Local Engagement Toolkit for HIV Prevention
HIV = Human Immunodeficiency Virus (a virus) People living with diagnosed HIV can expect to live a near-normal lifespan with effective treatment.
AIDS = Acquired Immune Deficiency Syndrome (a collection of illnesses caused by the virus) An advanced stage of HIV infection where the immune system is weakened (through lack of treatment) AND at least two HIV-related clinical conditions are present.
Effective treatment can restore the immune system. HIV and AIDS Defined
HIV: A National Epidemic – Introduction • People living with HIV can expect to live a near-normal lifespan and have very good health outcomes if diagnosed in the early stages of infection. • HIV in the UK remains relatively uncommon with an overall prevalence of 1.5 per 1,000 population (1.0 in women and 2.1 in men). • An estimated 98,400 people were living with HIV by the end of 2012. • Around 21,900 (22%) of people living with HIV are unaware of their infection. • Late diagnoses and high rates of undiagnosed infections remain the biggest challenges. • Of the 6,360 persons diagnosed for the first time in 2012, 47% were diagnosed late. HIV in 2014
HIV: A National Epidemic – Introduction (continued) • No one should die with AIDS in the UK. Yet, 390 people died of AIDS in 2012. • Despite continuous declines, death rates among people with HIV are three times those of the general population.
HIV in 2014
Who Are The People Most Affected/At Risk? 35000
Total living with HIV = 98,400 Total diagnosed = 76,500 Total undiagnosed = 21,900
People Living with HIV
30000
25000
20000
15000
10000
5000
0
MSM
Diagnosed
33600
African-born men 8100
Undiagnosed
7300
3000
African-born women 16400
Non Africanborn men 6700
Non Africanborn women 7600
Injecting Drug Users 1900
4300
3300
3400
300
Most At Risk Populations: Men Who Have Sex With Men and Black African People
Why Is Local HIV Prevention Important? • Effective HIV prevention makes for good public health and economic sense because every HIV infection prevented saves: o The public purse £280,000-£360,000 in lifetime treatment costs. o The effects of living a life affected by HIV.
• Most new infections are caused by people living with undiagnosed HIV.
The Economic and Public Health Reasons
Why Is Local HIV Prevention Important? (continued) • 47% of all new diagnoses are defined as late (a point after which treatment should have commenced), leading to potentially higher treatment costs due to comorbidities and the potential need for in-patient care. • People diagnosed late with HIV are at greater risk of avoidable morbidity and mortalityi. • HIV stigma still plays a significant part in reluctance to test and disclose status, leading to poor personal and public health. The Economic and Public Health Reasons
Why Is Local HIV Prevention Important? (continued) • Effective HIV treatment can: o Reduce viral load to an undetectable level. o Reduce onward transmission and save expenditure downstream by avoiding increased costs associated with late diagnosis. o Contribute to achieving the objective in the Public Health Outcomes Framework by reducing late-stage infection.
• Local Authorities: o Already address health inequalities: teenage pregnancy, adult mental health and supporting help-seeking behaviours. o Perfectly positioned to deliver cheaper community testing. Prevention and Treatment Options
How Does It Affect Us? What Is The Local Picture?
Know Your Needs: www.tht.org.uk/knowyourneeds
How Does It Affect Us? What Is The Local Picture?
Know Your Needs: www.tht.org.uk/knowyourneeds
How Does It Affect Us? What Is The Local Picture?
Know Your Needs: www.tht.org.uk/knowyourneeds
What About Our Neighbours? What is Their Local Picture?
Know Your Needs: www.tht.org.uk/knowyourneeds
What Can We Do Locally? •
Familiarise ourselves with the Terrence Higgins Trust’s HIV and Sexual health Guide for Councillors: www.tht.org.uk/councillorsguide
•
Ensure our Joint Strategic Needs Assessment (JSNA) and Health and Wellbeing Strategy (HWBS) includes HIV prevention through: • • •
•
Testing. Treatment as prevention (TasP). Behaviour change (eg, information dissemination, outreach, counselling, mentoring and condom schemes).
Some HIV high prevalence areas already have community based organisations who can help.
Support and Promote National HIV Testing Week Every November
What Can We Do Locally? • Over 340 organisations supported NHTW 2013 (extra services/ordered resources). These included: NHS organisations, Local Authorities/public health units, private healthcare providers, businesses and community-based organisations. • 1 million resources were ordered.
• 10,000 website visitors. • 1,000 HIV home sampling kits ordered. • 452 mentions of NHTW in traditional media publications provided 279 million opportunities to see the coverage. • Social media: 5,475 followers of the NHTW, 18,486 followers of ISWM.
Order Resources From: www.hivpreventionengland.org.uk/resources
What Can We Do Locally? Consider partnering with neighbouring authorities to provide a pan county/town/city regional prevention strategy and thereby secure greater value for money, improved visibility across the region and increased take-up within the community.
Case Study 1 Several south west London Local Authorities worked in partnership to expand Croydon’s 2012 initiative in booking advertising space on local public transport supporting Testing Week and giving local links to testing.
Support and Promote National HIV Testing Week Every November
What Can We Do Locally? Although responsibility for HIV prevention resides with Local Authorities, commissioning of testing and treatment resides elsewhere. Partnership working, as detailed in the case study below, can provide an effective strategic approach to prevention. Case Study 2 Kent’s Public Health Team and Maidstone and Tunbridge Wells NHS Trust worked together for Testing Week. They took an outreach bus around their relatively low prevalence local towns, raising awareness and offering testing. A survey was sent to local hospital consultants and GPs about HIV and clinical indicator diseases to support increased testing offers and diagnosis. Public Health provided funding while the clinical team donated their time. Support and Promote National HIV Testing Week Every November
Nationwide Network of Local Partners. Check Your Area
England-Wide Network of Partners Engaging With Local Communities
Normalise And Expand Local Testing To Increase Availability
64 of 326 (20%) local authorities across England had a prevalence of diagnosed HIV infection of ≥2 per 1,000 population (aged 15-59 years), the threshold for expanded testing (BHIVA 2008 & NICE 2010 guidelines).
Self Testing
Sexual Health (Clinical) Testing
Postal HIV Testing
21,900 people living with Undiagnosed HIV
Hospital Testing
HIV Prevention Need Not Be Too Testing
Community Testing
GP Testing
Useful Further Resources HIV Prevention England For details of their work, briefings for Local Authorities, a catalogue of free resources, sign-up to a free newsletter and for HIV Prevention England conference details: www.hivpreventionengland.org.uk or email:
[email protected] Public Health England For a wealth of statistics (local, regional and national): www.hpa.org.uk/hiv http://fingertips.phe.org.uk/profile/sexualhealth Local Government Association for guidance on Local Authority responsibilities: www.local.gov.uk/public-health
External Sources Of Support
Acknowledgements Unless referenced individually, all data used in this presentation sourced from: Public Health England, Addressing Late HIV Diagnosis through Screening and Testing: An Evidence Summary. 2014. www.hpa.org.uk/Topics/InfectiousDis eases/InfectionsAZ/HIV/HIVTesting/
Thank You For Your Time
