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HIV prevention: A quiet revolution

Source: PSE June/July 2018

Paul Steinberg, lead commissioner of the London HIV Prevention Programme (LHPP), argues that the capital’s successful fight against HIV is a remarkable example of what can be achieved when local authorities work innovatively across boundaries to speak with one voice.

It no longer hits the headlines as much as it once did, but HIV remains one of the UK’s most serious public health challenges.

This is particularly the case in London. The capital is home to an estimated 38,700 people living with HIV – accounting for 43% of all people with the condition in England. Lack of awareness, late diagnosis, and continuing stigma all contribute to the risk of onward transmission and poorer health outcomes.

The issue has undoubtedly been made even more difficult by cuts to local authority public health budgets, leading to reductions in many prevention, testing and support services. Yet, in the face of this immense challenge, and after a decade of worsening HIV rates, London has recently achieved remarkable progress in addressing the HIV epidemic.

For the very first time, there was a downward trend in the number of people being diagnosed with HIV in the capital in 2016, despite more people testing – and doing so more frequently. This includes an astonishing 40% drop in HIV diagnoses in five central London clinics – a reduction that has not occurred on the same scale in the rest of the country.

Earlier this year, the capital joined the worldwide Fast-Track Cities initiative and became one of the first global cities to meet the UN’s ambitious HIV diagnosis and treatment targets. Working together with other cities, London has pledged to achieve three key HIV goals by 2030: zero new transmissions, zero deaths, and zero stigma. If current trends continue, London can be confident of achieving these ambitious goals.

But this success has not happened magically – or overnight. In the past few years, the quiet revolution in the way London commissions HIV prevention and testing services has played a major role.

Responding to the capital’s high rates of HIV and to the transfer of public health responsibilities to local government, London boroughs came together and launched the innovative LHPP in 2014. 

The LHPP is a public health success story. Overseen strategically by London Councils and managed by the London Borough of Lambeth, the LHPP represents a radical reboot not only to HIV prevention, but also to the way public health campaigns are run. Through pooling resources across the capital, boroughs benefit from a high-value programme that delivers economies of scale and, most importantly, a clear impact on community health.

Furthermore, the LHPP’s city-wide public HIV awareness campaign – Do It London – has grown from an upstart campaign to becoming a mainstay of the capital’s sexual health offer. Using the latest data and advertising methods, it is both accessible and innovative. It was the first official campaign in the UK to promote Pre-Exposure Prophylaxis (PrEP) and ‘undetectable’ HIV status as core HIV prevention options, alongside more recognised methods such as condom use and regular testing.

Since its launch, Do It London’s messages have been shared in 17,000 street-side adverts, 26,000 ad panels inside buses and London Underground trains, and have been seen across 55 million digital display impressions on Londoners’ mobiles, tablets and laptops. It was praised by the president of the International AIDS Society as “simple but comprehensive,” and it has been copied by cities around the world.

Independent evaluation shows Do It London has had a real influence, boosting Londoners’ awareness of how to prevent HIV. The consistency of the campaign’s messaging throughout the capital is vital for amplifying the impact – it would be much harder to achieve this if each of London’s 33 local authorities ran individual HIV prevention campaigns. 

London now leads the way in the fight against HIV. We’re determined to continue this progress into the next decade, maintaining the momentum to achieve Fast-Track City goals. But we also stand as a testament to the power of collaboration across organisational boundaries, demonstrating what can be achieved through cross-borough working and innovation.


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