Copyright © AVERT

Much of the early response to AIDS in the UK was driven by a fear that the epidemic would eventually spread beyond the minority groups it was originally associated with, and would have a major impact on the general population. In recent years, with HIV not spreading as widely as many had once predicted, HIV prevention efforts in the UK have been focused on the communities most affected, including gay men, people of African ethnicity and injecting drug users.

This shift in focus seems to have been accompanied by a decline in spending. Funding for HIV prevention in England and Wales is no longer ‘ring-fenced’, meaning it can be spent at the discretion of local health authorities; reports suggest that this has resulted in prevention money being spent on other areas of the health service¹. In Scotland, HIV prevention money is still ring-fenced by the Scottish Executive².

As levels of HIV in the UK are still rising, many AIDS organizations believe that national HIV prevention programmes should be re-introduced. These programmes should not only aim to reduce the transmission of the virus but also encourage uptake of HIV testing so that people know their status and, if infected, can access treatment.

HIV prevention amongst the general population

During the early years of the UK AIDS epidemic the government launched a variety of prevention campaigns imploring the British public not to ‘die of ignorance’³. The campaign used a variety of media to educate and inform people about how to protect themselves from HIV/AIDS.

The comprehensive anti-AIDS campaign in the 1980s was credited with raising awareness of how HIV is transmitted, encouraging condom use, and lowering rates of casual sex. It is thought that behaviour change prompted by this campaign may have prevented some HIV infections, although this has not been conclusively proven.⁴

However, as time has passed and fears of a generalised epidemic in the UK have abated, there has been no further national HIV prevention campaigns aimed at the population as a whole. This means that a generation of sexually active young people have grown up largely complacent and unaware about the risks of becoming infected with HIV.

HIV education as prevention

HIV education is a vital component of HIV prevention strategies. Educating people about the virus can help them to protect themselves and others, and can reduce the fear and stigma surrounding AIDS.

A 2008 UK survey of peoples’ attitudes to and knowledge of HIV conducted by the National AIDS Trust has found “serious gaps” in people’s knowledge about the virus. The study found that levels of understanding about HIV transmission in the UK have fallen significantly since the year 2000. It was found that in 2007, over 90 percent of the British public did not fully understand the ways that HIV is transmitted, with Scotland and London reportedly being the least knowledgeable regions⁵.

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.”⁶

HIV education in schools is one way 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 this 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."⁷

In Northern Ireland and Scotland, HIV/AIDS is not a compulsory part of school education either.

The Terrence Higgins Trust, amongst other organizations, 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. HIV is now the fastest growing serious health condition in the UK, and there is no cure. It’s time to get our facts straight.” - Nick Partridge, Chief Executive THT⁸.

Men who have sex with men

Despite campaigns to raise HIV awareness, there is evidence to suggest that many gay men are still ignoring safer sex messages.

Since the beginning of the UK AIDS epidemic men who have sex with men (MSM) have been the group most at risk of HIV infection⁹. It is thought that multiple prevention campaigns targeting the gay community may have had some positive effect on sexual behaviour and HIV incidence in the 1980’s to mid-1990s¹⁰. However, the number of new diagnoses in gay men in the UK has risen by 63% since 1997. While the increase may in part reflect a greater number of gay men coming forward for HIV testing, it is also feared that there has been a rise in unsafe sex due to complacency and the knowledge that HIV treatment is now available.

Gay men are currently the focus of a number of HIV prevention campaigns in the UK. An important nationally coordinated campaign is CHAPS, which is funded by the Department of Health and run by a partnership of organisations, led by the Terrence Higgins Trust. It’s work is currently guided by a document called ‘Making it Count’, which sets out plans to reduce the number of HIV infections occurring through sex between men¹¹.

Another important campaign is The London Gay Men’s HIV Prevention Partnership (LGMHPP) – a programme funded by several local health authorities across London, and run by seven AIDS-related organizations. Interventions carried out by the LGMHPP have included condom distribution at gay bars and clubs, adverts in the gay press, a volunteer-run helpline, and internet resources.

Despite campaigns to raise HIV awareness, there is evidence to suggest that many gay men are still ignoring safer sex messages. A study released in 2007 found that 18% of HIV-negative gay men had engaged in sex without using a condom. Worryingly, this figure rose to 37% for gay men who were HIV-positive¹².

HIV testing is an important part of preventing onward transmission of the virus. Although the number of MSM accessing HIV testing in GUM clinics has risen by 42% since 2003, the fact that 31% of gay men were unaware of their infection in 2006 indicates that there is a need for further promotion of HIV testing¹³. Professor Peter Borriello, Director of the Health Protection Agency’s Centre for Infections says:

“Earlier diagnoses of HIV infection will give men access to treatment, improve their survival and reduce the risk of transmission to partners. I urge all gay men to test for HIV regularly”¹⁴.

African communities in the UK

The Department of Health-funded National African HIV Prevention Programme (NAHIP) co-ordinates a number of regional projects aimed at African communities in Britain. In May 2007 it launched the campaign ‘beyond condoms’, which aims to encourage condom use and greater openness about sexual health in the African community through outreach work, posters, leaflets and community workshops¹⁵. A number of AIDS organisations working with African communities in the UK, including The African HIV Prevention Network (AHPN), are campaigning for more funding for HIV prevention activities amongst African communities.

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 discrimination¹⁶. 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 positive¹⁷. Encouraging HIV testing uptake is a key part of preventing onward transmission of HIV in black communities. If people know their status they are less likely to pass the virus to others.

The Health Protection Agency (HPA) is concerned about the high proportion of black Africans in the UK who leave sexual health services unaware of their HIV status¹⁸. It has been proposed that this problem could be overcome by testing high-risk groups for HIV under an opt-out policy, which means that they will automatically be tested for HIV unless they specifically ask not to be. ¹⁹.

As the majority of Africans living with HIV in the UK were infected in sub-Saharan Africa, international aid from the British government for prevention programmes in developing countries can be seen as a strategy to reduce the number of people entering the UK who are already infected with the virus.

Injecting drug users

It is estimated that 131 injecting drug users (IDUs) became infected with HIV during 2006 – a fairly low number comparised with some other countries. However, the proportion of IDUs living with HIV has increased, with an estimated one in fifty infected in 2006. This is around twice the level seen at the beginning of the decade²⁰.

The government funds some harm reduction measures for injecting drug users including needle exchange schemes and methadone substitution programmes. Needle exchange schemes are run by community pharmacies, the NHS and specialist providers to provide clean syringes to drug users to stop them sharing injecting equipment and transmitting HIV and other blood borne viruses to others. In 2006, 90% of IDUs surveyed at specialist drug services in England reported that they had ever accessed a needle exchange service²¹. Needle exchanges also provide information and support that can help people to stop taking drugs²².

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.

Overall, the proportion of injecting drug users (IDUs) reporting that they had ever had a test for HIV increased from 50% in 1997 to 69% in 2006. Although this is a positive trend, in 2006 more than a third of HIV-infected IDUs who took part in an unlinked anonymous survey were not aware of their infection. This proportion is likely to be higher among IDUs who are not in contact with drug services.

Haemophiliacs and HIV transmission through blood products

In the late 1970s and early 1980s approximately 1,200 haemophiliacs were infected with HIV after being given imported plasma products. Three quarters of the people infected in this way have since died²³.

In April 2007 an independent public inquiry began to investigate why the use of imported blood products continued after it emerged that the UK health department had been aware of the risk of HIV contaminated blood as early as 1983. The UK was alerted to the threat of HIV contaminated blood products imported from the USA, but believed that the benefits of the treatment for haemophiliacs outweighed the risks of HIV infection.²⁴

In 1985 the National Blood Service (NBS) introduced HIV screening for donated blood, and since this time only three people have been infected with HIV in this way²⁵.

Preventing mother-to-child-transmission (PMTCT)

All pregnant women in the UK are routinely offered (and advised to take) an HIV test as part of their antenatal care. It’s currently estimated that around 95% of HIV-infected women in the UK are diagnosed before delivery²⁶. Where it is established that a pregnant woman is HIV-positive, measures are taken to significantly reduce the chances of mother-to-child HIV transmission (MTCT), including the use of antiretroviral drugs.

These preventative measures have helped to keep the number of cases of MTCT occurring in the UK very low. Only 1.2% of all HIV-positive women who gave birth between 2000 and 2006 passed their HIV infection to their child ²⁷. The majority of cases in which transmission of HIV did occur were due to either: late diagnosis of the mother (meaning that she did not start drug therapy at the recommended stage of pregnancy), poor drug adherence during pregnancy, or because of complications during birth ²⁸.

Conclusion

In 2006, an estimated 7,800 persons were newly diagnosed with HIV in the UK. In order to stop this number rising further, preventing new HIV infections in the UK must be made a priority.

The British government needs to invest in HIV prevention, both for the general population and high prevalence groups, making sure that the earmarked money reaches its intended destination and is well managed and distributed. If this does not happen, knowledge about how HIV/AIDS is transmitted will continue to fall and the number of new HIV infections in the UK will rise.

What's this?

WHERE NEXT ?

AVERT.org has more about:

• HIV & AIDS in the UK
• Help and advice for HIV/AIDS in the UK
• UK HIV/AIDS service organisations
• HIV and AIDS prevention