Sunday 1st December 2013
The NHS is providing poorer care for people with HIV since the implementation of the Health and Social Care Act, according to a third of specialist HIV doctors questioned by the British HIV Association (BHIVA)1.
Nearly two-thirds of BHIVA members surveyed felt care would decline further in the future as a result of changes to the commissioning of sexual health services. Fewer than one in 10 were optimistic that such restructuring would lead to improvements.
BHIVA Chair, Dr David Asboe, a consultant in HIV medicine at the Chelsea and Westminster Hospital, said: "Key to the concerns uncovered in this survey are fears about the separation of HIV care from broader genitourinary medicine (GUM).
"NHS services for HIV and GUM are commonly integrated, sharing staff and resources. But since changes to the law, GUM clinics alone are being separately tendered, which makes high quality HIV services extremely vulnerable. As a direct result there are HIV services being threatened with closure without adequate care arrangements made for the people living with HIV attending these services."
Dr Janet Wilson, President of the British Association for Sexual Health and HIV (BASHH), said: "Sexual Health clinicians have been sounding the warnings around restructuring since the introduction of the Government's health reforms. The threat to high quality HIV and GUM services is now extremely pressing, with a third of sexual health lead clinicians expecting their services to have been tendered in the next 12 months2.
"We are already hearing about tendered GUM services being prevented from undertaking partner notification on people newly diagnosed as HIV positive even though this is the most effective public health intervention for identifying undiagnosed HIV infection. We need Government, national and local agencies to urgently work together to prevent HIV and GUM care going backwards."
More than nine out of 10 BHIVA members surveyed have voiced their concerns to commissioners, clinical colleagues or the media, but one in five was unable to identify the individuals responsible for commissioning HIV prevention and training in their area.
The results come as the numbers of people living with HIV continue to rise, with no decline in HIV transmission among the most at-risk group, men who have sex with men (MSM). In 2012 the total number of people living with the disease neared 100,000 for the first time since the epidemic began.
Through the work of BHIVA, British HIV treatment and care has helped set global best practice, with many of the world's most respected clinicians working in the NHS.
Dr Asboe commented: "These findings lead to a worrying conclusion; HIV care in this country could start heading backwards, at a time when we need to do more not less. Rather than setting the pace, HIV care in the NHS in England and Wales could find itself stuck in the slow lane, unable to take advantage of the latest developments in holding back the disease, such as pre-exposure prophylaxis (PreP) and treatment as prevention (TasP) – two of the most promising advances in HIV medicine since the epidemic began."
1 BHIVA member survey, carried out November 2013
2 Preliminary results of BASHH and FSRH survey of lead clinicians in sexual health services carried out in Sept/November 2013. Due to be published online December 2013
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Founded in 1995, BHIVA is a well-established organisation which is committed to providing excellence in the care of those living with and affected by HIV. It acts as a national advisory body to professions and other organisations on all aspects of HIV care. BHIVA also provides a national platform for HIV care and contributes representatives for international, national and local committees dealing with HIV care. In addition, BHIVA works to promote undergraduate, postgraduate and continuing medical education within HIV care.
The British Association for Sexual Health and HIV (BASHH) is the lead professional representative body for those managing STIs and HIV in the UK. It seeks to innovate and deliver excellent tailored education and training to healthcare professionals, trainers and trainees in the UK, and to determine, monitor and maintain standards in provision of sexual health and HIV care.