OPINION PETER AGGLETON
Time to act T
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(from 210 in 1999 to 1,150 in 2010) among heterosexuals who are likely to have acquired their infection in the UK. Yet ask the average person on the street and they are likely to say that HIV and AIDS have gone away, or are only problems in developing countries in sub-Saharan Africa. The last 30 years have seen major advances in the clinical management of HIV. HIV in the UK has been transformed from a serious and near inevitably fatal diseases to a chronic illness for which highly effective treatment is available. But this has not been without its cost: a lifetime of antiretroviral treatment (ART) is estimated to cost between £280,000 and £360,000. Against this background, a House of
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Lords Select Committee has recently issued a major report. Chaired by Lord Fowler who was responsible for the 1986 ‘Don’t Die of Ignorance’ campaign, the committee spent eight months examining how HIV and AIDS is being responded to in the UK. Its report concludes that spending on prevention is ‘woefully inadequate’. In 2011-12, the Government will spend only £2.9 million on national prevention programmes compared with £762 million on treatment. It is not simply the lack of spend on prevention that is concerning but the balance between the different activities that make up an effective HIV prevention package.
16 SOCIETY NOW AUTUMN 2011
While there have been major advances in the treatment of HIV, spending on prevention of HIV cases remains inadequate, argues Professor Peter Aggleton
HE LATEST FIGURES from the UK Health Protection Agency suggest that the number of people living with HIV in the UK will reach 100,000 in 2012. The same
report indicates that if the estimated 3,800 UK- acquired HIV cases in 2010 had been prevented, ‘over £32 million annually or £1.2 billion over a lifetime in costs would have been saved and the impact of HIV on the most affected communities substantially reduced’. Among those most affected are gay and other men who have sex with men. After almost doubling in the last decade, 2010 saw the largest ever annual number of new HIV diagnoses (3,080) among such men. Heterosexually acquired infections (a cumulative total of 53,000 cases) increased rapidly from 1999. The vast majority of such infections were diagnosed among those born abroad but, since 2003, there has been an increase in diagnoses
Ask the average person on the street
and they are likely to say that HIV and AIDS have gone away
It is now well established that an effective set of measures to prevent HIV must be multi-faceted and substantial in scope. Single ‘magic bullet’ interventions simply do not work. Achieving and sustaining behaviour change (or in many cases the consolidation of existing behaviours that pose little or no risk of infection) is best accomplished by tackling both individual risk and broader social vulnerabilities. The latter include gender inequalities that make it difficult for women to insist on protection, and continued stigma and discrimination towards sexual minorities and people living with HIV. UNAIDS calls for a comprehensive, multi-component HIV prevention response attuned to the local epidemic, and delivered across a variety of contexts. Health services and facilities have a central
role to play in this respect, and have been heavily invested in over the last ten years. But HIV is a profoundly social disease: transmitted (in the UK) in social rather than clinical contexts, by sexual and drug-related practices that carry significance and meaning. HIV plays into the social inequalities that already characterise a community, triggering both positive (care, compassion and support) and negative (ostracism, stigma and discrimination) responses. Understanding these structured vulnerabilities and effects is central to an effective response. This is an arena in which high-quality social science has a real contribution to make – not as the handservant to biomedicine, but as an important contributor in and of itself. However, there has only been one large-scale,
UK-focused funding initiative on HIV within the social sciences – and that was supported by the ESRC over 20 years ago. In UK higher education the social dimensions of HIV remains a somewhat marginalised and specialist interest, a situation which compares unfavourably with Australia and Canada, for example, which have long-established national research centres, well networked with State and National Governments, focusing on the social dimensions of the epidemic. Here in the UK, we have been issued with a wake-up call. Now, not later, is the time to act. n
i Peter Aggleton is Professor and Head of the School of Education and
Email
p.aggleton@
sussex.ac.uk Telephone 01273 678252
Web
www.sussex.ac.uk nchsr.arts.unsw.edu.au
Social Work at the University of Sussex, and Conjoint Professor in the National Centre in HIV Social Research at the University of New South Wales in Australia
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