Our CEO Monty Moncrieff writes about the new UK data on HIV and the future of HIV prevention
Public Health England yesterday published the latest data on HIV in the UK. Once again new diagnoses amongst gay, bisexual and other men who have sex with men are at a record high, with 3,360 new diagnoses in this population. Whilst this number is worryingly high, the good news is that undiagnosed HIV is falling, meaning men are able to access vital anti-retroviral treatments which can reduce the level of the virus in their bodies and almost eliminate the risk of them passing it on. However 6,500 gay and bisexual men are still living with HIV without knowing their status. The report comes on the back of high profile media reporting of Charlie Sheen’s recent disclosure he is living with HIV, which has shone a spotlight on the stigma and myths still persisting around the virus.
The data now indicate one in 20 gay and bisexual men in the UK are living with HIV. In London this rises to one in 11. About 14% of these are those who are unaware they have it. As we head towards National HIV Testing Week which begins on Saturday we encourage people to take a test and reduce the risks to their own health as well as the risk of unknowingly passing HIV on to others. Along with a number of new projects announced yesterday as part of PHE’s HIV Prevention Innovation Fund is the launch of a new national postal service, allowing people to take their own tiny blood sample at home and send it off for testing. A positive result allows you to take action to protect your own health and that of others by beginning medication sooner.
Treatment as Prevention (TasP) marks a brave new world for HIV prevention and achieving an undetectable viral load is a key strategy in stemming future transmission. Despite the fact that around 90% of people diagnosed and on treatment now achieve an undetectable status, and are extremely unlikely to pass on HIV to others, knowledge of this remains poor. A survey for GMFA’s FS magazine found 49% of gay and bi men didn’t know what this meant. A third (31%) also were unaware of PrEP (Pre-Exposure Prophylaxis), a course of medication that can prevent you becoming HIV positive in the first place, which is widely expected to become available to men most at risk on the NHS next year.
Information needs on HIV prevention are changing fast: in a world of new acronyms navigating PEP, PrEP and TasP can be a minefield, both for gay and bisexual men themselves and the healthcare professionals who support them via HIV prevention outreach and care. Whilst our traditional message to always use a condom remains sound, and will offer additional protections against other STIs, the reality is not everyone uses them consistently. We need to be honest with men who sometimes, or always, don’t use them, with nuanced messages and information which reflects the new realities of how they have sex.
Public Health England acknowledges that whilst more men now test and have their HIV status diagnosed the number of new infections also continues to rise at a high level. Their report highlights the need for a multi-faceted approach: “The ongoing high rates of HIV transmission and acquisition among men who have sex with men emphasise the need for high impact, appropriately tailored combination prevention strategies and programmes”.
The report reinforces condom use as an important strategy, and also stresses the need to address the wider determinants of poor sexual health. These are outlined in PHE’s 2014 report Promoting the health and wellbeing of gay, bisexual and other men who have sex with men. They include mental health and the use of drugs and alcohol as factors that can increase risk. Yesterday the Public Health Minister Jane Ellison wrote in Pink News citing the challenge of chemsex, on the back of a new PHE briefing for substance misuse and sexual health services, which cites our own guidance to improve outcomes for LGBT drug and alcohol users.
Mental health and substance misuse are factors we are only too aware of at London Friend, and issues we seek to address through our Antidote and counselling services both of which have seen a huge rise in men engaged in chemsex. We’ve also begun SWAP, a new intensive therapeutic programme run over four consecutive weekends addressing chemsex in the context of self-esteem, relationships, identity and wider well-being.
Feedback from these services is extremely positive with the vast majority of men reporting abstinence or control over their drug use as a result of accessing support. But such services are almost becoming a luxury against falling HIV prevention budgets and slashed to public health funding like the £200million cuts announced earlier this summer. Our therapeutic services for HIV prevention took a 55% hit this year when the national HIV Prevention England programme shrunk, funding us only to provide brief advice and information. We await to see how much of the public health budget remains after next week’s Government Spending Review in unveiled. For the moment we’re lucky that most of our work is funded through charitable trusts rather than through public health monies.
Public Health England’s advice on HIV prevention states:
- Early diagnosis of HIV infection enables better treatment outcomes and reduces the risk transmitting the infection to others. Have an HIV test if you think you may have been at risk.
- Always use a condom correctly and consistently, and until all partners have had a sexual health screen.
- Reduce the number of sexual partners and avoid overlapping sexual relationships.
- Men who have sex with men are advised to have an HIV and STI screen at least annually, and every three months if having unprotected sex with new or casual partners.
- Unprotected sex with partners believed to be of the same HIV status (serosorting) is unsafe. For the HIV positive person, there is a high risk of acquiring other STIs and hepatitis. For the HIV negative person, there is a high risk of acquiring HIV infection (6,500 of MSM remain unaware of their HIV infection) as well as of acquiring STIs and hepatitis.
With new bio-medical options and a better understanding of the wider health and wellbeing needs of gay and bisexual men we are at a pivotal point for HIV prevention. At London Friend we would love to see a national strategy with a vision to end new HIV infections within a decade; to reduce the stigma of HIV; to equip our health and care sectors to support HIV prevention; and with programmes that offer men clear information about their sexual health and improving their confidence to choose safe, fun and satisfying sex.