London is facing up to reality in the HIV prevention fight

Reading recent coverage of the PrEP trial expansion and social media commentary, one could be forgiven for believing that local government in London had washed its hands of the relentless fight to tackle and prevent HIV.

The headlines could not be further from the truth in how they portray councils in the capital.

Councils have proudly taken up the fight to defeat HIV and AIDS. We are absolutely committed to playing a full part in the PrEP trial expansion and we make no apology for taking responsible steps to ensure sexual health services are sustainable for all Londoners long into the future.

London boroughs are proud of their work to tackle HIV. The borough-funded London HIV Prevention Programme has been central to achieving historic improvements in incidence and driving down new infections since it was created by London’s local authorities in 2014.

Figures released in September 2018 confirmed HIV infection rates are declining, with a substantial decrease over the past two years. At the same time, testing rates have continued to grow:

• 1,675 people were diagnosed with HIV in London in 2017 compared to 2,090 in 2016 and compared to 2,671 in 2013 (the year councils took over responsibility from the NHS);

• The 2016-17 decrease represents a fall of 21 per cent in London, compared to the UK-wide decrease of 17 per cent;

• The number of new diagnoses in 2015 was 2,729, meaning London has seen a decrease of 38 per cent between 2015 and 2017.

Committed to providing PrEP

Even before it signed up to the UN-backed Fast Track Cities Initiative, London had already met the 90:90:90 targets and, in 2017, London surpassed these three measures, becoming the first world city to achieve 95:98:97.

London backed early action to ensure that PrEP was provided via the IMPACT Trial and has already delivered 7,600 places in London, out of 13,000 nationally. Boroughs delivered this despite the absence of funding, while public health funding was falling and demand rising.

London boroughs have also just agreed to renew the London HIV Prevention Programme for a further three years. The councils-funded public health campaign “Do It London” has been promoting PrEP as a central part of London’s combination prevention strategy for over 18 months. 

It might make for easy headlines to avoid the hard facts of reality, and it may not make comfortable reading to restate here that the responsible thing to do is to ensure that the further expansion of the PrEP trial is delivered in a way which is sustainable, ensures continuity and does not destabilise other critical sexual health services.

But London boroughs are not shying away from these issues, particularly in our conversations with the Department of Health and Social Care about how we can work together with NHS England to deliver the trial expansion successfully. We all have an important role to play and valuable perspective to contribute.

London backed early action to ensure that PrEP was provided via the IMPACT Trial. Boroughs delivered this despite the absence of funding, while public health funding was falling and demand rising

Suggestions that councils in London do not care about the health of our gay and bisexual residents misrepresents our strong record on funding and delivering HIV prevention services for those most affected by the epidemic.  

Let’s be clear: London is not blocking the expansion of the PrEP trial – boroughs have offered to take on additional places.

Meanwhile, we have also rightly been clear that services in London are stretched, and growing more so by the day, and that adding more pressure without funding makes it more, not less, likely that access will be limited for other service users.

That is not a responsible way to manage essential services to meet the needs of our residents.

London commissioners are working with clinicians and the IMPACT Trial team to achieve the full roll out of the PrEP trial – London has been asked to double the number of trial places.

London is willing to take on this full expansion, but we need a long-term sustainable solution that sets the scene for us to be even more ambitious in the future.