Feature

Labour isn’t working for HIV

Before the last election Labour promised a national strategy on HIV – but we are still waiting. Tim Pickstone reports

The failure of the present government to develop a national HIV strategy is not its most high-profile climbdown, but for people with HIV it has serious implications.

In opposition the Labour Party made clear promises to develop and introduce a national strategy. Writing in the HIV policy journal Agenda in 1996, (Baroness) Margaret Jay argued that a national strategy was the best way to tackle HIV in Britain, and promised that a future Labour government would introduce one.

And, on the eve of the next general election, we are still waiting. It now seems certain that an HIV strategy – even as a chapter in a broader sexual health strategy – will have eluded this government, which lives in constant fear of offending ‘middle England’.

Yet there are now more people than ever before living with HIV in the UK – partly because of better drugs, which have enabled many to live longer and healthier lives; but also because of the record number of new infections – continuing high rates in gay men but also rapidly rising infection rates in sections of heterosexual communities.

New HIV treatments have brought their own problems. The cost – not only of the drugs but also of the necessary social support required by people taking them – has never seriously been addressed. In the absence of central planning, local planners in some parts of the country have cut HIV services in an attempt to make HIV budgets balance.

Evolving strategies

The government did go through the motions of developing a strategy. In 1997 it set out its public health white paper Our Healthier Nation. Unlike the Health of the Nation, which had five priority areas, Our Healthier Nation outlined only four: HIV was omitted.

Then public health minister, Tessa Jowell, announced that HIV was ‘so important’ that it was going to have a strategy all of its own. In 1998 she established a steering group to develop it. There were problems with the group’s composition (too few people with HIV, voluntary sector representation entirely from London) but it did meet, and began to develop a strategy.

Eighteen months later the government ‘published’ (on the internet and without a press release) a Progress Report from the HIV/AIDS Strategy Steering Group. The document informed us that it would be the basis of consultation with the HIV sector over the summer, with a final draft to be produced in autumn 2000 – for formal public consultation – and the finished strategy by the end of the year.

Yet weeks later, in June 2000, public health minister Yvette Cooper announced that the government was to abandon its plan to publish a national HIV strategy. Instead, HIV was to become a part of the national sexual health strategy for England. The reasons behind this sudden shift in policy were unclear. Sexual health is an important issue and needs a national strategy. But HIV shouldn’t be downgraded to the level of a chapter within it.

Key players in London – including the major HIV voluntary organisations represented on the steering group and speakers on HIV in Parliament – publicly agreed with the government on the merger. In what was described as a ‘leap of faith’, it was felt better to have some sort of HIV strategy (even a downgraded one) than nothing at all.

George House Trust opposed the merger of strategies from the start. Although there is obviously a link between HIV and sexual health, both issues go much further. And HIV is more than a question of sexual health. Some of the most important issues are about treatment and care.

HIV is a major, life-threatening disease of potentially devastating proportions, and has seen almost unprecedented levels of discrimination against people who have contracted it. Merging HIV and sexual health into one strategy has proved detrimental to both.

Can things get better?

HIV is an issue that Labour must address. The numbers of people living with HIV – and systematic discrimination – are set to rise 40-60 per cent over the next four years.

HIV is not simply a health concern and cannot just be a matter for the Department of Heath. As a major international public health challenge, nor can it be considered solely from a UK perspective.

An HIV strategy should not be difficult. It requires commitment to ensuring access to quality care and support for all people with HIV and a major effort to target prevention work at the communities affected. It is likely that through better allocation of existing money – and more rigorous monitoring and enforcement of how it is spent – the strategy could be paid for within existing resources.

A draft strategy recently prepared by George House Trust identified several key areas for action:

• Involving people with HIV in decision making at all levels and ensuring a comprehensive approach to HIV across government;
• Limiting new infections by targeted HIV prevention initiatives;
• Ensuring that all people with HIV have access to the best standards of treatment, care and support;
• Ensuring that HIV testing is based on informed consent;
• Ending discrimination against people with HIV;
• Playing a full role in countering the HIV epidemic worldwide;
• Ensuring the best use of government funds through effective targeting of resources and monitoring.

The government could have developed such a strategy in its first term. There have been a lot of meetings with no results. We are left to tackle a disease that the Public Health Laboratory Service puts at the top of its list of priorities for public health, without national leadership and direction.

The result has been that major HIV voluntary organisations have closed and their hard-won expertise and community involvement have been lost.

Without real and effective national direction, the number of new infections will continue to rise. Whatever the next government, it must not let down people with HIV.