What Led to England’s ‘Incredible’ Decline in HIV Among Gay and Bisexual Men?

There has been a sharp decline in new HIV infections among men who have sex with men (MSM) in England — particularly among Londoners. But what has caused this decline, and can we use this model to combat HIV on a wider scale?

Last week Public Health England, the oversight body in charge of monitoring health trends and providing insight for legislative action, released figures showing that new HIV infections logged by the biggest sexual health clinics in England have decreased. Between October 2014 and October 2015, there were 2,060 reported infections, while the following year saw 1,700. And this reduction was even more pronounced in London.

Admittedly, these figures only track new rates of diagnoses, so we can’t get a concrete figure for overall new rates of infections as not all will be tested for and caught. Even so, these figures are likely to mean a meaningful reduction in overall HIV infection rates — and one that has been sorely needed.

While HIV treatments have evolved dramatically in the past decade — and many otherwise healthy people who do contract HIV can expect to have a near-normal life expectancy with their HIV under control — the actual number of infections per year has remained relatively constant. What’s more, there were reports of escalating rates among gay and bisexual men in some areas, a warning sign that treatment and prevention efforts were not working as well as they should.

What explains the reduction in HIV infections?

Public Health England cites several strategies that are likely helping the MSM community — and the wider gay and bisexual community — to drive down HIV infection risks. And there’s no reason these tools cannot be used to tackle HIV across the UK.

One such intervention is a renewed emphasis on making testing easily accessible and well-known. Obviously, this doesn’t prevent HIV infection on its own, but it does let people know if they have contracted the virus. At that point, HIV-positive individuals may begin antiretrovirals, get their viral loads to undetectable levels and therein no longer present a transmission risk. Testing, therefore, works as both an intervention for those with the virus, and as a prevention strategy to safeguard those who don’t.

PHE also highlights the limited introduction of PrEP — a medication that, when used as part of a daily routine, can prevent HIV-1 infections with upwards of 70-90 percent efficacy.

The BBC reports on just how effective the introduction of PrEP in London has been:

Published in the journal Eurosurveillance, the PHE study looked at data from 200 sexual health clinics in England.

It found that new diagnoses of HIV in gay or bisexual men at five busy London clinics, where Prep is being trialled, had decreased from 880 in 2014-15 to 595 in 2015-16 – a drop of 32%.

And this drop had occurred despite the number of these men being tested in these clinics rising by 50% over the same period.

At 30 other London clinics, new diagnoses fell by just 8%.

And in 191 clinics across England, the drop was about 5%.

It may seem surprising, then, that the oversight body for the NHS is still moving slowly in rolling out PrEP to everyone who needs it. The organization argues that more trials and further data gathering will be necessary to justify the expense. There have been a number of major studies on PrEP, however, and its effectiveness is now well-established.

For instance, many MSM are turning to online retailers to get this medication, and this is both a testament to the need for PrEP and also the concerning fact that, without leadership from health authorities, people are taking PrEP access into their own hands. While there are a number of sites through which PrEP can be accessed, some are less reputable and could put people’s health at risk.

If there is a major takeaway from this data, then, it is that PrEP is valuable as one highly effective method of controlling HIV infections. What’s more, it enables MSM communities to engage in sex-positive practices that encourage safer sex. And this helps to fight other STIs, for which condoms are still very much needed.

In Public Health England’s own words, this is the “first downturn in HIV” among gay men that has been observed on a broad scale. It is now up to the government to heed this data and to capitalize on this moment. That means no more cuts to drastically underfunded sexual health services, and it means that PrEP should be rolled out as soon as possible.

It would be close to a criminal act to let slip an opportunity like this where pushing back against HIV infections is a real possibility — MPs must take action now.

Photo credit: Thinkstock.

59 comments

KimJ ManyIssues
KimJ M10 months ago

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KimJ ManyIssues
KimJ M10 months ago

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KimJ ManyIssues
KimJ M10 months ago

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KimJ ManyIssues
KimJ M10 months ago

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KimJ ManyIssues
KimJ M10 months ago

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Jim V
Jim Venabout a year ago

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Jim V
Jim Venabout a year ago

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Jerome S
Jerome Sabout a year ago

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Jerome S
Jerome Sabout a year ago

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Marie W
Marie Wabout a year ago

Thank you for sharing

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