How to Wipe Out HIV in England By 2030

Today, to mark World AIDS Day, the HIV Commission has published a series of recommendations aimed at eradicating new cases of HIV in England by 2030, with the goal of achieving an 80 percent reduction in transmission by 2025.

One recommendation made by the Commission – a joint project between the Terrence Higgins Trust, National AIDS Trust and Elton John AIDS Foundation – is that people should be offered HIV tests whenever they get a generic blood test, regardless of their race, gender or sexual orientation.

This would reduce the stigma of getting an HIV test, say the authors, and reach demographics who might not imagine they’re at risk. The measure would be “opt out”, meaning it wouldn’t be compulsory but you would automatically get one unless you specifically request not to.

By way of example, the report points to maternity care, where close to 100 percent of women are now being tested for the virus. The success of this initiative has led to almost no babies in the UK being born with HIV. As it stands, there are an estimated 5,900 people in England living with undiagnosed HIV; helping these people discover their HIV status via routine tests would be good for their own health (it’s better to be diagnosed early), as well as preventing new infections.

Kat Smithson, director of the National AIDS Trust, tells VICE World News, "That we're even discussing this goal is remarkable. World AIDS Day brings up memories for a lot of people of times of crisis and enormous grief. It's a testament to decades of effort by activists and advocates who fought for medication, stood against discrimination and demanded PrEP on the NHS that we can now talk about ending the negative impact of HIV in this country. It should be cause for great hope in a year where biomedical obstacles have sometimes felt insurmountable.”

Of course, while the proposal might seem sensible, it needs serious political will to actually come to fruition.

“None of this is going to happen by accident,” says Kat. “This is a radical choice that those in power can make. The public health budget is £1 billion lower than it was five years ago in real terms, and this year we've seen the government announce the closure of Public Health England in the middle of a pandemic. There's still very little clarity on what that means for national oversight of HIV prevention.”

There are also more specific details in the Commission’s report which may get overlooked in today’s headlines about the 2030 goal. After all, HIV is not a condition that puts every demographic at equal risk.

“We need to consider the detailed findings of the HIV Commission where action is needed,” says Kat. “The need to address treatment of HIV within the criminal justice system; the need for better services that understand the lives of those who engage in chemsex; the entrenched inequalities that mean we are failing to support women and people from migrant communities living with or at risk of HIV. We need a big, cross-societal effort and leadership, not small fixes. Our job is to see them through." 

Jay Hawkridge is a writer and activist who has recently become wildly popular on TikTok, where he posts educational videos about living with HIV.

“I think it’s a really inspiring idea,” he says. “HIV can be being entirely or mostly asymptomatic, which means you could easily be living with it and have no idea. This was especially true in my case: I was admitted to hospital with HIV symptoms – I had a high fever and rashes – and discharged a week later, without ever being told it was HIV. They tested me for appendicitis and then Crohn’s disease, and then discharged me a week later when they came back negative. I only found out by myself later. So, I see no downside to this proposal at all – I think it’s really important.”

While the HIV Commission is primarily focused on preventing new cases, Jay thinks its recommendations would benefit people who are already living with the condition.

“I think a lot of people now are put off getting a test out of fear,” he says. “It’s something I never looked into myself because I grew up on a media that portrayed HIV as dangerous and scary. It was really easy to not even acknowledge the fact that it was around. It became an elephant a room, which I think it is in the LGBT community. You only need to go on Grindr or Tinder to see the stigma attached. I think HIV testing becoming more common would normalise HIV a lot more, and would open a lot more people’s awareness to things like PrEP and the importance of safe sex.”

While these proposals are welcome, some feel they don’t do enough to tackle HIV as a global crisis. This isn’t necessarily a criticism, as the Commission’s report is focused on England, but it’s important to also address HIV at an international level.

“If we've learned anything from the last year, it's that infectious viruses that take hold in one part of the world do not stay confined to a particular region or nation,” says Dr Will Nutland, co-founder of PrEPster and The Love Tank CIC. “The outstanding steps that have been taken to reduce HIV infections across the UK will not bring us to ‘zero new infections’ if our focus is only domestic, and not global too. Half of gay men diagnosed with HIV in recent years were not born in the UK, and significant numbers of HIV diagnoses in heterosexuals were acquired outside of the UK.”

While it would be a positive step for the government to commit to these proposals, this commitment – says Dr Nutland – would be undermined by the cuts it is making to global aid and development elsewhere.

“Our responses to HIV prevention in the UK need to have a global focus as well as a national and regional focus,” he explains. “We won't meet those ambitious HIV prevention targets in the UK if someone travels to parts of the world with high HIV incidence, for example, and acquires HIV outside of the UK. Cutting developmental budgets works against our domestic HIV response, as well as our global response. UK goals can only be achieved by investing in HIV prevention and treatment internationally as well.”

While there is a lot of work to be done, and we cannot ignore the global nature of the ongoing epidemic, it’s still incredible that an ambition as bold as the end of HIV transmission is even on the cards. As Jay says, “I think for people who are positive now, it might be seen as a burden to be the last generation to go through HIV. But it’s also nothing short of a miracle.”