wes Streeting’s commitment in this area hasn’t waned, and I was proud to stand on a Labour manifesto that pledged to deliver a new HIV Action Plan for England.
So, what will it take? A lot has moved on since the HIV Commission published its findings in 2020, but a lot also hasn’t. An investment in an ‘opt-out’ approach to testing in emergency departments, including in my local Hillingdon Hospital, has diagnosed thousands of people with HIV, Hepatitis B and C. This simple principle first pioneered in maternity services – that everyone who has their blood taken is tested unless they ask not to be – has been game-changing. In two years, in just two cities, NHS England has undertaken nearly 2 million HIV tests in A&Es, an unprecedented increase since the 100,000 that took place a year pre-COVID. Introducing this programme was a key recommendation of the HIV Commission and I was proud to be one of many MPs calling for its extension this autumn. Ahead of World AIDS Day, the Prime Minister announced not just an extension, but an expansion of the programme – so that now 81 hospitals have continued funding and a further 9 will benefit.
This is a significant first step and a sign that this government is serious about ending the HIV epidemic. Beyond this programme, there has been little progress since 2021, so it will be crucial that we accelerate now. Ensuring everyone in England can get an HIV and STI test by post from a single service is crucial – and currently exists for Hepatitis C. It makes no sense that Hillingdon has a totally different testing system to neighbouring boroughs and crucially, it’s inefficient. 30% of rural England is without any postal testing service entirely.
Equally as important is to make sure everyone who could benefit from the HIV prevention pill PrEP can access it. PrEP changed the game for gay men like me, where our sexuality and relationships were always intertwined with the presence of HIV. It was part of driving a significant decline in new HIV transmissions for gay and bisexual men in England, but with access only possible through a sexual health service and those services under immense strain, too many are missing out or don’t know they could benefit. NHS silos are holding back access through other services: online, in GPs, pharmacies and prisons. Access to testing and PrEP through the NHS app would be a great first example of a shift from ‘analogue to digital’ in our health service.
To get HIV prevention right, we also must get HIV care right. We have some of the best HIV clinicians in the world. The ‘can’t pass it on’ message has been life-changing for people living with HIV. But despite these advances, stigma and poverty are still holding people back from getting the care they need: up to 14,000 in England haven’t been to their clinic for more than a year. And too often, people living with HIV experience stigma in the part of the system that should most know better: our health service. It’s time to right that wrong and ensure that there is a training programmes in all healthcare settings in England and a national programme to find and re-engage every person living with HIV in life-saving treatment.
None of this is new: the HIV response has always been at the forefront of piloting innovation. We have the tools and clear evidence of what works. Our job now is to roll that out at scale, ensuring everyone can benefit from the progress we know is possible. As we drive forward our mission to rebuild the NHS, there is a lot to learn from our HIV response. Get it right now and we could show the way for prevention, diagnostics and care across the health service and the world.
We have all the tools we need to end new HIV cases by 2030, but we’re not on track to reach that goal.
