The writer was secretary of state for health from 1981 to 1987
Forty years ago this year, the first cases of Aids were reported. The pictures remain in my mind — I was secretary of state for health at the time.
I remember a hospital ward full of young men destined to die within weeks or, at best, months. I remember the strained faces of doctors and nurses, knowing that there was no cure for their patients. Our only course was to warn the public of the danger and to battle against the stigma and prejudice surrounding not only HIV and Aids but the whole gay population.
I did not imagine that 40 years later, we could be looking at an end to HIV in this country for good. But that is indeed where we are — assuming that the government seizes the opportunity and, crucially, makes the right funding commitment to get us over the line.
We are in a very different place now. HIV is no longer a death sentence. People living with HIV who are on effective treatment have normal life expectancy — it reduces the viral load to undetectable levels, at which point it cannot be passed on sexually. But nevertheless treatment is most effective when a patient is diagnosed early. And the sooner their viral load can be suppressed, the smaller the chance of them passing the virus on.
We also now have access to Pre-Exposure Prophylaxis (PrEP), the drug that, when taken by anyone who is HIV negative, prevents them from acquiring HIV through sex. After unnecessary delays, this is now available on the NHS and presents a remarkable opportunity.
On World Aids Day last year, following the findings of the independent HIV Commission, the chancellor confirmed this government’s commitment to end new transmissions of HIV by 2030.
This ambition is eminently achievable. But with the government’s Comprehensive Spending Review under way, now is the time to make the sound fiscal case for funding it. In 2016, the annual cost of HIV treatment was estimated at around £14,000 per case with early diagnosis, and £28,000 per case when diagnosed late. Each infection per person was estimated at between £280,000 and £360,000 in lifetime costs to the NHS.
According to the Health Foundation, public health grant allocations for 2021-22 represent a 24 per cent real terms cut compared to 2015-16. Between 2014 and 2018 there was a 14 per cent reduction in local authority spending on sexual health. Meanwhile, demand for sexual health services has increased and the population living with HIV has grown. It is impossible to see how the 2030 goal will be achieved without bolstering the funding.
With diagnosis so crucial in the fight to end HIV, we must increase testing. In 2019, it was estimated that 6,600 people were living with undiagnosed HIV in the UK. Guidance already exists to expand testing, and the National Institute for Health and Care Excellence estimates that, if implemented, 3,500 cases of onward transmission would be prevented within five years, saving £18m a year.
Testing will also tackle late diagnosis — which is unacceptably high at 42 per cent in 2019. Late diagnosis means more time for a person to unwittingly pass the virus on. To identify cases earlier, there is a case for an opt-out system, with HIV testing becoming standard alongside other blood tests.
Making PrEP available to those who need it is essential. We must also ensure that all those living with HIV have access to the best care, including mental health — people living with HIV are twice as likely to experience poor mental health.
When I look back to my time as health secretary, I could not have imagined an end to the HIV epidemic in my lifetime. Yet it is entirely within reach for this government. Its HIV Action Plan is due to be launched on December 1, World Aids Day 2021. It must be fully funded.