HIV has always been a significant health issue in Greater Manchester – we have one of the highest averages of people living with HIV in certain boroughs (in Manchester a rate of 6.21 per 1,000 population, against the England average of 2.37 per 1,000), with more than 5,650 living within Greater Manchester.
Just over 250 new HIV diagnoses are made every year in Greater Manchester. This rate has fallen recently from 289 in 2017 to 253 in 2018, a 12.45% decline. However, 44% of these come at a late stage, greatly increasing the impacts to individuals’ lives, risks of onward transmission and the costs of treatment. In addition, around 745 people are thought to be living with HIV but unaware of their positive status.
When Andy Burnham announced at Pride last August that we were becoming a Fast Track City, it couldn’t have been more timely. We already had planned a ‘HIVE’ program – HIV Ending new cases within a generation – which is aimed at ending new diagnoses of the disease within a generation. Along with lung cancer, HIV was pinpointed as a preventable health inequality and it was allocated £1.3 million of funding from the Greater Manchester Health and Social Care Partnership.
Fast Track Cities added further political backing to the goal of ending HIV transmissions in Greater Manchester every year.
It’s early days, of course, and we’re hitting the 90-90-90 target, (90% of all people living with HIV are diagnosed, 90% of people diagnosed are on treatment, and 90% of those being treated have reduced infection to levels which prevent HIV being passed on). Our latest figures are 91, 97 and 97. But it’s that first 91% of undiagnosed cases that is a real focus for us – we can only estimate how many people are living undiagnosed with HIV, making it the least scientific of those statistics.
Within the BAME community, for instance, we’re pretty sure we’re not hitting that 90% benchmark, but by how much we simply don’t know.
Manchester has always been quite forward looking across the health and voluntary sectors – the Greater Manchester Sexual Health Network comprises commissioners and clinicians and the third sector who’ve worked together for more than 15 years to improve the sexual health of the population of Greater Manchester.
By capitalising on these partnerships we hope to upscale testing among those people we feel we haven’t been able to reach before, working with colleagues within the LGBT Foundation, BHA for equality and the George House Trust, under the umbrella of PASH, or Passionate About Sexual Health.
People within those charities and organisations are trained by clinical colleagues to perform testing everywhere from community centres to sex-on-venue premises, Manchester Pride, and the city’s annual Caribbean Carnival. No stone should go unturned.
And we shouldn’t forget those currently living with HIV, how we can support them with housing, asylum, food banks and more.
Crucially, Greater Manchester’s programme is now funding targeted support workers who go into those communities to help those with HIV adhere to a medication regime so their vital load remains undetectable and untransmittable (U=U), and so they live longer, better lives.
We’re also working with GPs so everyone working in those practices gets tested, and through Fast Track we’re hoping to become the first UK city to introduce HIV testing as standard for anyone who visits A&E within Manchester. This is actually part of 2016 NICE guidelines for high prevalence areas, but it hasn’t been implemented yet.
And like our fellow Fast Track Cities we understand the stigma around HIV is a massive obstacle. We’re developing stigma training packages for healthcare workers and those in local government and also looking at the wider population.
We also need to see HIV in a wider context – Manchester has seen a rise in cases of syphilis, gonorrhoea and significant levels of hepatitis C, which we need to test for at the same time as HIV as there’s a big cross-over in the at-risk populations. Crucially we have very effective treatments for these sexually transmitted infections which we hope will break the chain of infection.
And the availability of “PrEP” medication, which has been proven to stop HIV in its tracks, is really worrying. Demand currently outstrips the ability to supply this within the existing PrEP trials in England so people are having to purchase PrEP online or are continuing to be at high risk of acquiring HIV. In Scotland and Wales it’s available on the NHS, and we’re hoping England will follow suit.
Unfortunately cuts in funding to our sexual health services and local authorities mean that we are basically trying to do more with less, which is why the Fast Track Cities is perfect framework for the current climate.
We can share best practices without doubling up and wasting precious resources. We really are knitting all our brains together in a way that hasn’t happened before. It’s exciting, but also essential.