Kat Smithson

Policy and Campaigns Manager, NAT

HIV prevention in England’s high prevalence local authorities: 2013/14 2014/15February 2015

Who are NAT?

The UK’s leading charity dedicated to transforming society’s response to HIV (since 1987)

Our goals:

Presentation title

HIV prevention in England

NAT (National AIDS Trust)

HIV prevention in England

Significant numbers of people continue to acquire HIV in the UK – 6,000 people were diagnosed in 2013;There are over 107,000 people living with HIV in the UK and nearly a quarter are unaware;Nearly half (42%) of adults newly diagnosed have a CD4 count below 350;NAT research with Ipsos MORI indicates that while some HIV knowledge is increasing, misconceptions are also on the rise. 20% of people are unaware that sex without a condom is a transmission route – fairly static over the years.

HIV prevention is as important as it ever has been; but, we don’t really know how much is being spent on it, and who is benefitting.

HIV prevention in England

The problem:

There has been consistent difficulty in assessing what is being spent on HIV prevention and where. 2013 London HIV prevention needs assessment stated:

“the data on HIV prevention spend in London is still not robust. The process of trying to identify local spend has highlighted

variation in the way local authorities categorise their spending. There have also been challenges in disaggregating spend on HIV

prevention where this is included in broader contracts.”

HIV prevention in England

Other factors to consider in the context of HIV prevention:

New health system = new public health systemLocal authorities now have responsibility for GU services AND public healthLocal authorities are responsible for HIV prevention

HIV prevention in England

In 2014 NAT wrote to the Director of Public Health for all high prevalence local authorities in England.

58 in total; 32 in London, 26 outside London.

We asked for information for 2013/14 and 2014/15 on:• Health promotion services targeting people who are HIV

negative (‘primary HIV prevention’) and which are delivered outside the clinic setting; and

• HIV testing services commissioned outside the sexual health clinic.

HIV prevention in England

What we did:

The survey also included:

HIV Prevention England – locally commissioned services

London HIV Prevention Programme

HIV prevention in England

What did we find?

HIV prevention in England

2013/14:£9,473,341

(incl. £1.33m on additional testing)£0.66 per capita (15-74)

2014/15£10,317,312

(incl. £1.57m on additional testing)£0.68 per capita (15-74)

HIV prevention in England

*Estimated to be < 0.1% of the overall public health allocation*

In 2001/02 the ring-fenced budget for HIV

prevention was £55 million

In 2007 NAT conducted a survey of local authorities and an extrapolated figure for HIV prevention spend in 2005/06 was

£38 million

HIV prevention in England

London • £5.1m in 2013/14 (£0.81 per capita)

• £5.6m in 2014/15 (£0.87 per capita)

NB. The London Councils needs assessment published in 2013 estimated HIV prevention spending in the capital to be £10.5m

HIV prevention in England

HIV prevention in England

Local authorities in London: 2014/15

• 5 local authorities reported spending nothing

• 12 reported spending < £50K

Outside London

• £4.3m in 2013/14 (£0.55 per capita)

• £4.7m in 2014/15 (£0.59 per capita)

HIV prevention in England

Local authorities outside London: 2014/15

• 3 local authorities reported spending nothing

• 12 reported spending <£50K

Health promotionUsed as an overarching term incorporating a range of intervention types.

Examples include: free condom schemes, media campaigns, outreach work, group-based support and information sessions, 1:1 counselling and support, and information leaflet distribution. Health promotion may also include targeted work with people at higher risk of HIV, or non-targeted work aimed at the general population. This term does not include additional HIV testing interventions but does in effect include all other activity cited in responses with HIV prevention as a primary aim.

Health promotion interventions by target group in 2014/15:

LondonThere is a huge variation in health promotion spend across London. In 2013/14:

• Eight local authorities reported no relevant locally commissioned health promotion apart from their contribution to the London HIV Prevention Programme;

• five spent less than £25,000;

• 13 local authorities in London were spending more

than £100,000, but one local authority reported spending as much as £710,839.

London health promotion by target group in 2014/15:Total = £4,591,247

Outside London health promotion by target group in 2014/15:Total = £4,157,576

HIV testing beyond GU services

Local authorities have to provide HIV testing through sexual health clinic services.

NICE recommends: Expansion of HIV testing services outside the sexual health clinic to reach both MSM and black African communities. E.g. routine HIV testing in primary care and secondary care or community-based HIV testing.

Testing in London

• £970,513 in 2013/14

(11 of 32 local authorities)

• £1,033,751 in 2014/15 (12 of 32 local

authorities)

Testing outside London

• £355,282 in 2013/14 (7 of 26 local

authorities)

• £534,698 in 2014/15 (11 of 26 local

authorities)

Testing in London

• Greater proportion of ‘community testing’

• Black African population a key target group

Testing outside London

• Significant proportion of testing targeted at MSM

• Smaller proportion targeting Black African population than in London

• More GP testing but less in hospital and community settings

Testing across high prevalence local authorities

We want to see a more consistent approach • The national programme is important for providing leadership and

ensuring that there is some baseline prevention work happening across England. NAT will continue to campaign for an enhanced and improved national programme.

• Local authorities with a high prevalence of HIV should be investing more in HIV prevention. NAT recommends a combination approach to HIV prevention with more investment across health promotion and testing based interventions.

• Interventions should be targeted where appropriate, evidence-based and should follow guidelines such as those on testing produced by NICE.

• Local authorities need to have a clear idea of how they are meeting their local HIV prevention needs.

Thank you

The full report is now available on www.nat.org.uk

Please email further questions or comments to kat.smithson@nat.org.uk or call on 020 7814 6727