How street teams and vending machines are helping to eradicate HIV

It’s been nearly six months since Mark Arthur (not his real name) got the diagnosis that he was HIV positive after doing a finger-prick test at home. But within a few months, the antiretroviral therapy medication Arthur takes has reduced the HIV viral load to an undetectable level – and he can no longer pass it on.

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Arthur, 33, lives in Brighton and Hove. The city has been hit hard by HIV. In 2017, it had the highest rates of the virus outside of London at eight per 1,000 people (aged 15-59 years), compared to two per 1,000 in England as a whole. In 2016, it was estimated that 17% of people living with HIV in Brighton and Hove had not been diagnosed, while 7% of those with an HIV diagnosis were not receiving treatment.

But efforts to tackle the issue are starting to bear fruit. In 2016, Brighton and Hove city council became the first in the UK to join the Fast-Track Cities initiative, an umbrella group of more than 300 cities across all continents that have pledged to work towards zero new HIV infections – and zero Aids-related deaths. Brighton, like the other member cities, committed to ensuring that by 2020 90% of people who have HIV know they have it; 90% of those with an HIV diagnosis receive sustained antiretroviral therapy; and 90% of those in treatment achieve undetectable HIV viral loads.

Remarkably, the city has already beaten those targets. By substantially improving access to testing, helping those with an HIV-positive diagnosis to stick to their medication, as well as promoting pre-exposure prophylaxis, a drug shown to substantially reduce the risk of contracting HIV, it estimated that by the end of 2017, just 7% of people with HIV in Brighton did not know they had it, while 98% of those in treatment had undetectable viral loads. And new HIV infections are falling – in 2016, there were 85 new diagnoses in the city (aged 15 and over). In 2018, there were just 33.

Gillian Dean, consultant HIV physician at Brighton and Sussex University hospitals NHS trust, says that one way it has improved diagnosis rates is by introducing the world’s first vending machines for HIV testing kits. Installed by HIV prevention charity the Martin Fisher Foundation, the machines are located in five venues frequented by high risk groups in the city.

Glasgow, Liverpool, London and Manchester are also Fast-Track Cities members. Since 2015, Glasgow has witnessed the UK’s worst outbreak of HIV in 30 years, with drug users and homeless people most at risk. Tackling HIV within this community is particularly difficult, but a specialist street team from Waverley Care, Scotland’s HIV and hepatitis C charity, offers rapid HIV testing to people who inject drugs. It’s particularly difficult for those are who HIV positive and homeless to attend regular appointments and stick to the medication protocol – yet since joining Fast-Track Cities late last year, only 10% of people who are diagnosed with HIV in Glasgow are not receiving treatment.

Manchester also joined Fast-Track Cities last year. Despite having one of the highest per capita ratios of people living with HIV – 6.21 per 1,000 people – it is exceeding the diagnosis and treatment targets. But late diagnosis is an issue in the city: 44% of new diagnoses come at a late stage, greatly increasing the health risks to patients, and the chance of infecting others. To tackle this, the Greater Manchester health and social care partnership hopes to become the first UK city to introduce HIV testing as standard for anyone who visits A&E, in line with 2016 NICE guidelines.

But there’s still a long way to go. Spending on sexual health services fell by 35% to £47m a year between 2013-14 and 2017-18, meaning many HIV service providers are struggling to get by on much less. And for many, – and for many, it’s still a taboo subject. Back in Brighton, Stephen Nicholson, lead commissioner for HIV, sexual health and substance misuse at the city council, says he is proud of the progress so far, but that a “great deal of work” is now under way to tackle stigma and discrimination. Arthur agrees that stigma is still a big problem and says he has even experienced it within the gay community, which has left him feeling “dirty” and supports the global U=U (Undetectable equals Untransmittable) campaign. It’s a message that’s being promoted by all of the Fast-Track Cities and one which is now emblazoned across one of Brighton and Hove’s city buses.

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Arthur says: “It feels like the conversation is starting to shift. But I have told some friends about my diagnosis – and they haven’t all known what undetectable means, so there is still a lot of work to do.”