England: health and wellbeing boards not prioritising HIV

In areas of high HIV prevalence in England, half the local authorities have not made HIV a public health priority, according to an analysis presented to the British HIV Association conference in Manchester this week.

In the new organisation of health care – which took effect at the beginning of April – local authorities have responsibility for public health. In each area, a health and wellbeing board brings together representatives from public health, local councillors, social services, clinical commissioners and Healthwatch (a ‘consumer champion’). The board is meant to produce a strategy document as well as a Joint Strategic Needs Assessment. These two documents outline priorities for public health commissioning and service provision.

For this analysis, the 35 local authorities which have both a high prevalence of diagnosed HIV (greater than 2 per 1000 adults) and problems with late HIV diagnosis (at least 50 people diagnosed late in the past three years) were identified.

The strategy and needs assessment documents were obtained (often with great difficulty – the materials are not always easily accessible to members of the public) and their content examined. The strategies always explicitly state their public health priorities, so subjective interpretation was not required.

• 18 of the 35 health and wellbeing strategies in these high-prevalence areas did not make HIV a priority.
• HIV was left out of the priorities in some of the most-affected parts of the country, including Brighton & Hove, as well as Camden and Islington in central London.
• Joint Strategic Needs Assessments were more likely to address HIV, with 28 of 35 including data on HIV and making at least one recommendation.
• Some local areas had much better practice, and did address HIV in an effective, targeted and outcome-driven way. Merton in South London was given as an example.

Speaking this morning at the conference, an ex-NHS commissioner, Graham Atkinson, urged clinicians, service providers, people with HIV and members of the public to engage with their local health and wellbeing board. “If the right things aren’t being discussed, get involved and help shape the agenda,” he said. “If you know there’s an issue, convert it into a solution that they [commissioners] can act on.”