Day: December 1, 2020

As the world grapples with the effects of Covid-19, a more protracted battle against a pandemic that has claimed far more lives continues to be fought.

To mark World Aids Day, campaigners are renewing calls for the government to honour an existing commitment to eliminate HIV transmission in the UK by 2030.

Medical science has already made massive headway in tackling the virus. As Deutsche Welle notes, “for most people, an HIV diagnosis in the 1980s was an automatic death sentence”. Four decades later, the NHS says life expectancy averages for HIV-positive patients are “near normal”.

But is eradication really in reach?

Where are we now?

The rate of HIV transmission in the UK steadily declined from a peak in the 1980s before spiking again in the 2000s. But since then, the drop in transmission has accelerated.

According to the most recent report from Public Health England, “the total number of people newly diagnosed with HIV continued to decrease in 2019 to 4,139” – a 10% fall from 4,580 in 2018, and down by 34% from 6,312 new diagnoses reported in 2014.

“The decline in new HIV diagnoses in recent years is largely driven by a steep fall in diagnoses among gay and bisexual men”, among whom confirmed cases have almost halved in the past five years to reach 1,700 in 2019, the report says.

Mortality rates among people with HIV have “remained stable, with 622 deaths” in 2019 – which equates to an average mortality rate of 631 per 100,000 people diagnosed with the virus.

A total of 105,200 people were estimated to be living with HIV in the UK last year.

Can we stop transmission by 2030 – and how might we do it?

The drastic declines in the number of people testing positive for HIV “in most populations and in most settings” over the last few years “shows that, if progress is maintained, the UK could be a very low-incidence country by 2030”, says information site AidsMap.

According to the government, “the goal of eliminating HIV transmission by 2030 depends upon sustaining prevention efforts and further expanding them to reach all at risk”.

Public Health England has suggested that measures necessary to tackle the virus include an increase in testing in non-traditional settings such as A&E departments, prisons and via self-testing; more consistent testing of people who come to clinics with symptomatic STIs; and instituting routine commissioning of pre-exposure prophylaxis, a preventative drug which helps reduce the risk of transmission in high-risk individuals.

Dr Noel Gill, Head of STIs and HIV at Public Health England, said earlier this year that “we are well on our way” to wiping out HIV transmission by the start of the next decade.

“Testing is a key part of the UK’s success – if you have HIV you can benefit from life-saving treatments that also prevent further transmission of the virus,” he continued.

“Certain groups of people are at higher HIV risk and are advised to have regular tests, including men and women who have had unprotected sex with new or casual partners from countries where HIV is common, who should test every year, and men who have sex with men.”

Welcoming data showing continuing declines in transmission in the UK, Health Secretary Matt Hancock said that “HIV has brought untold hurt and suffering to so many”.

“We should be rightly proud of the incredible progress we have already made” in reducing infection levels, he added.

What else is being done?

To mark Worlds Aids Day on 1 December, England’s first HIV Commission – established by the Terrence Higgins Trust, National Aids Trust and Elton John Aids Foundation – is publishing “20 recommendations” to help halt new transmissions in the UK within the next ten years, Reuters reports.

The campaigners are calling for “HIV testing to be standard practice for patients registering with a new doctor, undergoing routine smear tests or being admitted to hospitals’ emergency departments”, the news agency reports. Under the plans, “tests would also be available at pharmacies in areas with a high prevalence of HIV”.

The UK’s 2030 goal mirrors that of the Joint United Nations Programme on HIV/Aids (UNAIDS), which is following a “fast-track strategy” to end the Aids crisis.

The so-called 90:90:90 targets are for 90% of people with HIV to be diagnosed, 90% of diagnosed people to be receiving treatment, and 90% of people on treatment to have an undetectable viral load by 2030.

“To reach this visionary goal after three decades of the most serious epidemic in living memory, countries will need to use the powerful tools available, hold one another accountable for results and make sure that no one is left behind,” the organisation says.

According to the UK government, Britain is “one of the few countries in the world to have reached and exceeded all UNAIDS 90:90:90 targets”. Of the 103,800 people living with HIV in the UK in 2018, 93% were diagnosed, 97% of people diagnosed were receiving treatment and 97% of people receiving treatment were virally suppressed.

The Week’s daily round-up highlights the five best opinion pieces from across the British and international media, with excerpts from each.

1. Marina Hyde in The Guardian

on new rules

Who cares about jobs and experts? Suddenly, Brexit’s snake-oil salesmen do

“Oh dear. I see Michael Gove now gives a toss about experts. And I see Steve Baker now gives a toss about economic impact statements. The Cabinet Office minister spent Tuesday blitzing the airwaves to explain why the government’s imminent tier system is done for your own good, for reasons you’re too dim to be given the data to understand. Meanwhile, Baker, Jacob Rees-Mogg’s former robot sidekick, is leading the rebellion against the tier system, on the basis that it will cause huge economic damage. Presumably Brexit ironies are cheaper by the dozen. For the past four years, political analysis has been honed, refined and reduced to a single immutable truth. And that is that all these guys should be made to fight each other in a Wetherspoon’s car park.”

2. Christine Stegling in The Independent

on the other pandemic

We must not allow coronavirus to undo a decade of progress in HIV prevention

“HIV prevention is in crisis too, and governments need to be brave on this issue as well, and to face up to the things which need changing – criminalisation of LGBT people, drug use and sex work for example, stigma and discrimination in healthcare settings, harmful gender norms and comprehensive sexuality education. Without addressing these difficult subjects, and without renewed commitment to the Aids response in the face of Covid-19, the next set of targets are likely to fail too. This World Aids Day more than ever, we need governments to remember the HIV challenge and to commit to a future which is free from Aids for everyone, everywhere.”

3. Various writers in Politico

on room for improvement

The von der Leyen Commission end-of-year report card

“Von der Leyen has struggled most in moments when she couldn’t be found. At the start of the year, the president was silent for days as crisis engulfed the Middle East. And her team stirred unnecessary controversy by not being forthright when von der Leyen left Brussels to self-isolate because of a coronavirus risk. At the start of the pandemic, she was slow to pivot from a crisis on the Greek-Turkish border. And last spring, a dismissive reference to so-called “coronabonds” in an interview with German news agency DPA caused a furor in Italy with even European Parliament President David Sassoli demanding a clarification. Current and former EU officials have accused von der Leyen and her cabinet chief, Björn Seibert, of creating a huge backlog of senior job vacancies by insisting on personal control over appointments — an allegation the Commission denied.”

4. Izabella Koziell in Al Jazeera

on dirty business

How to defuse the human waste time bomb in low-income countries

“In addition to market opportunities, the sanitation service chain also offers environmental benefits. For example, Sulabh International has pioneered public toilets connected to bio-digesters in India. This has created a simple, affordable technology to treat faecal matter in the absence of a sewerage network, or to reduce the load on the existing sewerage, while also contributing to the circular economy. Dignified sanitation is a basic human need that does not end with a toilet, and in fact, delivered in full, can offer opportunities for sustainability through nutrient and energy recovery. But this can only be delivered if sanitation is treated as an entire chain, with its own market opportunities, regulatory needs and an infrastructure that supports sustainable services to grow, whether sewered or non-sewered.”

5. Nick Timothy in The Telegraph

on walking a fine line

The ethics and politics of the vaccine are still perilous for the Government

“One of the biggest issues is that without any net zero roadmap or guidance from the government, businesses have been left to interpret it for themselves. Businesses told us net zero involved carbon offsetting, carbon reduction or carbon elimination – similar-sounding phrases that vary wildly in their impact on an organisation’s footprint. (Carbon offsetting involves taking action to compensate for emissions in other areas, compared to bringing emissions down or getting rid of them entirely). None of the definitions are ‘wrong’ – put simply, net zero means achieving an overall balance between emissions produced and taken out of the atmosphere – but without an overarching framework to follow, businesses are left with room to interpret it as they choose. In fact, almost two thirds of businesses feared their own targets could be seen as greenwashing and 86 per cent believe net zero is in danger of becoming a meaningless statement without consistency in approach and measurement amongst businesses.”