Matthew Hodson

October 2017 brought some brilliant news. Public Health England announced that in 2016 the number of new cases of HIV across the country had fallen by 18%. The drops in diagnoses were even steeper among gay and bisexual men, and particularly among those who live in London.

This decline was driven by an increase in the number of people testing more often, with treatment being offered immediately to those who received a positive diagnosis. In addition, a significant number of people had chosen to self-source PrEP, a course of treatment which, while still not available as standard on the NHS, can effectively prevent HIV infection.

The message rang out loud and clear: combination HIV prevention can work. Increasing testing and early access to HIV treatment, plus adding PrEP to condom use as a safer sex strategy, gives us the power to if not end HIV then at least send it into retreat. After many years when the news about HIV was often grim or frustrating, this story was one of many good news stories that NAM has published in recent months.

Our ability to treat HIV has never been so good. Although some still experience adverse effects, the numbers are now relatively small. Where there is access to treatment, we’ve moved on from discussing life expectancy to a greater examination of life quality. Increasingly we need to look at the co-morbidities associated with aging with HIV but this is a luxury we can only afford now that so few are dying.

In addition, a growing body of evidence tells us that when people living with HIV are on effective treatment we do not pass the virus on to sexual partners. The message that ‘undetectable equals un-transmittable’ underlines the importance of effective HIV testing programmes and of universal access to HIV treatment for those diagnosed. The knowledge also challenges some of the stigmatising attitudes too often expressed towards people living with HIV.

Internationally, there has also been good news. In New York, San Francisco and Sydney, to name just a few, we’ve recently reported progress in reducing new diagnoses, again, particularly among gay and bisexual men. Swaziland, which 15 years ago had the highest HIV infection rates in the world, has seen the number of new infections halved over a five-year period, as the proportion of people on antiretroviral treatment with fully suppressed viral load has doubled. We’ve seen successful roll-out of PrEP in rural communities in Kenya. Cautiously, we are on track to meet the UN AIDS 90-90-90 targets by 2020.

The challenges ahead remain daunting. In most countries, the steep drop in diagnoses is concentrated among urban, well-educated gay men. Many gay men still aren’t benefiting – and large numbers of women and heterosexual men are still diagnosed at a late stage, while the sexual health needs of trans people are all too often ignored entirely. Now we’ve proven that combination HIV prevention works we need to apply force to ensure that momentum is maintained.

NAM plays an active role. We don’t just report change but, through education and empowerment, we help to drive it forward. NAM’s reporting on PrEP has contributed to increased awareness, supporting not just those people who self-source the medication but also the calls for PrEP to be provided on the NHS. As one of the most trusted sources for HIV information globally, our early support for the UequalsU message was seen to be pivotal. The information we produce supports people living with HIV, throughout the UK and internationally, to live longer and healthier lives.

We are making progress but there is much more to be done. Here’s my goal for the next decade: no new HIV infections, no AIDS-related deaths, no HIV stigma – not just for gay men in the UK but for all people, everywhere in the world. Is this ambitious? Yes. However, we should not be limited by the extent of our own ambitions. Let us not falter or hesitate in the fight against AIDS - let’s end this.

  • Matthew Hodson is the executive director of NAM/Aidsmap.