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Gambling with gay lives

HIV prevention funding for gay Londoners under threat

The social group at highest risk of HIV could lose up to £650k in funding, despite no proper consultation and the protests of experts

The Guardian - Comment Is Free - 29 November 2007

London NHS chiefs have drawn up recommendations to slash funding for HIV prevention work among gay men in the capital by 36% in 2008 - a cut of more than £650,000.

This decision was announced by the body representing London NHS Primary Care Trusts (PCTs) in the run-up to World Aids Day, which takes place this Saturday.

Following a storm of protest, the NHS Overview and Scrutiny Committee has requested London PCTs to reinstate the cuts. But there is no guarantee that they can or will. Some PCTs are less than sympathetic to the health-care needs of gay and bisexual Londoners.

HIV charities fear that the Committee has no power to insist on local PCT compliance and that some PCTs will simply ignore the Committee's request.

If the cuts are not cancelled, it will mean that the NHS money allocated for HIV prevention work among gay men in London next year will be less than half the money invested in 1997.

Regardless of the final decision on these cuts, HIV expenditure in the capital is badly skewed. The London NHS is spending over 200 times more on HIV treatment than on HIV prevention among gay men. This is a perverse, distorted health-care prioritisation.

Cutting finance for prevention work among the highest HIV risk group is just plain stupid. Prevention makes more sense, and is more cost effective, than treatment.

The proposed cuts were announced without proper consultation with gay and HIV organisations, and against the advice of expert HIV agencies and professionals, such as the Terrence Higgins Trust and Gay Men Fighting Aids.

Recent public consultation meetings were held at the University of London Union, which is not a well-known, popular or appropriate meeting place for London's gay male community. The meetings were badly organised, badly advertised and badly attended. There was little and very last minute publicity via the gay press.

Much of the consultation was via the Overview and Scrutiny Committee website, which hardly any gay men in London know about, let alone regularly read.

It feels like the London NHS was just tick-boxing; going through the motions of consultation, with little interest in genuine feedback from the gay community. Health bosses wanted, it seems, a smooth, tame, rubber-stamp consultation exercise: small, quite and acquiescent.

According to a report in last week's edition of the London gay weekly magazine, QX:

"After last year's ridiculous plans to introduce an unfeasible plan to interview every single gay man in London (estimated to be at least 152,000 men) about their sexual health habits and, even more controversially, store that information on a database, this year the NHS, through its PCTs structure, proposes to allocate a budget of just £1,145,960 to HIV prevention for gay men. This budget currently funds HIV prevention adverts, websites and group work from GMFA and PACE, the Freedom condoms scheme, and counselling services at PACE and THT, alongside other services. To give you an idea of what this means to London's gay community, last year's budget was £1,796,491."

The budget cuts, as previously announced and not yet rescinded by all London PCTs, represent a one-third reduction in finance for HIV prevention work targeted at gay men. Or put another way, the London NHS was proposing to spend in 2008 a mere £7.50 per gay man living in London.

We are constantly being told about the massive investment being made in the NHS by the government. Indeed, these investments are so great that there is currently a whopping surplus of £92 million in the budgets of London PCTs.

Given this huge surplus, and the government's professed commitment to the NHS and to action against HIV, why were cuts in HIV prevention funding for gay men ever proposed in the first place?

London has a huge concentration of gay and bisexual men. Gay sex is much more prevalent in the capital than anywhere else in the country. One in 12 male Londoners have acknowledged having had a same-sex experience, according to the National Survey of Sexual Attitudes and Lifestyles (1990). The actual and current figure, 17 years later, is probably much higher.

A follow up nationwide survey in 2000 revealed that since the original 1990 survey there has been a roughly 80% increase in men across the UK reporting same-sex contact. It is likely that such a rise nationally has also occurred in London too; making it therefore reasonable to conclude that as many as one in seven London males have had gay sexual experiences.

Given these statistics, it is crazy to undermine life-saving HIV prevention work among men who have sex with men.

The London NHS's recommended funding cut was a short-sighted move that was likely to result in more HIV infections, more illness and death and, given the high treatment costs, more NHS expenditure in the long term.

The Health Department's economists have estimated that the monetary value of preventing a single onward transmission of HIV is between £0.5 and £1 million in individual health benefits and treatment costs. This means that spending up to £0.5 to £1 million to prevent one transmission would be cost effective.

Any cuts are a short term NHS budget gamble that could put at risk the lives of gay Londoners.

Gay and bisexual men remain the highest risk group for HIV in the UK, accounting for 80% of all domestically-acquired HIV infections.

The rate of HIV infection in the gay community has risen by 20 per cent in the past five years. The need for education and prevention work is still very great.

Condom use and safer sex messages are not reaching many men who have sex with men, especially teenagers and members of minority race and faith communities. Almost half of HIV infected men who have sex with men left sexual health clinics last year unaware of their HIV infection.

There is an obvious and urgent need for more and better HIV prevention campaigns for gay people, rather than penny-pinching cutbacks.

Nick Partridge, chief executive of the Terrence Higgins Trust, said: "We need more investment in HIV prevention, more HIV testing in local communities and stronger national leadership. This is a real test for national government and local health services - and one we can't afford to fail."

Well said. I agree entirely.

If you also feel enraged that these cuts were ever contemplated, or even you feel only mildly miffed, please write a letter of protest to the Health Minister, Alan Johnson MP, House of Commons, London SW1A 0AA.

Note: Before the usual suspects accuse me of ignoring women, black people, heterosexuals and refugees with HIV - and the catastrophic HIV pandemic in the developing world - let me pre-empt their curses with my assurance that I have also written and campaigned on all these other HIV issues for nearly three decades. I am not prioritising gay and bisexual men over and above other people at risk of HIV. All affected communities need well funded and targeted HIV prevention campaigns and condom provision

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