The results of the 2005 UK general election have been declared and Labour have won a third successive election with a comfortable majority.
HIV and sexual health were barely mentioned during the month long election campaign, but over the course of the next parliament ministers in numerous government departments will have to decide how they respond to the HIV epidemic both domestically and in resource-limited countries.
New health team
Health was one of the key election themes for Labour and on the day after re-election Prime Minister Tony Blair reshuffled his cabinet, appointing Patricia Hewitt as Secretary of State for Health. The Prime Minister will also have to appoint a junior minister for public health to assist her, as the previous incumbent of the post, Melanie Johnson, lost her Welwyn and Hatfield seat.
Johnson was not a popular minister within the HIV sector. There was a perception that she was not interested in HIV and sexual health and did not understand the issues. This was demonstrated, they believe, by her rejection of the public health and health economics arguments for the restoration of free HIV treatment to failed asylum seekers and those of doubtful immigration status awaiting deportation.
Cost of HIV treatment
Doctors and activists are hopeful that they can be more persuasive on the issue of cost with Johnson’s successor, who ever he or she may be (the Prime Minister is expected to announce his junior ministerial team on May 9th.)
They are also hopeful that they can persuade the minister to understand that HIV and sexual health should be included as one of government’s key health priorities. They may have a tough time. Despite record investment in the NHS, bruising encounters with the public will have left Tony Blair and his reduced number of Labour MPs aware that the electorate have concerns about the most basic issues of healthcare, such as access to GPs and hospital hygiene. In these circumstances, the attention of ministers and money will go to the issues affecting the greatest number of voters, and it is worth remembering that there are only an estimated 50,000 HIV-positive people in the UK.
Nevertheless, HIV prevalence in the UK is increasing steadily year-on-year, and more HIV-positive individuals are taking anti-HIV therapy. This is putting an increasing strain on some health budgets, with HIV treatment taking up a disproportionate amount of some drug budgets in areas with high HIV prevalence. This could mean that health ministers will have to make some potentially unpopular decisions about restricting the ability of doctors to prescribe drugs on the grounds of cost.
In an attempt to be proactive, the latest draft treatment guidelines of the British HIV Association mention, for the first time, the price of drugs as a factor for doctors prescribing treatment. However, there is a fear that in the future the Department of Health could issue much more stringent guidelines on which drugs doctors are allowed to prescribe on the basis of cost.
Waiting times
The increasing number of people with HIV in the UK means that specialist HIV clinics are busier than ever before. When compared to waiting times for other chronic disease specialists, it is generally easy for HIV patients to get an appointment to see their HIV consultant. But many clinics are reporting that they are finding it increasingly difficult to cope with increasing patient numbers, and many sexual health clinics are still having to turn away patients on a daily basis. Could waiting times targets become an issue for HIV clinics like for the rest of the NHS?
HIV prevention
A year into their first term of office, Labour announced that the UK was to have a national HIV and sexual health strategy. This materialised mid-way through the second term. However there has been criticism from politicians of all parties, as well as HIV professionals and charities, that the government has not done enough to prevent neither HIV infections nor increases in the rate of sexually transmitted infections.
Still, the government has acted by providing £10s millions of additional funding for sexual health, and somewhere in the in-tray of the new pubic health minister will be plans for a national campaign designed to increase awareness about sexual health and HIV.
Routine HIV testing
Many HIV physicians and prevention workers are also hoping that the new public health minister endorses recommendations in the latest British HIV Association guidelines that HIV testing should become more routine without a requirement for specialist pre-test counselling. Just before the election Johnson, in an interview with Positive Nation magazine, rejected such proposals. She argued that HIV should always be a special case.
This was believed to be another example of Johnson’s failure to understand HIV. Approximately half of all AIDS deaths in the UK are amongst individuals diagnosed with late stage HIV infection, and most of these individuals had seen a health professional with symptoms suggestive of HIV before their diagnosis. What’s more, diagnosing and treating HIV reduces the chances of an individual transmitting HIV.
Too biological
It is not just the public health minister who will have to consider HIV in the next parliamentary term. Ministers in the education department will also have to take action on sexual health education
In the first eight years of office Labour did much to generally promote the equality of gay people. Many HIV prevention workers are nevertheless concerned that gay teenagers leave education without the skills to protect their own sexual health, and want action to address this. General sex education in schools has also been condemned as being too superficial and biological.
Are you thinking what I’m thinking? Not really
Immigration was one of the key pillars of the Conservative election campaign this year. Just before the election was called the Conservatives announced that they would introduce mandatory HIV and tuberculosis screening for all migrants from outside the European Union.
A similar plan was considered Labour a year earlier, and rejected as unworkable. Still, there are hints that it may well resurface as an issue. On the day after the election outside 10 Downing Street, Prime Minister Tony Blair acknowledged that immigration was a concern for the British electorate and promised to take action, aware that Labour had lost some of its traditional support to the Tories over the issue.
A recent study in the British Medical Journal showed that 95% of heterosexuals with HIV in the UK originated from another country, mainly sub-Saharan Africa. However, a recent study found that most HIV-positive migrants to the UK are unaware of their health status when they enter the country, and there is no substantial evidence of HIV-positive individuals travelling to the UK to access free NHS treatment for HIV.
Tough on HIV criminals?
During its first term in office, Labour ministers in the Home Office decided not to implement proposals from the law commission to make deliberate, but not reckless transmission of HIV a criminal offence.
Since then, things have moved on. In the past couple of years number of successful prosecutions for reckless HIV transmission have been brought by the Crown Prosecution Service (CPS), which acts independently from ministers and politicians. These prosecutions have been brought using existing offences against the person legislation.HIV community organisations have expressed their concerns about the prosecutions and are currently in consultation with the CPS.
One way to stop the current wave of prosecutions would be to revive the proposed legislation to make deliberate, but not reckless transmission a crime. Although this option is supported by some HIV community organisations, others fear that it could actually make the situation worse.
International HIV aid
The UK is the second biggest contributor to international HIV aid after the US. International Development Secretary, Hilary Benn, is widely admired for his commitment to improving access to HIV treatment and care in resource-limited countries. Just before the election Benn announced that the government was increasing its funding for research to find an HIV microbicide.
In recent years, the UK has met shortfalls in funding for HIV prevention and reproductive health projects, caused by the withdrawal of US money for ideological reasons.
Chancellor of the Exchequer, Gordon Brown, widely expected to take over fro Tony Blair as Prime Minister at some point in the next parliament, has been a champion of international development for some time. Earlier this year he made a visit to areas of Africa hard-hit by HIV, prompting him to call for rich nations to provide £5.5 billion a year for the international fight against AIDS.
But the government has also been criticised for its international HIV efforts. When Benn returns to his office this week he will be aware that just before the election an all party committee of MPs suggested that UK funds to help tackle HIV in poorer countries are often not reaching those most in need.
All this means that HIV will remain firmly on the agenda throughout Labour’s third term in office.