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N o 1062 16 J uly 2015
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Is HIV Prevention Failing?
Let down by a now decimated HIV prevention budget,
a record number of gay men were diagnosed with
HIV in 2013. Chris Godfrey speaks to the National
Aids Trust, GMFA and ACT UP London to find out how
current HIV prevention strategies are failing and what is
3,250 gay men were diagnosed
with HIV in 2013. It’s
the highest number recorded since the start of the epidemic.
Increased testing testing will have contributed, but the
harsh reality is that rising transmission rates are primarily
responsible for this surge. And the problem is set to worsen.
The rising levels of STI diagnoses like gonorrhoea (up
32% between 2013 and 2014) and syphilis (up 46%) among
gay men are strong indicators that future HIV transmission
rates will continue rising. If it isn’t already, the situation is on
the verge of once again becoming a public health crisis.
“In one year those are massive spikes in STIs amongst
gay men,” says Yusef Azad, director of policy & campaigns
at the National Aids Trust (NAT). “They suggest very
significant increases in unsafe sex. Gonorrhoea especially is
considered to be an indicator of HIV transmission rates and future diagnoses of HIV.”
Though more people than ever are getting tested, hook-up apps have increased
partner turnover, unsafe sex and access to ‘chillouts’ for many gay men. The
persistent rise of transmission rates suggests the current prevention strategies are
failing to adapt to these changing behaviours, leaving a huge demographic unmoved
or unreached by dated campaigns.
“Gay men especially…need intensive targeted interventions that make sense to
them. It is, in the end, a question of money,” says Azad. “Money doesn’t necessarily
equal impact and effectiveness, you need to prove that money works, but on the other
hand no money can’t work.
“I don’t think there is, as of yet, a coherent London wide strategy for HIV that includes:
schools and young people strategies, the roles of sexual health clinics where many
gay men attend regularly, engaging with social media apps and gay venues, which is
advocating for PrEP and which significantly increases the amount of HIV testing.”
Compared to a lifetime of treatment (estimated between £280,000 and £340,000)
the cost of prevention is fractional. Treating the 3,250 gay men diagnosed in 2013
would cost at least £910 million – and that’s a conservative estimate.
But according to NAT, the NHS is spending 55 times more on treatment for people
living with HIV than is spent by local councils on HIV prevention. And while all but one
of the London local councils are designated high prevalence areas, where two people
in every 1000 have been diagnosed with HIV, just 81p per person was spent on HIV
prevention in the capital during in 2013/2014.
needed to curb the worrying increase in transmissions.
All images: ActUp - PrEP NHS Demo 2015 © mikekear.com
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Since 2001, the budget for HIV prevention designated to
local authorities for HIV prevention services has been slashed
from £55 million to just £10 million. With funds severely limited,
those financing the programmes want to maximise their return on
investment, the goal being to reach as many people as possible. But
this drive towards ‘efficiency’ has effectively eliminated the likelihood
of any new prevention strategies being adopted, or for checking the
efficacy of those currently underway.
“Room for real innovation on the front line is slim,” says Dan Glass,
an activist with ACT UP London. “HIV prevention work is so tied up with
tick box exercises, delivering the minimum and ‘ticking all the boxes’
to satisfy the authority that work is being delivered. But often room for
providing excellence or going above and beyond is not encouraged.”
Without any meaningful research into the potency of campaigns
there’s no way of knowing exactly who is being reached. But with
all current government-funded prevention programmes designed to
reach as wide an audience as possible - providing that all-important
‘return on investment’ - there’s a feeling that
they’re only leaving an impression on a certain
kind of person.
“It’s not that these campaigns shouldn’t exist,
it’s the fact that they’re the only ones that do,”
says Liam Murphy, campaigns manger at GMFA.
“And the sort of person they might appeal to,
maybe they wouldn’t be taking those risks with
their sexual health in the first place. There’s
a large group of gay men that aren’t being
reached. We’d target them in a different way…
and talk the way they talk. If you don’t recognise
yourself in the campaign it doesn’t resonate.”
Gay men and the African community are
the two high-risk groups most vulnerable to
these rising transmissions. But these are two
ostensibly different demographics, and for
prevention interventions to resonate effectively
with them separate approaches would be
needed. It’s one of major the concerns with
nationwide programmes: by trying to appeal
to everyone, they reach no one. Gay men in
particular stand to benefit from a more nuanced approach.
“We need to see more sex. I don’t think it has to be crude or overt,
but it has to be something somebody recognises in themselves,”
says Murphy. “We’re trying to put the sex back into the sexual health
which has been taken away. It’s not there and I feel people aren’t
making the connection. You can’t shy away - people are fucking and
they’re having great sex, so why is that not being brought into our HIV
prevention and sexual health.”
Just as the response to shifting demographics has been slow, so too
has the response to behavioural changes. The well-documented rise
of chemsex is believed to be part of the reason for rising transmissions
among gay men, yet the` government-funded response aimed at
addressing the issue has been minimal.
Current HIV
prevention
strategies have
been hit hard by
budget cuts and
the drive towards
efficiency.
“There’s been a failure to recognise and respond to emerging new
scenes,” says James Johnson, also a member of ACT UP London.
“Many HIV prevention organisations have been ill equipped to deal
with the escalating numbers of chemsexers and the impact this is
having on rising HIV rates.”
That more people than ever are getting tested is one of the big
successes of campaigns like THT’s ‘It Starts With Me’. But testing alone
isn’t going to halt rising transmission rates; a more nuanced approach
is needed, one which incorporates these large scale programmes with
refined interventions that resonate with the high risk categories, as well
those who remain unmoved and unreached by current campaigns.
“We need more partnership work, more community led responses,
less reliance on old methods,” says Johnson. “We need less
organisations relying on the fear factor to elicit donations and more use
of mass media to impart simple messages about living with HIV.”
And of course, there is the ongoing NHS decision-making process as
to how to distribute PrEP, potentially one of the most effective prevention
techniques for curbing new transmissions.
“PrEP is not the answer to reducing HIV,
it is just one tool,’ says ACT UP’s Dan Glass.
“It is likely to be most useful and successful
with very high-risk group. But it won’t reduce
transmission numbers overnight as the one in
four who remain undiagnosed continues to
be the pool of HIV that is hardest to tackle.”
PrEP is unlikely to be the silver bullet
that finally brings an end to HIV, but it is
a very potent weapon, particularly for the
gay community. And at a time when local
councils in London are neglecting their
responsibility to confront the problem and
when transmissions are rising to levels not
seen since the eighties, it’s a weapon the gay
community, not only needs, but deserves.
As the NHS budget comes under even more
scrutiny, the fight to make PrEP as widely
available as possible is on.
“We’re arguing very strongly that it should
be made available to enough gay men to
make a public health difference,” says NAT’s Azad. “In the end that
will be cost effective because it will reduce the amount of HIV in the
community and significantly reduce over time HIV transmissions. So
at a time there’s real pressure on NHS budgets we have to make the
argument very strongly that gay men’s health matters, that prep is
something that absolutely has to be funded.”
Current HIV prevention strategies have been hit hard by budget
cuts and the drive towards efficiency. Ill equipped to address evolving
demographics and behaviours, the current provisions are now wholly
inadequate. It’s short-termism, and it’s failing. If the government wants
to avert an impending public health crisis then serious innovation is
required, more money desperately needed. Until they recognised this,
transmission rates are only going to go in one direction.
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HIV Activist
Erasing Ignorance
Luke Alexander:
For those who lived through the AIDS crisis
HIV stigma is still a huge issue, but for those
born after the epidemic there’s a different
issue entirely: ignorance. Chris Godfrey talks
to young HIV activist Luke Alexander about his
generation’s worrying lack of knowledge and
the danger this poses.
Hey Luke. Firstly congratulations on
completing your A-Levels! How did you feel
going back to college after your diagnosis?
It was incredibly daunting actually. If I remember rightly
I was diagnosed three months before I went back into
my education and I remember one of the first thoughts
on my mind was that I didn’t really want to be judged. I
would be older as well, so that would be something to
take into consideration.
The whole thing was daunting because you don’t know
how young people are going to react and in that time
frame between being diagnosed and going to college
I’d met a few young people who were very ignorant,
not through their own accord but just through the lack of
knowledge that they haven’t received which
they probably should’ve done.
So I was a bit daunted, a bit scared
actually, to think I don’t know how I’m going
to handle this because it only takes one
person to add me on social media to even
find out.
So how was it being there in the end?
It was brilliant! I didn’t go out shouting about
it, but if anyone asked I was there to give
some information and after about eight
months of being there I actually had the BBC
in for a radio piece they were doing on HIV.
I had them in college on a lunch break so
everyone was really intrigued. So that was
quite a big step for me.
I was also given an assignment where you had to
write about something in your life, so I wrote about my
HIV diagnosis. At the end I had to read it out to my
whole English class and they were quite shocked. But
overall I think I got more questions than ridicule and
that was something I welcomed very much. Anyone
Anyone who
is young and
unaware
asking me
questions is a
good thing.
who is young and unaware asking me questions is
a good thing.
Do you think that ignorance about HIV is a
serious problem in the young generation?
I think it’s a massive gap in knowledge between
the generations. But also stigma isn’t fixed in any
generation. I’ve always said from day one that I’ve discovered there’s
two demographics: there are those who remember the John Hurt ‘Don’t
Die of Ignorance’ AIDS advert in 1986, who lived through the horror of
the eighties and saw things such as the activism from Princess Diana and
Elizabeth Taylor. There are people who witnessed all that and they hold
AIDS in their minds as the death sentence that it was.
Then we have another demographic, people like me who were born
in the 90s and who pretty much skipped over it; we were never told,
we were never taught. It was something we had to look at in films like
Philadelphia and Trainspotting.
When I was at college and got a bit more comfortable with my status
I went around and did a very mini questionnaire and I asked 16 and 17
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year olds what HIV is, what did it do, is there a cure for it - just very
mundane questions. Some of them had never heard of it, half of them I
asked thought it was curable, and I think about a third thought it could
be passed on through kissing or sharing a glass. It just goes to show that
these people didn’t know. It was really disheartening to find these young
people, my generation, have absolutely no idea.
That same week I got a horrible message, which really made me cry,
from a young boy, 17, who’s just been diagnosed. He sent me a message
and he was asking me where he would have to hide his medication from
his mother when he starts. I asked him what do you know about HIV and
he said practically nothing, I’ve heard of AIDS and I’ve heard it kills you.
People are either stuck in the 80s or have no clue at all.
Given the ignorance around the subject what do you think
is the most important thing young people should know that
they might not already?
The main message I would give to anyone is to get tested. I’m not the
type of person to scream condoms and throw them at people. I have
the philosophy that most people who don’t like condoms won’t use them
ever. But most new transmissions come from those who do not know they
have HIV because they have a high viral load, because their virus isn’t
suppressed, so it is much easier to pass on and most people who acquire
HIV get it from someone who doesn’t know they have it themselves.
Even with the ignorance among the younger generation, is
stigma still a big issue?
Personally I’ve seen the majority of stigma come from within the gay
community. A lot of young people I’ve spoken to about HIV don’t even
really know what it is. So there isn’t that stigma built in to a lot of people.
It obviously does still exist but I’ve had young people think they could get
it from touching, so that stigma is present in their mind. But the majority
of the stigma I’ve found is from within the gay community, probably out
of fear because it’s a high-risk demographic.
The older generation actually still regard HIV as the AIDS death
sentence that it was. That’s where the stigma is most strong. I think
that’s where most of it comes from today. It’s very mismatched and all
over the place, you never know who you’re going to talk to and what
they’re going to know.
What would be your advice to someone who has just
received a positive diagnosis?
I would advise them to not worry, to know that HIV is completely
manageable condition. If you take your medication properly every
day and you keep your body healthy and you do all the things that
someone with HIV should do, you will live a long life, should you be
diagnosed early.
To young people specifically I would just say do the sensible thing
and be yourself. Don’t let it get to you. The deadliest part of HIV now is
the stigma and that is something you’re totally able to overcome if you
have the right mentality.

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