For those living with HIV, we must guarantee no discrimination or stigma
Following his Westminster Hall debate, Chair of the All-Party Parliamentary Group on HIV & AIDS Mike Freer writes for PoliticsHome on the priorities for the long-term condition management of the disease.
Ever since becoming Chair of the All-Party Parliamentary Group on HIV & AIDS after the 2015 General Election, I, along with my APPG colleagues, have heard from a wide variety of representatives from the HIV community that the Health & Social Care Act 2012 has had a far-reaching and often unforeseen impact on the commissioning and delivery of HIV services from prevention to long-term condition management.
I should stress that the purpose of my debate was not to call into question the continued existence of the Health & Social Care Act. After all, I and many APPG colleagues voted for the legislation as it passed through Parliament and I still believe that the principles behind the Act were sound. Nonetheless, it is clear that HIV services have been divided between three commissioning bodies (local authorities, NHS England and clinical commissioning groups) and in some instances, this has led to uncertainty around the responsibility for commissioning of certain services.
This has particularly affected community-based HIV clinical nurse specialists, support services and treatment information for people living with HIV where the guidance only specifies that commissioning responsibilities should be ‘determined locally’. The Group has been told that this lack of clarity means that services are in many instances, not being provided or have been reduced. Similarly, while local authorities are responsible for commissioning sexual health services, they are not responsible for all aspects of the HIV service. Where HIV clinics are separated from GUM there remains the potential for the loss of patients to care. Integrated models of sexual health and HIV care work. In my constituency, in the event of a positive diagnosis, sexual health professionals can walk the patient to the adjacent treatment clinic for counselling and treatment. Referring vulnerable people to a clinic further away risks patients being lost to care when they need it most.
The purpose of Wednesday’s Westminster Hall debate then, was to recognise the excellent evidence that was provided from all parts of the HIV sector, recognise where the Government has already acted on recommendations made in the report and to promote further clarification and reassignment of some commissioning responsibilities to ease the pressure on local authorities to provide the lion’s share of HIV services beyond treatment.
The Group was therefore, very pleased to hear the Minister’s announcements in Wednesday’s debate that the public health ringfence has been extended by a year until 2019, that Public Health England will launch an action plan to support commissioners to provide the sexual health and HIV services that local populations need and pilot local delivery models working with local authorities and CCGs to help to build on effective models of commissioning.
The process of gathering evidence for the inquiry has reinforced that it would be myopic to suggest that access to antiretrovirals (ARVs) means that HIV is no longer a problem. The UK is a world-leader in the provision of HIV care and treatment and we should be justifiably proud of this. Indeed, as a nation, we have already met the last two UNAIDS 90:90:90 targets of 90% accessing care and 90% virally suppressed (where the virus is no longer detectable and therefore cannot be transmitted to others) and are 3% from meeting the first criteria (90% of people living with HIV diagnosed).
Nonetheless, in order to truly meet the needs of people living with HIV in the UK today, we need to look beyond the clinical goals of ‘on treatment’ and ‘virally suppressed’ to broader goals such as ensuring quality of life for people living with HIV, ensuring that they age well and guaranteeing that their lives are free from discrimination and stigma.
We have come a long way since the tombstone adverts of the 1980s and the Government has made announcements that go some way to addressing the ever-changing challenges of HIV but HIV commissioning, much like the virus itself, remains a difficult puzzle to piece together.