2020 Vision – Making England’s HIV Prevention the best in the world Paul Ward

1. 2020 Vision – Making England’s HIV Prevention the best in the world Paul Ward Acting Chief Executive, THT 20 February 2014

2. The story so far • Increasing HIV testing • World class HIV treatment & care • HIV transmission levelled off • Sustained condom use But • Levels of undiagnosed HIV • High sexual risk taking amongst some groups • Little city wide or programme planning • Major investment risk

3. 2020 Vision – 50% reduction in undiagnosed HIV • Reduce by 10,000 the number of people undiagnosed • Full usage of integrated testing approach

4. 2020 Vision – 50% reduction in undiagnosed HIV • Embed recall/reminder process within local HIV testing Programmes and service • Overhaul of partner notification – traditional and digital • Exploration of use of Viral Load HIV testing with highest risk groups

5. 2020 Vision – 250,000 more HIV tests

6. 2020 Vision – 250,000 more HIV tests • A 125% increase in tests with high risk groups needed • £20m annual investment to achieve lifetime cost savings of at least £250m pa • Rebalance HIV testing so that more occurs in low cost settings • Major shift in testing culture through advocacy & community engagement • Get public health value from 98% of HIV testing resources spent on people without HIV

7. 2020 Vision -75% of PWHIV uninfectious • Although UK performance is amongst best in world, there are still too few people retained on treatment & uninfectious • Expansion in community & clinical advocacy for treatment • New approaches to case management & case finding to reduce people lost to care • New Positive Prevention care pathway to help people living with HIV to optimise their health • Explore reducing threshold for HIV treatment

8. 2020 Vision – Increasing condom use & harm reduction • 80,000 infections prevented by condoms to date • Societal challenge re condom use • Community & clinical advocacy for condom use, backed up by free/low cost availability • Full access to behaviour change services for those in highest need • Increased access to PEP and PREP • Active encouragement of a range of harm reduction approaches • Twin track approach to HIV & STI/HCV harm reduction

9. 2020 Vision – Healthy communities, healthy people • Mandatory SRE in schools • Integration across Sexual health, Mental health & Substance use services • Specialist drug services focusing on recreational drug use • Step change in Corporate Social Responsibility expectations from community businesses • Community involvement & engagement to increase our collective HIV Prevention capacity

10. Making It Happen Leadership • Strong Local Authority & NHS leadership, political and officer • Active community leadership & involvement holding to account • Fully co-ordinated local HIV testing & prevention programmes • Redirection of less than 1% of Public Health resources • Operation of effective surveillance and monitoring systems • Continual improvement by local and national comparison • London is pivotal to this, with nearly 50% of undiagnosed HIV in the capital

11. Making It Happen: Urban ResponsesSan Francisco / Washington DC / London

12. Making It Happen – signs of optimism • UK Brighton – 50%+ HIV diagnoses now out of hospital • UK HIV Home Sampling – 6,000+ tests in first year, 1.7% positivity diagnosed • UK – falling levels of undiagnosed HIV • US – 4,000 home HIV testing kits sold per week • US – strong reductions in undiagnosed HIV in some cities • US – first fully engaged urban testing programmes

13. 100% 90% 89% 84% 80% 78% 70% 75% 60% 78 % 73 % 6 9 % 61 % 50% 2020 ambition 2012 actual 40% 30% 20% 10% 0% HIV infected HIV diagnosed Retained in care On treatment Undetectable VL (n=98,400) (n=7 6,8 00) (n=72,840) (n=6 7 , 600 ) (n=59 , 900 ) Achieving success Fall in HIV transmission • Crucially achieving this, will together with condom use, help England reduce HIV transmission – the overall aim

14. Together….. Thank you! For further information: Paul.ward@tht.org.uk 0207 812 1850