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We cannot miss the opportunity to end the transmission of HIV by 2030

December 1, 2020 12:45 PM

By LGBT+ Liberal Democrats and the Lib Dem Health and Care Association. An abridged version of this piece first appeared on the federal party website (see here).

This World AIDs Day we have the opportunity to set ourselves an ambitious but achievable target: to end the transmission of HIV in England by 2030. Published today, the HIV Commission has outlined 20 measures necessary to achieve this worthy goal. As Liberal Democrats we have a responsibility to help make sure that we achieve it.

The challenges we face

The fight against HIV has progressed strongly in recent years. Since 2014 new diagnoses are down by as much as half (2019 data). And the development of PrEP has meant that we have more tools in our arsenal than ever before. Due to the coronavirus pandemic, it's unclear what the data will show for 2020 - but with changes in the way that people meet and have sex this year, new cases may be down even further.

However, there are still a number of challenges. PrEP, while a fantastic development, has been delayed in its rollout. Last year the Government, the NHS, and local Government wrangled over just who was responsible for its distribution. In the end, the responsibility fell on local government - but many local authorities complain that they have not been given sufficient funding to deliver it. The impact of COVID on local government budgets has exacerbated this further.

There are some bright spots however. In Southwark (which along with Lambeth has one of the highest rates of HIV in the country) Liberal Democrats helped make sure that PrEP would be rolled out across Southwark - with distribution beginning in October. Providers like Sexual Health London are also showing the way in at home testing - something we could hope to see done right across the country.

But those are not the only challenges. Stigma around HIV still persists - not just among the general public, but in health services as well. Not all health professionals have up to date knowledge of HIV. This means that HIV indicators can go unnoticed - but also fuels concerns among people living with HIV, who may as a result avoid health services altogether. There are also misconceptions around who can get HIV. While there has been a lot of progress communicating with gay and bisexual men, other groups are also at risk - both heterseoxaul men and women, and in particular black African people. England is not yet on track to meet the 2030 goal, and there are still an estimated 6,000 undiagnosed cases. Addressing these misconceptions and tackling stigma will be vital to changing that.

What needs to be done?

So what needs to be done, and how can Liberal Democrats - be it at national or local level - help? Helpfully, the Commission's report outlines a series of concrete steps which we can help implement and advocate for. The report highlights the need for a big increase in localism and local implementation - this is a challenge our local government base must take to.

First of all, the report recommends to the government the adoption of a crucial milestone: an 80% reduction in transmissions by 25, leading to the end of transmissions by 2030. This would be an historic commitment and achievement and Liberal Democrats should urge the Government to adopt it. We will also need to push for particular departments - the Commission recommends the Department of Health and Social Care and the Cabinet Office to be jointly responsible - to take the lead. Our Parliamentary Teams will need to push for this, and also push for the Government to produce a credible roadmap, and to report back at least annually. We must not let HIV fall off the national agenda.

We can also push for HIV to stay on the agenda locally. Where we are in local government, we should work with experts to produce local roadmaps, and where we are in opposition we should be similarly pushing for leadership and accountability.

A key priority is continuing to encourage testing. In the context of the COVID pandemic, the general public have heard more about testing their health than possibly ever before! We should keep this up and encourage the application of this mentality to HIV as well. In order to find the estimated 6,000 undiagnosed people living with HIV in England, HIV testing must be normalised. Whether it's our local and national leaders showing that they are taking part in testing, or helping promote campaigns like HIV Testing Week (now to take place in February 2021) - we need to help make sure everyone knows their HIV status, and that access to this testing is easy and equitable.

In the spirit of more testing we can also call for an important change: making HIV testing opt-out rather than opt-in. Just like Liberal Democrats called for with organ donation back in 2002, by changing the 'default' we can make a massive impact on people's lives. Some liberals argue against this approach, seeing it as too paternalist. But there is no 'neutral' default here. People can still say no - but by making it the default and setting it as the norm we can help tackle stigma and help equip people with more information about their health. We need to diagnose every case of HIV if we're to stop preventable transmissions. By stopping late diagnosis we can better help people living with HIV, prevent new infections, and save on the costs associated with long term care.

We have already seen in maternity units how transformative this subtle change is. By switching to default 'opt in' midwifery services have reported almost entirely eliminating 'vertical transmissions' to children. Switching this default will help professionals on the frontline, reaching more people and also helping to tackle the stigma that still persists around HIV.

As the HIV Commission's report says: "if we get this right… England will stand tall as a global pioneer" by ending "a five decade-long pandemic". The opportunity to end transmission of HIV is one we cannot miss. Liberal Democrats must urge the government to adopt a roadmap, must push to keep HIV on the agenda, and must demand the changes we need to see at every level we can. Following the commission's action points we can end transmission of HIV by 2030 - but only if the government local authorities and society get it right.

You can read more at hivcommission.org.uk.