Better Health For All

•  Helen Skirrow, Specialist Registrar in Public Health at Southwark and Lambeth Public Health team

Worlds AIDS Day will be marked on 1st December 2015. Though HIV is no longer the deadly disease associated with the initial epidemic in the 1980s and 1990s, it remains an important public health issue today in the UK.

It is estimated that 103,700 people in the UK are living with HIV and around one fifth (17%) of these are thought to be unaware of their diagnosis. It is more common among men who have sex with men (MSM) and black African men and women. Geographically, high HIV prevalence is found in London and in pockets outside of the capita,l for example in Brighton and Hove and Manchester.

All but one of the London boroughs had a diagnosed HIV prevalence rate of above 2 per 1,000 in 2014.  This is  considered high and above the threshold for routine testing of new GP registrants, so HIV is a significant public health problem in London.

One of the key public health challenges is to improve the early diagnosis of HIV and thus prevent transmission and enable early treatment initiation. Late diagnosis of HIV is associated with higher mortality so ensuring that those at risk get tested is a priority. The number of people living with HIV continues to rise in the UK.  With the introduction of effective anti-retroviral therapy, if detected early people living with HIV can expect a near normal life expectancy.  However reducing the entrenched stigma associated the disease remains a challenge.

HIV prevention can be through a number of initiatives. Promoting consistent safe condom use is vital and needs to be focused particularly among key risk groups such as MSM.

Targeted and relevant safe sex messages are needed for MSM, particularly those  likely to engage in HIV transmission risky behaviours such as having multiple casual partners, making assumptions about HIV status, and those who recreationally use drugs prior or during sexual intercourse: termed ‘chemsex’.

Increasing HIV testing rates is also a key prevention initiative to reduce onward transmission and new innovative ways to improve access and uptake of HIV testing are being developed.

There are many national and local initiatives aimed at improving HIV testing rates and promoting safe sex. For example National HIV Testing week runs in the week prior to Worlds AIDS day and promotes HIV testing nationally. This year saw the launch of the ‘National HIV Self-Testing Service’, funded by local authorities in conjunction with Public Health England.

In the capital, where almost half of all HIV cases are diagnosed, ‘Do it London’ is the campaigning element of the multi-faceted London HIV Prevention Programme (LHPP). This is a London-wide sexual health promotion initiative aimed at increasing HIV testing and promoting safer sex to all residents in the capital, funded by every London borough according to their diagnosed HIV prevalence.

As well as the city-wide Do It London campaign to promote HIV testing, the LHPP also provides free and low-cost condoms in over 80 London gay clubs, bars and saunas, supported by a highly specialised gay men’s outreach service which targets high risk men for health promotion interventions and on-the-spot rapid HIV testing.

In Lambeth and Southwark, which experience high levels of sexually transmitted infections and the highest HIV rates in England, SH:24 is leading the way in improving access to sexual health screening for residents by using internet and telephone technologies to deliver sexual health care remotely, 24 hours a day, seven days a week.

SH24 is fully integrated with local NHS services and enables Lambeth and Southwark residents who are concerned about their sexual health to log onto the SH24 website, receive health information, signposting to services and order a STI testing kit (including HIV) to be delivered to their home. They take a sample themselves at home, post it to the laboratory and receive results by text or from a local clinic depending on whether or not treatment is required.  User feedback has been overwhelming positive and activity has continued to increase since the service went live in March 2015.

Looking to the future of HIV prevention and management, easier access to testing is vital to reduce the burden of disease caused by late diagnoses.  Innovative solutions such as SH:24 will likely expand nationally and receive greater focus as these programs improve access to HIV testing whilst realising cost savings for local sexual health commissioners.

Many local authorities have signed up to the ‘Halve It’ initiative, including Lambeth and Southwark. This is a national coalition of experts brought together with the aim of tackling the public health challenges of HIV: namely halving the proportion of people diagnosed late with HIV and halving the proportion of people living with undiagnosed HIV by 2020. ‘Halve It’ is now also working with the London HIV Prevention Programme. Its shared aims should be recognised and endorsed by everyone working within public health in the UK.

Significant progress has been made over the last decade in the treatment of HIV. The challenge now is to ensure we work to achieve the aspirations set out in the Halve It campaign through a multi-faceted and targeted programme of increasing access to testing amongst high risk groups.

Key References

• http://www.worldaidsday.org/index.php
• Public Health England , HIV in the United Kingdom – 2014 report
• Bourne, A; Reid, D; Hickson, F; Torresrueda, S; Weatherburn, P; (2014) The Chemsex study: drug use in sexual settings among gay and bisexual men in Lambeth, Southwark and Lewisham. Project Report. Sigma Research, London School of Hygiene & Tropical Medicine, London
• http://www.tht.org.uk/itstartswithme/itstartswithme?persona=2
• http://doitlondon.org/
• https://sh24.org.uk/
• http://www.halveit.org.uk/