February 2007:

HIV in the UK Today

A Summary of the APPG AIDS meeting with the Health Protection Agency and Terrence Higgins Trust on 22^nd February in the House of Commons.

Speakers:

Dr. Valerie Delpech, Consultant Epidemiologist at the Health Protection Agency Centre for Infections;

Lisa Power, Corporate Head of Policy and Public Affairs at Terrence Higgins Trust.

Dr. Delpech was invited to give an epidemiological overview of the HIV epidemic in the UK today.

Dr. Delpech gave a quick summary of what the UN has termed a Global Emergency and showed Sub-Saharan Africa as the worst affected area on the globe. The epidemic in Sub-Saharan Africa is a heterosexual epidemic i.e. it is in the population at large. The WHO and UNAIDS 3 by 5 initiative (to get 3 million people onto Antiretroviral Treatment by 2005) was a tremendous effort and although it did not achieve the intended target it reached 1.5 million people.

The link between the epidemic in Sub-Saharan Africa and other highly affected areas and Europe is mainly through immigration. The WHO definition of Europe is wide and includes Russia and the CIS states. The epidemic in Europe is different to the Sub-Saharan one and still mainly affects key groups. In Eastern Europe sex-workers and injecting drug-users are still the most vulnerable group although the number of new infection, incidence, is growing rapidly and becoming prevalent in the general population.

In the UK the epidemic disproportionately affects men who have sex with men (MSM) and Black Africa Communities. In 2005 it was estimated that 63,000 people (15-59 years) are HIV-positive in the UK and an estimated one third are unaware of their infection. The same estimate put the number of new infections in 2005 at 7,400.

The incidence of HIV had dramatically increased since 1999. This is, as mentioned above, due to the heterosexual epidemic via immigration from Africa and also because the incidence is rising significantly again amongst MSM. The prevalence has also increased and that is mainly because the number of deaths has dramatically fallen. 

Since 1982 over 17,000 deaths have been reported but the number of people dying of AIDS related illnesses has drastically reduced since 1996 when HAART (highly active antiretroviral treatment) was introduced. People still die of AIDS related illnesses in the UK but that is almost exclusively (90%) related to late diagnosis. Targeted interventions to reduce the transmission (such as advertising in the gay community and information targeted towards Black Africans), early testing and access to treatment remain crucial to reduce morbidity associated with HIV.

In 2005 more diagnoses of HIV were found outside of London than in London and access to HIV health care is no longer solely focused in London.

In the UK most testing is done in GUM clinics and at antenatal care. To increase the uptake of testing there is a push to extend testing facilities to community settings. One example is The Peckham Pulse which at the moment offer HIV-tests.

More information about HIV statistics in the UK can be found on the Health Protections Agency’s website and in their free publications. www.hpa.org.uk

Lisa Power of the Terrence Higgins Trust’s presentations was called the HIV in the UK – what now?

The population living with HIV in the UK is changing. The epidemic is today seeing an increasing proportion of gay men once more. The epidemic is becoming more complex as numbers of dual and multiple infections is increasing (TB and Hepatitis).

With numbers rising it is estimated that 100, 000 people will be living with HIV in the UK by the end of 2010. This will lead to a rising cost for the NHS and a strain on services. Increased numbers will also give rising impact of stigma and discrimination and also rising potential for onwards transmission.

The NHS is already today looking at streamlining services, and this is not always in the best interest of patients. There is a lot of commitment from the Government on Sexual Health but it is complicated by the fact that the PCTs are in charge of the spending. PCTs are mainly concerned with short-term health spending and therefore money is funnelled out of the Sexual Health budget to meet other budgetary constraints and to clear deficits, i.e. it is clear that the money is not reaching the sexual health settings.

Stigma, discrimination and ignorance is rising again despite and increase in incidence. It is thought that the UK has gone too long with out a public campaign on HIV. There is also a strong link between criminalisation, prosecution, immigration and HIV in the media. This creates a vicious circle and a climate of fear. If the impact of stigma continues to rise there is potentially a major damage to the social and economic fabric as well as individual lives. Ignorance increases the rise of risk of spreading HIV.

There is a need to examine the impact of services on different groups. In the 1980s the Government was joined up cross departments in the fight against HIV. We need that now to ensure that interventions don’t cancel each other out.

What do we need to know now?

-         Who is still dying and why? Misdiagnosis, No Testing? No Information?

-         Who is presenting late and why?

-         What affects individuals testing decisions?

-         What affects sexual decision making?

-         How do we keep the general population informed about HIV?

-         How to we get the NHS to see what politicians, health economists and the public all agree about – that HIV and STIs are a major threat to our public health?