World AIDS Day is an opportunity to remember those we have lost, celebrate our successes and focus our minds on what still need to be done to end the global epidemic by 2030, writes Barts Health sexual health consultant Dr Rageshri Dhairyawan.
This year in particular has reminded us about the challenges of responding to new viruses, their disproportionate impact on marginalised populations, but also how quickly scientific advances can be made through resolve and collaboration.
In the last 40 years, we have made significant advances in treatment, prevention and knowledge of HIV:
- People living with HIV in the UK who are on effective treatment can expect a normal lifespan.
- One of the most prominent HIV messages in recent years is ‘Undetectable = Untransmittable’ (or U=U) which means that people cannot pass HIV onto their sexual partners.
- It is also possible to have a HIV-negative baby and in the UK, the chances of passing HIV through pregnancy is <0.1%.
- For the last three years, HIV care in the UK has achieved excellent outcomes, surpassing UNAIDS 90:90:90 targets (90% of people with HIV diagnosed, 90% of diagnosed people on treatment, and 90% of people on treatment undetectable). Last year, 97% of all people on treatment in the UK were undetectable.
- HIV diagnoses are also rapidly reducing, especially amongst gay and bisexual men. This is likely to be due to combination of interventions including frequent testing, starting treatment as soon as possible and pre-exposure prophylaxis (PrEP). PrEP is an antiretroviral tablet that can be used to prevent people getting HIV. It is suitable for anyone who may be at risk of getting HIV.
Despite our successes, there are still significant challenges.
One in 12 people living with HIV do not know they have it. People with undiagnosed HIV may end up being diagnosed late and can pass HIV on to their sexual partners. Late diagnosis means that their immune system may already be damaged and result in an eight times higher risk of death in the first year after diagnosis.
New national testing guidelines have recently been published to reduce late diagnosis. Last year we were delighted to offer opt-out HIV and Hepatitis C testing to adults attending the Emergency Department at The Royal London Hospital, and we picked up several new diagnoses. The contract for this has now ended, but we hope to find a way to restart and roll it out across the Trust.
Stigma is still a significant concern for people living with HIV and can prevent them from engaging with health services, sharing their diagnosis with others and taking treatment. In the last year, we carried out a survey for healthcare staff at The Royal London, St Bartholomew’s and Newham hospitals looking at knowledge and attitudes to HIV.
This was presented at the British HIV Association Conference last week, by our lead HIV nurse, Moses Shongwe who won the inaugural Chloe Orkin prize for best social sciences presentation. The survey found that there is a need for more education on HIV amongst our staff and we hope to carry out some of the recommendations in the next few months.
Our aim is to make sure that Barts Health becomes a HIV stigma-free zone and we hope that you will join us to make this a reality!