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HIV & AIDS in the UK
The current situation
The UK has a relatively small HIV and AIDS epidemic in comparison with some parts of the world. An estimated 98,400 people in the UK – or around 1.5 per 1000 of the UK population – are currently living with HIV.1 While this number is relatively low, it has increased dramatically since the 1990s, alongside a general rise in the prevalence of sexually transmitted infections. For UK specific help and advice about HIV and AIDS see here.
Although HIV and AIDS gets less attention from the media in the UK than it did during the early years of the UK AIDS epidemic, it’s far from an issue of the past. In fact, the epidemic has expanded, with the annual number of new HIV diagnoses nearly tripling between 1996 and 2005, when the annual rate peaked at almost 8,000 diagnoses.2 Annual diagnoses have slightly declined since then with 6,360 people diagnosed HIV-positive in 2012.3
The UK HIV and AIDS statistics show that of the 98,400 people living with HIV in the UK at the end of 2012, approximately 22 percent were unaware of their infection.4 This figure is declining year on year, showing the uptake of HIV testing.
Relatively low numbers of people in the UK have died from AIDS in recent years thanks to the availability of HAART (Highly Active Antiretroviral Therapy), which dramatically increases the life expectancy of people living with HIV. In 2012, around 490 HIV-infected people died, compared to 1,723 in 1995, when antiretroviral treatment for HIV was not widely available.5 6 Over the last few years, the majority of AIDS-related deaths have occurred because people were diagnosed late and therefore did not start treatment early enough. In the UK, this can increase the risk of AIDS-related death tenfold. Just under half (47 percent) of all diagnoses were at a late stage in 2012.7
Since 1996 the life expectancy of people living with HIV in the UK, on antiretroviral treatment, has increased by 15 years.8 Until recently, an average person living with HIV aged 20 years was expected to live an additional 30 years (they would live to be 50 years). However, a 2011 study indicates that an average person living with HIV aged 20 is now expected to live an additional 46 years (they would live to be 66 years). This is still about 13 years less than the general UK population.9 Improvements to antiretroviral treatment were cited as the main reason for the increase.
However, this estimation of life expectancy does vary depending on certain factors, such as sex, CD4 count, and lifestyle. For example, women living with HIV in the UK have a slightly higher life expectancy than men. Also, if a person's CD4 count is low when they begin antiretroviral treatment, their life expectancy is expected to be significantly lower, at least 10 years less, than if they had started treatment at the recommended CD4 count of between 200-350 cells/mm3. Factors such as smoking, alcohol and drug use and the existences of comorbidities can also affect life expectancy, but were not measured in the study.10
Despite rising numbers of people infected through sexual transmission within the UK, public knowledge of HIV and AIDS appears to have declined. In 2000, 91 percent of people in the UK knew that HIV was transmitted through unprotected heterosexual sex; by 2010 this figure had fallen to 80 percent.11 A 2011 report by the House of Lords Select Committee into HIV and AIDS in the UK noted that, "awareness of HIV and AIDS in Britain has fallen below the public radar".12
More resources directed towards HIV prevention, including wider access to HIV testing, were identified as key measures needed to reduce new HIV infections in the UK and effectively deal with the epidemic. Despite this, since the UK's previous national strategy for HIV and sexual health came to an end in 2010, the UK has remained without a renewed strategy for more than two years.13 14
In 2013 it was announced that healthcare workers living with HIV are now allowed to undertake certain medical procedures, from which they were previously banned. Positive governmental changes like this may go a long way towards changing negative attitudes towards people living with HIV.15
UK regions affected by HIV
In 2012 there were 5,846 new HIV diagnoses in England, 287 in Scotland, 125 in Wales and 95 in Northern Ireland.16 London is the epicentre of the UK HIV and AIDS epidemic, accounting for roughly half of HIV diagnoses in the UK so far.17 There is a good distribution of services around the country, with more than 80 percent of people with a diagnosed HIV infection living within five kilometres of an HIV service.18
HIV transmission routes in the UK
Of the total HIV diagnoses reported in 2012, 51 percent resulted from sex between men, 45 percent from heterosexual sex, 2 percent from injecting drug use, and less than 2 percent combined from mother-to-child transmission, blood/tissue transfer, and other or undetermined routes.19 Transmission from sex between men became the largest transmission route in 2011, when it overtook heterosexual sex.
Infections acquired through heterosexual sex accounted for 45 percent of diagnoses in 2012.20 The number of people who acquire HIV heterosexually overseas is continuing to decline; conversely the number of infections acquired in the UK continues its dramatic rise from 27 percent in 2002, to 52 percent in 2011.21
The increasing number of people infected with HIV through this route means that the number of women living with HIV is increasing. The male to female ratio of HIV diagnoses made before 1995 was around 6 to 1, whereas in 2011 the ratio for new diagnoses was around 2.1 males to 1.0 female.22
HIV/AIDS and gay men in the UK
As a result of the dramatic rise in new infections among gay men (and other men who have sex with men) over the last decade, one in twenty men who have sex with men (MSM) live with HIV in the UK.23 Sex between men accounted for around 51 percent of observed diagnoses in 2012, and 10 percent more infections amongst MSM were observed in 2012 than 2011.24
There is a great need for consistent testing at least once a year, and every 3 months if having unprotected sex with new partners among this group; around 18 percent of MSM living with HIV in the UK are unaware that they are infected.25
Injecting drug use
The level of HIV infection caused by injecting drug use is relatively low in the UK; around 2 percent of all new HIV diagnoses in 2012 were attributed to injecting drug use.26 Around 52 percent of infections were amongst people who were born abroad and inject drugs.27
Although injecting drugs isn't a major cause of HIV infection in the UK, drug users are at higher risk for HIV co-infection with hepatitis. Around 90 percent of hepatitis infections in the UK are among current or former IDUs. Treatments for co-infections are complicated, requiring earlier treatment in order to prevent liver damage.28
In 2013, a study found that HIV prevalence among men who inject image and performance enhancing drugs (IPEDs) was similar to men who inject psychoactive drugs in the UK. The study pointed out that it is not the type of substance injected that causes HIV infection, it is the injecting practice itself.29
Mother-to-child transmission of HIV in the UK
A high uptake of antenatal HIV testing and the availability of drugs to prevent mother-to-child transmission of HIV has contributed to a low mother to child transmission rate of just 1 percent.30 HIV diagnoses attributed to mother-to-child transmission totalled 95 in 2011, though the majority were from infections that had actually been transmitted outside the UK. There have been nearly 2,200 UK diagnoses of HIV in people who acquired the virus from their mothers, since 1985 when the first diagnosis was reported.31
A 2012 study found that pregnancy rates among HIV-positive women in the UK have increased. Additionally, the proportion of pregnancies that were terminated among the women taking part in the study decreased from 13 percent in 2000-01 to 3 percent in 2008-09. The investigators concluded that this increase in women choosing not to have an abortion was likely to result from increased access to prevention of mother-to-child transmission.32
HIV infected blood/tissue transfer
Blood safety measures within the UK have minimised the risk of transmission through infected blood transfusions and tissue to such a degree that there have been no reports of HIV infection being acquired in this way, in the UK, since 2002.33 The last recorded incident of HIV transmission through infected blood donated in the UK was in a female blood transfusion recipient in 2003.34
To minimise the risk of receiving infected blood whilst donors are in the window period, the UK has certain restrictions on who can donate. Individuals that have ever been a sex worker or have ever injected drugs are banned from donating blood for life. Other behaviours that are considered to be high-risk result in an individual being deferred from donating blood rather than having a lifetime ban. For example, individuals that have had sex with somebody who has been sexually active in a high-prevalence country, with a sex worker or with an injecting drug user, cannot donate blood for twelve months afterwards.35 Until 2011, men who have sex with men (MSM) were permanently excluded from donating blood in the UK. The blood donation criterion was changed in England, Scotland and Wales on 7th November 2011, bringing the donation criteria for MSM in line with other high-risk groups with a twelve-month deferral period.
Occupational exposure is very rare in the UK, with one definite documented case since 1997.36 Medical settings have procedures in place in case of a ‘sharps injury’, which can involve PEP if there is a danger that the health care worker has been exposed to HIV infected blood.
HIV and Africans in the UK
Africans in the UK are affected by HIV and AIDS to a far greater extent than other broadly defined ethnic groups, representing 19 percent of new diagnoses in the UK during 2012.37 This percentage is decreasing year on year, however the continued high level of HIV infections amongst this group reflects the severity of the HIV and AIDS epidemic in sub-Saharan Africa.
HIV diagnoses among black Africans often occur at a late stage of infection - when antiretroviral treatment is less likely to work as effectively. In 2012, over 66 percent of black African heterosexual men, and 61 percent of black African women, were diagnosed late, highlighting the need for increased HIV testing in this population.38 Other minority ethnic groups are also disproportionately affected by a need to access testing: in the same year 66 percent of diagnoses among black Caribbean heterosexual men, and 47 percent of black Caribbean women were also late.39 There have been calls for urgent testing campaigns with targeted messages for African communities. However, there is also resistance to this approach in tackling the problem, due to potentially fuelling stigma by targeting one particular group.40
The National AIDS Trust (NAT) recommend that sexually active Africans in the UK have an HIV test once a year.41 To access information about how to get tested for HIV in the UK, see our help and advice page.
HIV and AIDS prevention in the UK
For serodiscordant couples, where one person is HIV positive and the other negative, there are various HIV prevention options available in the UK, the most common being condoms. Treatment as prevention is now recommended in some circumstances. The UK, unlike some high-income countries, is yet to prescribe pre-exposure prophylaxis due to a lack of evidence of its effectiveness.42
Men who have sex with men (MSM)
Gay men are currently the focus of a number of HIV prevention campaigns in the UK. An important nationally coordinated campaign body is CHAPS, which is funded by the Department of Health and run by a partnership of organisations, led by the Terrence Higgins Trust. CHAPS produces various research-informed campaigns through interventions in the media, such as ‘smart arse, clever dick’.43 Taking the view that people can be more influenced by what their peers do than what government and health agencies advise, the campaign allows men to see other men endorsing the positive aspects of condom use.
Promoting HIV prevention at MSM community events has also been found to be successful. A study of one intervention, which offered HIV and syphilis testing to men attending Birmingham Gay Pride, found that the uptake was high.44 The study recommended testing men for HIV at other Gay Pride celebrations in the UK.
Most MSM use condoms most of the time.45 However, there is still a need to increase overall consistency of condom use. In 2010, around a quarter of MSM had unprotected anal sex with two or more partners.46 Risks remain even when MSM have unprotected sex with someone of the same status. This practice, known as ‘serosorting’, can put men at risk of other STIs, and if both are positive, potential reinfection with a different strain of HIV. Due to the proportion of MSM who are unaware that they are living with HIV, serosorting can also put men at risk of HIV if they both believe themselves to be negative.47
In 2011 HIV organisations in London expressed 'disappointment' and 'concern' over 20 percent cuts to their funding for HIV prevention services in the capital city,48 commenting,
“Targeted HIV-prevention strategies are vital, especially for those most at risk, such as gay men, and without them it could lead to infection rates going up and awareness of HIV going down.” Deborah Jack, National AIDS Trust chief executive49
Greater MSM-targeted HIV testing and the early initiation of antiretroviral treatment have been highlighted as two key areas that could reduce the transmission of HIV.50 The preventative benefits of early antiretroviral therapy were endorsed by the British HIV Association (BHIVA) in 2013; this is a prevention approach that has also been identified as a priority for inclusion in national HIV prevention plans.51
Africans in the UK
The National African HIV Prevention Programme (NAHIP) is a country-wide prevention campaign funded by the Department of Health. It is managed by the African HIV Policy Network and collaborates with a number of smaller organisations that aim to prevent HIV among African people in the UK.
Among the NAHIP’s most prominent initiatives are the ‘Do It Right – Africans Making Healthy Choices’ campaign which provides information on sexual health, condoms, and where to access help. Its website features a series of soap opera-styled videos encouraging viewers to think about HIV, condom negotiation and testing.52 The ‘Beyond Condoms’ campaign promotes debate among African communities about a wide range of issues regarding sexual health and ‘building a safer sex culture’. The campaign’s literature targets different religious groups and is available in five different languages.53
It is important that any prevention work targeting African communities in the UK be supported by parallel activities that aim to reduce the problem of HIV-associated stigma and discrimination.54 A 2006 study found that fear of discrimination is stopping some people of African origin from accessing HIV testing services for fear of community reaction if their result were to be positive.55 Encouraging HIV testing uptake is a key part of preventing onward transmission of HIV in all communities. If people know their status they are less likely to pass the virus to others.
Injecting drug users
A lot of early media coverage of AIDS in the UK focused on injecting drug users. During the early 1980s it was a big problem, particularly in Scotland where areas such as Edinburgh and Dundee had a very high prevalence of HIV among IDUs. In 1986 needle exchanges began to operate all across the UK, providing clean needles and giving drug users access to information and support. These schemes were largely effective, and helped to substantially reduce the prevalence of HIV among IDUs during the 1990s. From 1990 to 1996 prevalence among this group fell from nearly 6 percent to 0.6 percent, rising slightly around 2003 and remaining fairly stable since.56
Needle exchange services are run by hospitals, pharmacies, drug agencies and other organisations. While over 90 percent of current and former drug users in England, Wales and Northern Ireland have used a needle exchange service, campaigners argue that needle exchange provision in the UK is patchy, out of hours provision is poor and there are disparities in the availability of equipment.57
On average, the UK distributes 188 needles per person who injects drugs, per year, still below the internationally recommended level of 200.58 59 Risk taking among this group has improved, but remains high. One in seven IDUs continue to share needles in 2012.60 However, recent outbreaks of HIV among groups of people who inject drugs in Scotland demonstrate the continued need to improve access to clean and safe needles.61
Doctors in the UK are permitted to prescribe methadone as a substitute for injected heroin. Through methadone substitution, users can also be helped to end their dependency on drugs.
HIV/AIDS education and awareness
HIV education is a vital component of HIV prevention strategies. Educating people about HIV can help them to protect themselves and others, and can reduce the fear and stigma surrounding HIV and AIDS.
A 2010 UK survey of peoples’ attitudes to and knowledge of HIV conducted by the National AIDS Trust found that levels of understanding about HIV transmission in the UK have fallen significantly since the year 2000. It was found that in 2010, only a third of the British public could correctly identify all true and false HIV transmission routes.62 It was also noted that there had been an increase in the proportion of people who incorrectly believe HIV can be transmitted through spitting and kissing.
The over-50 age group has also been overlooked by those providing HIV and AIDS education in the UK. In the ten year period 2002-2011, new HIV diagnoses almost doubled among the over 50s.63 In 2012, over 63 percent of adults aged 50 years and over were diagnosed late, compared to 44 percent of adults under 50.64
Deborah Jack, Chief Executive of the National AIDS Trust, emphasises the need to educate the general UK public about HIV:
“Ignorance about HIV increases vulnerability to infection and also contributes to stigma and discrimination. The Government must re-invest in educating the public about HIV.”65
HIV education in schools is one way to overcome this ignorance over time and to target young people with HIV prevention. In England and Wales, the government encourages secondary schools to teach pupils about HIV/AIDS as part of Sex and Relationships Education (SRE), although it is not a statutory subject on the national curriculum. Ofsted – an official body that regulates schools in England – reported in 2007 that:
Schools gave insufficient emphasis to teaching about HIV/AIDS. Despite the fact that it remains a significant health problem, pupils appear to be less concerned about HIV/AIDS than in the past.”66
In Northern Ireland and Scotland, HIV/AIDS is not a compulsory part of school education either.
The Terrence Higgins Trust, amongst other organisations, believes that sex and relationships education should be a core part of the National Curriculum in the UK:
“The lack of good sex education means many young people are leaving school ignorant about HIV and safer sex...It’s time to get our facts straight.”Nick Partridge, Chief Executive, THT67
In 2009 it seemed as if this was set to change. In response to recommendations following an independent review, it was announced that Personal, Social, Health and Economic (PSHE) education would be made compulsory at primary and secondary schools in the UK from 2011.68 This was to ensure that all young people in the UK would be provided with some sex and relationships education before they leave school. However, in 2010 this part of the Children, Schools and Families bill was omitted and as a result, PSHE education is not a statutory part of national curriculum.69
Prevention of mother-to-child transmission
The UK has been very successful at preventing mother-to-child transmission of HIV. All expectant mothers are offered an HIV test and women who are identified as HIV-positive are offered antiretroviral treatment to prevent transmission to their unborn baby. Of all children born to women living with HIV in the UK, an estimated 927 have become infected. Declines in transmission through this route meant that there were only 18 reported HIV diagnoses among children in 2011.70
HIV testing in the UK
According to British Association for Sexual Health and HIV guidelines, HIV testing should be offered at genitourinary medicine (GUM) clinics as part of routine STD screening, regardless of symptoms of disease or risk factors of infection. The guidelines state that everybody taking an HIV test should have a pre-test discussion. People should be offered counselling if they request it or if there is a high risk of a positive result.71
The number of people tested for HIV and other STDs at GUM clinics (where many people are tested for HIV) has risen in recent years, with 71 percent of clinic attendees being tested for HIV in 2012.72 Many policies around preventing HIV in high-risk groups involve increasing testing.73 Results from the Gay Men's Sex Survey in 2008 revealed that around two-thirds of MSM in England and Wales had taken an HIV test, a rate which, promisingly, is steadily rising year on year.74
It can be difficult to treat someone with HIV if they are diagnosed late, and in some cases late diagnosis leads to death.
Whilst these increases in testing are encouraging, a major worry is that many people infected with HIV aren’t accessing testing services soon enough. In 2012, 47 percent of all people newly diagnosed with HIV were diagnosed late (CD4 count below 350 cells/mm3).75 76 It can be difficult to treat someone with HIV if they are diagnosed late, and in some cases late diagnosis leads to death. According to the British HIV Association (BHIVA), at least a quarter of deaths reported in HIV-positive people in the UK between 2004 and 2005 may have been avoided if HIV had been diagnosed at an earlier stage.77
To address this issue, in August 2013 the UK government announced that HIV self-testing kits will now be available for the public to buy, once the kits have passed certain regulations. This is a positive move in getting people to access testing earier, in the comfort of their own homes.78
Another reason that testing is so important is that it is a preventative measure. People are more likely to take measures to ensure that they don’t infect others if they know that they are positive. Within the UK, more emphasis is being placed on ensuring that HIV-positive people lower their ‘viral load’ through treatment, to dramatically reduce the risk of transmitting the virus. For the public health benefits of this to be felt, it is vital that people are diagnosed before they have a high viral load.79
BHIVA, along with other experts, say that non-HIV clinicians such as General Practitioners (GPs) need to be made more aware of the importance of early diagnosis. This was in reaction to findings that GPs were reluctant to provide HIV testing because of a common perception that special training and lengthy counselling are required.80 Guidelines published in 2008 suggest offering an HIV test to all adults registering with a GP in areas with a relatively high HIV prevalence (where more than 2 in 1000 people have diagnosed HIV).81
These guidelines have since been found to improve health outcomes and save money.82 By 2010 results from eight projects in primary care and general medical admissions showed an overall positivity rate of five per 1,000 tests conducted. Routine testing in these settings was found to be both feasible and acceptable among staff and patients.83
"Only through more effective and more widespread testing can we make earlier diagnoses, reduce undetected HIV cases and thus halt onward transmissions."84
Many groups continue to push for a move from ‘opt-in testing’ to ‘opt-out testing’ (where patients are given an HIV test alongside routine checks unless they explicitly say no). National Institute for Health and Clinical Excellence (NICE) has advocated for expanding testing outside clinical settings by engaging community organisations, developing local strategies to increase testing, and providing rapid HIV tests.85
According to the NICE national costing model, for every new positive diagnosis of HIV, 0.03 cases of onward transmission are avoided, resulting in significant cost savings.86
HIV and AIDS treatment and care in the UK
All UK residents and overseas visitors to the UK are eligible for free HIV/ AIDS treatment from the NHS.87 The first antiretroviral drug to treat HIV became widely available in the UK in 1987. Since then, the availability of HIV treatment in the UK has greatly reduced the number of people who die from AIDS-related illnesses, and has profoundly improved the quality of life of many people living with HIV.
Economically, there is a case for investing in HIV prevention and education services within the UK. The cost to treat a person living with HIV can be very expensive. For example, it costs an estimated £5485 a year to treat a 35-year old living with HIV in the UK.88 Therefore, if a person of this age lives for a further 37 years (the average life expectancy for someone aged 35, living with HIV in a developed country), the total lifetime treatment costs may be anywhere between £200,000 to £360,000.89
However, antiretroviral therapy has been shown to be, not only an effective HIV treatment, but an effective form of HIV prevention. Consequently, in 2013, the British HIV Association (BHIVA) released a position statement that recommended early initiation of antiretroviral treatment in people wanting to reduce the risk of HIV transmission to a partner.90 Part of BHIVAs support for the use of treatment as prevention was based on a study, which found the risk of HIV transmission among heterosexual couples was reduced by 96 percent when the HIV-negative partner adhered to antiretroviral therapy. Access the full BHIVA position statement.
Care and support
Care and support for people living with HIV in the UK is extremely important. Symptoms of HIV can fluctuate, making the support needs of someone living with HIV change over time. Additionally, many people experience mental health problems due to medical triggers such as medication and illness, or social triggers such as isolation or fear of stigma. Social care and peer support can help to alleviate these issues.91 The Terrence Higgins Trust and numerous other local organisations provide such services.
In the UK, social care and support for people living with HIV has been provided since 1989 through the AIDS Support Grant (ASG). In June 2010 it was announced that £28 million allocated for HIV/AIDS support services in the country would no longer be protected. Charities such as the Terrence Higgins Trust and the National AIDS Trust expressed concern at the time that such cuts would affect local HIV organisations who rely on such funding to provide specialist social care support to HIV-positive people who are not necessarily catered for by mainstream services.92 93 In 2010/11, over a third of local authorities did not spend all their HIV and AIDS support allocation directly on providing social care for people living with HIV, a proportion that has risen from 14 percent in 2008.94
For many people living with HIV, it has become harder to qualify for social care. In this environment, voluntary-sector, open-access services are becoming increasingly important to meet the needs of those that don’t qualify, as well as those whose immigration status means that they cannot access government-provided services.95
Stigma and discrimination
People living with HIV may face prejudice as a result of their condition, and the social stigma surrounding AIDS can stop people from discussing it. Ignorance of how HIV is transmitted can lead to discrimination against people living with HIV. More than two-thirds of people in a nation-wide survey felt there was a lot of stigma around HIV in the UK and one in three people living with HIV said they had experienced discrimination based on their status.96
HIV in prisons
Recent HPA figures for England suggest that HIV prevalence in prisons in England is more than double that than the general population.97 However, it has been noted that because of a lack of data in this area this number is probably an underestimation.98 This high prevalence is partially driven by high-risk behaviour, including injecting drug use.99 100
A 2005 survey found that prisons in the UK were lacking in many of essential preventative measures necessary to lessen the risk of HIV infection and other STDs:
“Many prisoners did not have appropriate access to condoms, disinfecting tablets, clean needles or healthcare information and so were not able to protect themselves from HIV if injecting drugs or having unprotected sex whilst in prison”.
The government announced plans to provide disinfectant tablets to prisoners, which can be used to sterilise needles, in 2005, and steps were taken to introduce disinfecting tablets into prisons in October 2007.101However, some campaigners argue that this does not go far enough and that needle exchanges, as well as a variety of other harm reduction methods, should be introduced to prisons.102
More up-to-date data is needed on the prevalence of HIV within prisons, and the extent and nature of HIV prevention, testing and treatment services. This can then be used to determine gaps in provision and ensure that steps can be taken to reduce new HIV infections in prisons and provide care and treatment for those already infected. AVERT.org has more information about prisons, prisoners and HIV/AIDS.
Criminal transmission of HIV
There have been several high profile cases in the UK of individuals being prosecuted for reckless transmission of HIV because they have failed to tell sexual partners about their condition. These cases generated a lot of debate about how the law should deal with this issue, and in 2008 the Crown Prosecution service released guidelines to clarify the law in England and Wales. As of 2008 reckless HIV transmission is only punishable in court in England and Wales if HIV is actually passed on and if the defendant is aware of their HIV status103 and in 2012 Scotland released equivalent guidance on prosecutions.104 In 2010 the Association of Chief Police Officers (ACPO) issued guidance to help police officers deal with cases of reckless transmission of HIV in a fair and sensitive way that respects the rights of people living with HIV.105 The prosecution of the reckless transmission of HIV remains contentious; a number of HIV organisations maintain that promoting knowledge of status and safer sex are more effective in preventing transmission than prosecuting those who have transmitted the virus.106 107
People living with HIV who migrate to the UK often encounter difficulties in accessing treatment, care and support. In 2012, treatment was made free to overseas visitors after much lobbying by campaign groups, consequently removing one of the main barriers to treatment - cost.108 Guidelines around dispersing migrants to different parts of the country now include ensuring that those with HIV have sustained access to treatment and are placed where there are appropriate facilities.109 There are also guidelines for people who are detained in immigration removal centres (IRCs). For example, people who are newly diagnosed should be referred to an HIV specialist and those who are removed from the UK should be given three months supply of medication.110 Unfortunately, there are still many instances when these rights are not met.111
The way forward
The recent history of HIV and AIDS in the UK has been marked by a number of important changes. As the situation continues to shift, government responses need to reflect these changes to minimise the future impact of HIV and AIDS in the UK.
There is a great need to ensure that HIV prevention services, particularly testing for high-risk groups, do not get overlooked in the midst of NHS cuts and restructuring.112 As health budgets come under pressure it is all the more important for decision makers in the UK to recognise that testing is cost-effective. Some innovative measures to combating the problems with late diagnosis in the UK have been recommended, such as sending out text message reminders to MSM and changing regulations to allow regulated home-testing HIV kits.113
High costs of treatment, thousands of new HIV diagnoses every year, and persistently high levels of stigma and discrimination are some of the challenges that remain. A 2011 House of Lords Select Committee report into HIV and AIDS in the UK concluded that:
“Not enough is being done to respond to a steadily growing risk to public health. There are potentially huge cost implications in both the short- and long-term in failing to deal effectively with the epidemic. At a time when public health in the United Kingdom is subject to major reform, the Government should ensure that HIV and AIDS is a key public health priority. ”114
Many campaigners feel that there needs to be a greater focus on, and an improvement in, the services aimed at the two groups most affected by HIV in the UK: gay men, and people of African ethnicity. HIV infection in the UK is not limited to these groups though, and with sexually transmitted infections becoming more widespread amongst the population as a whole, it’s clear that unsafe sexual practices are common in the UK. Sexual health services in general need to be improved, and the declining awareness of HIV amongst the general public needs to be addressed. If such steps aren’t taken, it’s likely that the UK epidemic will continue to expand in coming years.
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- 2. HPA (2012) ‚ ‘United Kingdom New HIV Diagnoses to end of June 2012’
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- 9. May, M et. al (2011) 'Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study' BMJ 343:d60616
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- 32. nam/aidsmap (2012) 'Pregnancy rate among HIV-positive women in the UK has increased significantly'
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- 34. Serious Hazards of Transfusion (2003) 'Annual Report'
- 35. NHS Blood and Transplant (2011) 'Give Blood - Who Can't Give Blood'
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- 41. National AIDS Trust (2012) ‚ ‘HIV Testing Action Plan to reduce late HIV diagnosis in the UK'
- 42. aidsmap / NAM (2012) ‚ ‘PrEP needs more study before being provided, UK physicians conclude'
- 43. CHAPS (2012) ‚ ‘Smart arse, clever dick’
- 44. Newton R. et al (2012, December) ‘The uptake of HIV and syphilis testing in a nurse-delivered service during Gay Pride events.’ International Journal of STD and AIDS, 23 (12)
- 45. CHAPS (2012) ‚ ‘Smart arse, clever dick’
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