The HIV Action Plan, launched on World AIDS Day 2021 by the Secretary of State for Health and Social Care Sajid Javid MP, is the UK Government’s blueprint for achieving the 2030 goal of ending new transmissions in England. We welcomed its release but cautioned that in many areas the action plan was not ambitious enough.
Alongside the action plan was a £20 million commitment to fund opt-out testing in accident and emergency departments (A&E). This funding was focused on the South East of England, with funding for London and Brighton alongside high incidence areas of Greater Manchester.
In the past six months opt-out testing has been launched in all these areas – an incredible endeavour. Credit to Integrated Care Systems (ICSs), NHS colleagues and all who have been a part of this rapid roll out that is already diagnosing individuals with HIV in its first months.
A national HIV implementation steering group has also now been established, which will play a role in advising and overseeing the implementation of the action plan. With Professor Fenton (Chief Advisor on HIV to the Government) in place as Chair, the group is set to be impactful and help to set the agenda.
Now that the building blocks are in place, the real work begins. In the next six months we need to see a step-change in action.
Pre-Exposure Prophylaxis (PrEP) is a vital HIV prevention tool. Yet we know that many communities who could benefit are not aware that it exists. And even in those individuals who are PrEP-aware, being able to actually access PrEP can currently be a challenge.
The action plan committed to a 'plan to drive innovation in PrEP delivery to improve access for key groups including provision in settings outside of sexual and reproductive health services.' This plan, and its subsequent implementation, is needed as a matter of urgency.
The inequalities in access to PrEP that we currently see must be addressed. In the coming six months we want to see firm action to pilot new ways of accessing PrEP, including through community pharmacists and GPs, alongside an increase in awareness activity among communities who are not currently feeling the benefits of PrEP.
The roll out of opt-out testing so far is impressive. But this cannot be the end. There are areas of the country – from Bristol to Leicester to Liverpool – who could benefit from opt-out testing in A&E. For those areas that have particularly high levels of late HIV diagnosis, opt out testing in A&E and GPs has huge potential. We need to see a clear plan of action – and funding – to learn from the initial implementation of opt-out testing and further roll out of this important initiative so that many more areas of England benefit.
In London, ICSs are being encouraged to spend 10% of their opt-out testing budget on community support initiatives. Those diagnosed with HIV via A&E need to be supported to initiate treatment and remain in HIV care. In the coming six months we now need to see all ICSs in London consistently make this community support available.
The action plan also included an independent review of the Sexual Health, Reproductive Health and HIV Innovation Fund. That review is complete and its outcome must now be publically shared. If the fund is scrapped or the announcement of the outcome of the review delayed, the UK Government must be clear on how the budget for the fund will be spent – including in this financial year.
World AIDS Day will see the first annual parliamentary update setting out the progress that has been made on the HIV Action Plan. A monitoring and evaluation framework will also be released. It is vital that progress reports look at progress within all communities. How equitable is the progress on HIV that is being made? And which communities are being left behind? The Government must then stick to its action plan promise: 'If sufficient progress is not being made, we will consider what additional action may be required to remain on track.'
The next six months is a real opportunity to set us on the right track to achieve our joint aim of ending new HIV transmissions by 2030.
Debbie Laycock is our Head of Policy and Parliamentary Affairs.