Time to read
James Cole, Senior Policy, Research and Influencing Manager
UN Member States recently agreed to a new Political Declaration on HIV/AIDS, reaffirming their commitment to end AIDS as a public health threat by 2030. At a time when the global HIV response is facing unprecedented challenges, the UK Government’s support for the Declaration is welcome.
While negotiated at a global level, the Declaration also has clear relevance for the UK’s HIV response. Many of its priorities mirror those already reflected in England’s HIV Action Plan and HIV strategies across the devolved nations, including actions to reduce HIV transmissions, tackling stigma and discrimination, improving quality of life and strengthening the role of communities within the HIV response.
Delivering on HIV Action Plans
The UK is often regarded as a global success story in the HIV response. New diagnoses have fallen markedly over recent years, treatment outcomes remain strong, and we are among the countries closest to achieving the goal of ending new HIV transmissions.
But there is no room for complacency, and there remains much to be done to support people to live well with HIV and to end new transmissions.
Persistent inequalities continue to drive HIV acquisitions and prevent many people from living well with HIV. Late diagnosis remains a challenge, stigma continues to affect wellbeing and engagement with services, and community organisations that have been instrumental to the UK’s success are facing significant pressures.
The Political Declaration’s emphasis on the importance of community leadership, tackling discrimination, improving access to prevention and strengthening person-centred care are the same solutions that we believe are fundamental here in the UK.
For UK governments, the task now is clear: deliver. We’ve had commitments, we now need actions. That means sustained investment in prevention and testing, tackling stigma and discrimination across the board, stronger support for communities experiencing the greatest inequalities, and a recognition of the vital role played by the voluntary sector within funding models and care pathways.
Putting quality of life at the heart of the response
One of the most encouraging aspects of the Declaration is its recognition that success cannot be measured solely through transmissions averted or lives saved.
The Declaration recognises that people living with HIV are living longer, but may face ageing-related needs, multiple long-term conditions, mental health challenges, poverty and social isolation. Ensuring that people living with HIV have access to high-quality care, effective treatment and holistic support should be a core priority of the UK’s HIV response.
As we move closer to 2030, it is vital that the focus of HIV policy does not shift entirely towards prevention. Quality of life matters now and will continue to matter for as long as people are living with HIV – whether transmission targets are achieved or not. Indeed, prioritising quality of life of people living with HIV must be thought of as central to prevention strategies.
The Declaration also rightly recognises that people living with HIV need more than HIV care alone. It calls for better integration between HIV services, primary care, mental health support and care for long-term conditions. For the UK, this reinforces the case for more joined-up, person-centred care. HIV Outcomes UK’s recent briefing sets out how this could be delivered in practice through implementation of the Government’s 10 Year Health Plan. Community leadership has been recognised in the Declaration as being central – and this should reinforce the urgency for UK governments to invest in a sustainable HIV voluntary sector and fully embed community-led services within HIV care pathways (as highlighted in research from HIV Outcomes).
Similarly, the Declaration highlights the impact of stigma and discrimination on the mental health of people living with HIV. Access to timely, person-centred, HIV-informed psychological support remains inconsistent across the UK. Over the coming year, HIV Outcomes UK will research mental health service provision and advocate for the consistent delivery of the updated Standards of Psychological Support.
The Declaration also calls on governments to remove barriers to HIV services. In the UK, this means addressing the wider drivers of HIV inequalities, including poverty, insecure housing, immigration policy, stigma and discrimination. As National AIDS Trust will set out in a forthcoming report, ending new HIV transmissions by 2030 will require a cross-government response to these social, economic and legal determinants of health.
The UK’s global responsibilities
The Declaration should also serve as a clear call for the UK Government to reaffirm and strengthen its commitment to the global HIV response. The UK has historically been a global leader in HIV, and that leadership is needed now more than ever.
Progress around the world is increasingly fragile and the Declaration highlights a significant funding gap. Community-led organisations and HIV services in many countries are grappling with the consequences of unprecedented reductions in international funding, including from the UK Government.
Recognising that the UK cannot end new HIV transmissions in isolation, the UK Government’s HIV Action Plan rightly commits the Government to continue its long-standing support of the global health organisations at the core of the international HIV response. Following the cuts made to the UK’s contribution to the Global Fund, the next Prime Minister should work towards increasing our investment in key partners and international initiatives which are vital to the global response to HIV.
The People’s Declaration
While the National AIDS Trust welcomes the agreement of the Political Declaration, we were also proud to endorse the People’s Declaration on HIV and AIDS alongside hundreds of organisations worldwide.
Although the final Political Declaration contains important commitments it does not fully reflect the scale of ambition needed to respond to the unprecedented emergency that people living with HIV are facing around the world.
The People’s Declaration calls for stronger commitments on human rights, sustainable HIV financing, community leadership, gender equality, access to medicines and support for key populations disproportionately affected by HIV.
Declarations provide important foundations, outlined shared ambitions, and principles that can deliver success. But the true test will be whether governments turn these commitments into action. For the UK, that means fully implementing HIV Action Plans at home while continuing to play a leadership role in the global response abroad. The UK Government has joined the world in recommitting to ending AIDS by 2030. Now the Governments of the UK must match that commitment with the ambition, investment and leadership required to make it happen.