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© Ed Marshall
Will a cut in the HIV prevention budget lead to a rise in infections?
Latest figures suggest that one in every 200 people in London is living with HIV. For gay men in the capital, that figure rises to one in ten.So it's rather alarming to discover that funding for HIV prevention in London has just been cut by a whopping 42 per cent.
A spokesperson for NHS North West London confirmed this, saying, 'In planning for 2011/12 eight PCTs [Primary Care Trusts] decided to reduce their financial input and ten PCTs withdrew funding completely. The impact of this was the reduction of the pan-London HIV prevention financial funding envelope by 42 per cent from that of 2010/11.'
Time Out has previously raised questions about the effectiveness of some prevention campaigns. But a cut of 42 per cent will have a massive impact on efforts to reduce the number of people testing positive for HIV, and could well lead to a rise in infections. We asked people working in the HIV sector for their reaction.
Deborah Jack chief executive of National Aids Trust
'Targeted HIV-prevention strategies are vital, especially for those most at risk, such as gay men, and without them it could lead to infection rates going up and awareness of HIV going down. HIV prevention should not be regarded as an easy target for short-term cost cutting.Any savings made now are likely to result in increased costs in treatment and care in the longer term.'
Ben Tunstall head of health improvement for the Terrence Higgins Trust
'Prevention initiatives are vital in educating people about HIV and keeping infection rates down, so we're worried about the potential effects of any cuts to this area of funding. Our priority at THT is to continue to support people with HIV and those at risk across London so we're concentrating on making the most of the prevention funding that is currently available and trying to maximise its impact across the capital. We're also working to make the strongest possible case, to local and national government, for prevention services to be maintained. It would be a dangerous mistake to reduce the funding which supports these vital services.'
Matthew Hodson of gay men's health charity GMFA
'Every year HIV prevention work is given less funding and expected to deliver more. Just in economic terms, prevention is far cheaper than treatment. If these cuts result in even a handful of men becoming infected with HIV, then the cost of treatment would mean that PCTs won't have saved the taxpayer a single penny. And the human cost of these cuts is that fewer men are able to access information and, as a result, more men become infected and have to live with the virus.London has the largest gay population in the UK and the highest number of people living with HIV. This round of cuts is just the latest in a long series in HIV-prevention funding. Best estimates suggest £19.2 million was spent on HIV prevention in London in 2001. By 2008 that had been cut to around £4 million and now it looks likely that the funding will be cut almost in half again. The HIV-prevention budget isn't slowly being eroded, it's being swept away.'
Peter Scott of new HIV prevention group Status
'At a time when new HIV infection among gay men is far too high and rising it would be a costly mistake to cut HIV-prevention funding. However, much of what passes for HIV prevention is irrelevant, ineffective and a waste of public money. That is why 42 per cent cutsacross the boardmake no sense: they punish some prevention projects that are efficient and effective and reward those that have wasted precious funds. This should act as a wake-up call. The cash envelope needs to be preserved but it needs to be spent more wisely. There is an opportunity in this funding dispute to thoroughly review HIV prevention in London and develop a truly effective programme. It's no bad thing if money is taken away from the failing organisations, so long as that money is spent on HIV prevention that actually works. From now on there has to be proper accountability for how the money is spent and what exactly it has achieved.'
Just a comment to Paul;
(a) If gay men who have HIV have to pay for their own medication, it would be classified as discrimination considering there are straight people out there who also carry the disease (unless they would have to pay too), and what about children who get HIV from birth or breast milk, or immigrants/ asylum seekers from countries with high HIV rates (where there aren't sufficient precautions/ medical aid, and education)...would they have to pay?
(b) There are several ways of being infected with HIV (does not have to be sexual contact), what if you had a gay man who contract HIV from an accident, any voluntary work, from his mother etc.... would they have to pay?
(c) you can say the same thing about obesity, smoking, hepatitis, diseases/ chronic illnesses related to alcoholism, other STI/ STDs.. maybe if we stopped treatment for these, made people more responsible - we could definitely use the money elsewhere... we might as well ask them to pay...
(d) Citizens continually pay taxes; Income, VAT etc...; how can you refuse the right to treatment to people who contribute to society - unless you believe that all gay people are on the dole, and receive other welfare benefits...
This country seriously needs to educate ignorant people who stigmatise communities in society; and further supports the view that education is key in HIV reduction and discrimination issues...
The cut in public health spending is unacceptable; what is needed are re-organisation of strategies such as, significant increases in awareness (can be done through education, Charity work, propaganda) and increases in access to free condoms (could be achieved through donations from manufacturers) and awareness/ increases in testing (not just gay men but everyone; also increase funding to charities who can then buy equipment to provide testing services), in which the reduction in yearly HIV infections would result in savings from the stagnant/ decreasing expenditure from treatment...
Given the current economic climate, should the NHS continue to fund anti -retroviral therapy . Perhaps if gay men had to pay for their own medication they would take more responsibility for their welfare, and resources could be put to better use elsewhere.
I agree new prevention strategies are needed. Scaremongering does nothing but stigmatise the virus and push barebacking into the realms of the taboo. We've already seen this happening . . . and unfortunately, whatever is taboo usually becomes desirable/kinky. How much new porn is bareback? It's clearly been fetishised as something 'naughty' and dangerous, and for many gay men this replaces the thrill illicit meetings and forbidden passion.
We need a frank and open dialogue about sex now. This should be non-judgemental and receptive (if you excuse the pun).
HIV prevention should be about making informed choices, and giving access to services and healthcare. It should not be about guilt, which only makes these issues harder to broach.
There can and must be no cut in any HIV budget, now or ever, not untill a real cure has been found, the very idea is ridiculous, HIV stats rise every year, with fewer and fewer clinics open for easy access, neither do i see any free condoms in bars or clubs, i feel sadley we have gone back 10 years in the approuch to this pandemic disease, i will keep this short, no cuts in budget but a huge increase is needed and now!
"Just in economic terms, prevention is far cheaper than treatment" but "much of what passes for HIV prevention is irrelevant, ineffective and a waste of public money".
So cheaper irrelevant prevention is worse than expensive treatment that actually saves lives and prevent further transmission. Treatment is prevention and should not be pitted against prevention (and vice-versa) particularly at a time when treatment guidelines have been revised in London.
Maybe it is time for those doing HIV prevention to rethink what they are doing and how they are doing it?
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