At an event with Sir Elton John to mark World AIDS Day, the Health Secretary announced that the Government will be investing nearly £20 million to expand opt-out HIV testing to 46, now 47, more hospitals across England. From Birmingham to Bristol, Luton to Leeds, Portsmouth to Peterborough, Southampton to Sheffield, millions more people will now be tested for HIV when they go to their local emergency department.  

This substantial new funding put England’s annual HIV test total over five million – a huge step forward. For context pre-COVID the country was doing about 1.8 million each year. This tripling of the number of HIV tests done in England every year will turbo-charge our efforts to end transmissions of HIV by 2030.

Alongside so many of our incredible partners and supporters, we campaigned hard for this and we won.

Here’s how we did it.

Opt-out HIV testing in emergency departments was first trialled in hospitals in South London, with funding from The Elton John AIDS Foundation (EJAF) and National Lottery. The principle is simple – every time someone has their blood taken in A&E, they are tested for HIV unless they specifically ask not to be.

The evidence from those pilots was clear – opt-out HIV testing in A&Es works. It worked even more for women, heterosexuals, Black and Asian populations and older people. It also effectively reaches men who have sex with men but wouldn’t think of themselves as gay or bi.

In 2020, we founded the HIV Commission with our friends at National AIDS Trust and EJAF. It set out the roadmap to ending new HIV cases by 2030, with Wes Streeting MP (now shadow health secretary) and Steve Brine MP (former minister-turned-chair of the health select committee) serving as commissioners. The commission’s clarion call was for Government to ‘test, test, test’. Getting opt-out testing to all A&Es in areas with a high HIV prevalence was the flagship recommendation.

We campaigned hard for action on these recommendations and in December 2021, the Government’s HIV Action Plan included a £20 million investment in HIV testing in four cities with the very highest prevalence. Thanks to additional funding from the Hepatitis C Elimination Fund, every London A&E was included (regardless of prevalence rate) and hepatitis B and C were also included. Within months, 33 A&Es were doing the testing.

However, the HIV Commission’s recommendations, based on NICE Guidance, was they 80 plus A&Es should be doing this routine testing. The gap meant people were being left behind. Our campaign continued.

Over the last 18 months, the Government’s opt-out programme has found thousands of people unaware that they were living with HIV, hepatitis B and hepatitis C in those four cities. Thanks to the commitment of our brilliant NHS colleagues, the programme has been diagnosing people at a speed and on a scale not seen before. We’ve been using these results to tell the Government that it’s time to expand the programme across the country.

1. Thousands of you signed our open letter to the Public Health Minister

With support from Gilead, we teamed up with National AIDS Trust, Hepatitis C Trust, British Liver Trust and Elton John AIDS Foundation to write to the Public Health Minister and Chief Executive of NHS England to calling for an expansion of opt-out testing. Thousands of you signed our open letter that sent a clear message to the government – expand opt-out HIV and hepatitis testing now.

2. Supported MPs, Mayors and Councillors to write to the Health Secretary

We worked with MPs, mayors and council leaders from across the country to write letters to the Health Secretary to call for testing funds for their areas – and more than 50 did so.

We also invited every councillor in England representing an area with a high HIV prevalence to a briefing to hear for themselves the benefit opt-out testing would have at their local hospital and asked them to raise this in their town halls.

3. Worked with MPs and peers to raise opt-out testing in parliament

A strong group of politicians backed our campaign in parliament, leading debates and asking questions.

Maggie Throup MP, Nicola Richards MP and Lloyd Russell Moyle led parliamentary debates, Chris Clarkson MP called for funds for Rochdale, Lord Black asked a question in the House of Lords, Florence Eshalomi MP spoke about the power of opt-out HIV testing in her local hospital and Penny Mordaunt MP praised the success of the programme at Business Questions.

Members of Parliament from across political parties asked parliamentary questions about the issue, including Steve Brine, Caroline Nokes, Paul Holmes, Nickie Aiken, Holly Mumby-Croft, Andrew Gwynne, Elliot Colburn, Tan Dhesi, Lloyd Russell-Moyle and Dan Carden.

4. Took the call to Prime Minister’s Questions 

In National HIV Testing Week, Peter Gibson MP asked about our campaign at Prime Ministers Questions – paying tribute to his friend who was diagnosed with HIV too late.

In October, Nicola Richards MP urged Rishi Sunak to make funding available for her constituency in West Bromwich East and across the country.

5. Built an opt-out testing coalition in the West Midlands

With five boroughs in the West Midlands missing funding, Mayor Andy Street stood up to be counted and called for expanded HIV testing funds for his region. In the summer, with Birmingham-based Saving Lives and Positive Peers, we brought together key politicians, doctors, commissioners and community members – in partnership with opt-out testing HIV champions Dr Radhika McCathie and Dr Steve Taylor - to meet the Mayor and build the local case for expansion.

Our colleagues at NHS England were crucial to highlighting the success of the existing opt-out testing programme and consistently generous in sharing their time and expertise, including at events like this one.

6. Made the case at party conferences 

We headed to Conservative and Labour Party conferences two years in a row to talk to party members, MPs and local leaders about the power of opt-out HIV testing. We briefed politicians in meetings, nabbed them in corridors and asked questions of Ministers on panels. With our partners at the British Association of Sexual Health and HIV (BASHH) and our friends at LGBT+ Conservatives and LGBT+ Labour, we hosted events to spread the word about our campaign.

Our message was heard. Both the outgoing Health Secretary Steve Barclay and Public Health Minister Neil O’Brien mentioned the power of opt-out HIV testing at Conservative Party Conference this year, while Shadow Public Health Minister Preet Gill backed our call in her speech at our event at Labour Party Conference.

Left to right: Richard Angell, Mayor Andy Street, Nicola Richards MP, Gary Sambrook MP, BASHH President Dr Claire Dewsnap at Conservative Party Conference this year.

7. The Elton John event

The All-Party Parliamentary Group hosted a very special event in Speakers House to mark World AIDS Day in honour of Sir Elton John. Due to their timely and brilliant organisation, and Sir Elton’s persistence on HIV testing and the efficacy of opt-out testing, the opportunity to share a stage with the Rocketman proved to be the final push we needed to get the government to commit the seven figure sum.

Less than three weeks into the job, Victoria Atkins has recognised the strength of our case and made this her first spending announcement as Health Secretary. 81 A&Es will now routinely test for HIV in 2024-5. Pretty amazing when you think about it.

An army of people worked tirelessly behind the scenes – not least Victoria’s predecessor Steve Barlcay and his team – so that this decision was a no-brainer. We are indebted to the special advisors, public health officials, NHS England colleagues, parliamentary staffers, doctors, nurses and community of people living with HIV who made this possible. You know who you are – and we hope you are proud of the difference you have made.
 
Thanks to this amazing coalition, we’ve won a change that will take us one step closer to ending the HIV epidemic in England and change thousands of lives along the way.

We have to keep our foot on the pedal. We won’t end new HIV cases with testing alone – we must also get more people on to PrEP and make sure every person living with HIV is getting the care they need.

There are still stark health inequalities at the heart of the HIV epidemic, so we must make sure that no community is left behind from the progress we know is possible.

We need to see the roll out of opt-out HIV testing pilots in Scotland and to maintain the vital funding promised for the HIV Action Plan in Wales. And with the HIV Action Plan for England expiring in 2025, all political parties in Westminster must start thinking about a refreshed HIV Action Plan for England now, so that it can be published in the first year of a new Parliament, whenever that may come.

We can’t win campaigns like this without you, our supporters. Your generous gifts, regular contributions, participation in marathons and the like, and visits to our charity shop, Boutique, are the vital funds used to run transformational campaigns.

If you want to help us make further change, support our work and donate today.

Together, we can end the HIV epidemic in the UK, for everyone, once and for all.

Katie Clark is our Policy and Campaigns Officer.