I was tempted to start the new year by saying ‘the less said about 2020 the better’. However, as my colleague Fraser outlines in his review of the year, we made some really significant steps forward in a year that we’ll never forget and are indebted to all of our supporters for the achievements made.
Now it’s my job to look at what we can expect in 2021. Below is just a fraction of things I'm looking forward to at Terrence Higgins Trust as the HIV sector redoubles our efforts and work to make this the first country to end new HIV transmissions.
The year will start with our own response to the HIV Commission. While it makes many demands on government – and despite excellent commitments from ministers so far each will need to be campaigned for and made reality – there are also demands on the sector and the way we work. We can't expect change from government without creating change among ourselves.
The early part of the year will also see the publication of the PrEP Impact Trial data, available for all to see. This will be rich in information about how people are taking up the wonder drug and, critically, who is not. We'll be able to see any health inequalities opening up and any trends that should be informing the commissioning of PrEP. If we don’t learn these lessons quickly, we won't do enough to stop unnecessary onward transmission of the virus.
The first week in February will host National HIV Testing Week where we hope the demand for HIV postal testing kits will be high. Recent figures show that Terrence Higgins Trust and 56 Dean St's Break the Chain campaign was a huge success. Public Health England issued 10,000 online tests with a huge return rate and a higher than normal positivity rate.
Make sure National HIV Testing Week is in your diary, running from Monday 1 to Sunday 7 February 2021.
But this is not just a time to encourage individual testing. We'll be championing the main recommendation of the HIV Commission: ‘normalise HIV testing across the NHS’. Why are 250,000 people a year leaving a sexual health clinic without being offered an HIV test, and why are 300,000 refusing one? Why isn’t everyone presenting at A&E, registering for a doctor or otherwise having a blood test being offered an opt-out HIV test? The change from opt-in to opt-out has been transformational for organ donation. It would be the same for HIV diagnosis.
The new financial year should provide some future funding for the routine PrEP rollout. We, along with our partners in local government and the HIV and sexual health sector in general, have called for £16 million in ring-fenced funding per year for the rest of the parliament. The Chancellor’s 2020 winter spending statement didn’t provide this but we understand the public health grant will have a PrEP calculation included for commissioners. Whether this is in addition to the current grant is unknown but unlikely. What we do know is this is definitely not ring-fenced. This is very disappointing but we will not stop until PrEP is routinely commissioned everywhere in England, as it has been in Wales and Scotland for some time.
By this point the development of the UK Government’s sexual health strategy and the HIV action plan should be in full flow. This is the sector’s big opportunity to shape the Government’s strategy to end the epidemic before the decade is out. We must ensure the HIV Commission’s recommendations are included. This will need the cooperation of not just the Department for Health and Social Care but Public Health England, its one or two successor organisations, NHS England and Directors of Public Health. The hard work really begins here. We expect this to be finalised by summer.
July is when the four nations implement the next and most transformative changes in the blood donation rules. No longer will groups be banned from giving blood based on gender or sexuality; a new individualised risk model will be implemented. This will ensure science – not stigma – decides how we collect blood. Underneath the headlines, there are big changes for women who have slept with men who have sex with men (no longer a default ban), and the partners of those living with HIV. If your HIV-positive partner is on treatment for six months and has a suppressed viral load, meaning HIV can’t be passed on, then you will no longer be excluded. There are still changes we would like to see: a review for those on PrEP as the evidence evolves and the bans on those from sub-Saharan African and drug users. At every stage, the safety of the blood supply is paramount and will be guided by the science.
This year, I will be looking to the Comprehensive Spending Review – expected in autumn – to see if the UK Government put their money where their mouth is on ending new cases by 2030. Not one but two chancellors responded positively to the HIV Commission's report on World AIDS Day: Chancellor of the Exchequer Rishi Sunak ‘welcomed the report’ and said he was ‘proud of our policy to end new HIV transmissions by 2030’ while Chancellor of the Duchy of Lancaster Michael Gove said the Prime Minister had asked him to ‘make sure resources are there and that there is no slackening in our resolve.’ The HIV action plan will be worked up, published and in place. If the Government doesn't take this opportunity to fund the plan they won't meet the new goal to reduce new HIV diagnoses by 80% by 2025, let alone the 2030 aspiration or any chance of us being the first country to end new cases.
By December's World AIDS Day, I very much hope that PrEP will be available outside sexual health services – available from your GP, a local pharmacy, as part of maternity care, termination clinics and gender clinics. There will be no truck with arguments that it can only be available at public health facilities – if you can get the pill or statins from your GP, those who test negative for HIV should be able to be prescribed PrEP in all the settings above. We're working with the British Association of Sexual Health and HIV and others to get draft guidance on place so the NHS can adopt it wholesale, and in all four nations. This is not just the right thing to do but good policy for rural communities and those less likely to use specialist sexual health services: women and those of Black African heritage in particular.
While 2020 showed our resilience against the new pandemic, 2021 will see us redouble our efforts to end the HIV epidemic after five decades. It will need us to dig deeper, work in ever closer partnership, keep on the Government’s heels, and tell the real stories of people living with HIV and those trying to end new cases within the decade. Together we can do this but we need your support to make all of this happen. Start the year as you mean to go on – give resources to our resolve – and donate to Terrence Higgins Trust today.
Richard Angell is Terrence Higgins Trust's interim Head of Policy.