'There can be no complacency in our endeavour to end this epidemic.' Not my words, but those of Sir Keir Starmer when he addressed a room of MPs, charities and people living with HIV on World AIDS Day last year. At an event in honour of Sir Elton John, the Labour leader committed that a government in his name would commission a new HIV Action Plan within 100 days if elected.
Fast forward seven months, and Starmer is entering Downing Street at a crucial moment for HIV. He has appointed Wes Streeting as his health secretary, who was a member of the 2020 HIV Commission, which authored the roadmap to ending new HIV transmissions in England. The midway target of an 80% reduction in new diagnoses by 2025 – that Streeting helped set – is now just around the corner but not on course to be achieved. The HIV Action Plan that followed the HIV Commission’s work expires next year. And the data tells us our progress is stalling.
So, what would a jump-start approach look like? The new government needs to kick off a new HIV Action Plan process by 12 October this year to honour Starmer's promise, and publish that plan by 4 July 2025 – the anniversary of Terry Higgins being the first named person to die of an AIDS-related illness in the UK. If that plan is to get us to zero, it will have to be ambitious and implemented. That’s only possible with funding.
The next comprehensive spending review – the process of setting government departmental budgets – is due this autumn. It will decide how much funding is allocated to HIV and public health from April 2025 onwards, so it could make or break the next HIV Action Plan.
On HIV, as with any investment in prevention, there are long-term savings to be made by investing early. The earlier you diagnose someone, the better their health is and the lower the cost. Stopping the onward transmission of HIV saves a lifetime of stigma and cost.
In the first 100 days of opt-out HIV testing in A&Es, £2.2 million was spent, but an estimated £6-£8 million was saved in care costs. That programme has been a triumph and is now being expanded to all areas with a high prevalence of HIV: 47 more hospitals, taking the total to 81. This type of routine testing must now become part of business as usual in these hospitals, with central government funding to guarantee it continues everywhere.
But one – highly successful – scheme does not end an epidemic. We will need to go further to reach our goal, and every part of the health service will have a part to play. We need opt-out HIV testing in GPs and PrEP access in pharmacies. Our HIV clinics and the community sector need the resources to find and support the 14,000 people not accessing HIV care, and our sexual health services need the funding to do proactive HIV and sexual health prevention. Our HIV and sexual health manifesto sets out six clear calls to action. It also shows the level of consensus on what’s needed, with over 20 charities and doctors’ groups in agreement.
Starmer and Streeting take up the mantle when we are on the cusp of something extraordinary: ending the onward transmission of a virus without a vaccine or a cure. It would be the first time that’s ever been done. Few viruses are as stigmatised as HIV. At Terrence Higgins Trust, it’s our job to encourage, cajole and support governments of all stripes to make it happen. But time is running out to do so.
That’s why we need your help to make sure the new government doesn’t let this opportunity pass by. We want to give every new MP an induction on HIV, build key relationships and brief new ministers. That work is often, by definition, behind the scenes. But it takes time and resources. So if you can, please donate to support our work today.
Together, we can make new cases of HIV in the UK a thing of the past. There is no complacency here.
