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Can Sheffield end new HIV transmissions by 2030?

In anticipation of next week’s Festival of Debate panel, Rei Takver speaks with Sheffield doctor and HIV specialist Dr Claire Dewsnap about what the city still needs to do to tackle the virus.

P Re P bottles

PReP – pre-exposure prophylaxis – is highly effective at preventing HIV and is available in the UK for free.

Sam Gregory

On World Aids Day in 2021, the government announced an ambitious plan for England to make history by being the first country in the world to end all HIV transmission by 2030. It might sound like an impossible pipe dream – but could it be possible?

To find out what it would take here in Sheffield, I spoke with Dr Claire Dewsnap, a doctor, former Clinical Lead for Sheffield’s Sexual Health Service and past President of the British Association for Sexual Health and HIV.

The picture of what it’s like to have HIV seems like it’s really changed since the 80s and 90s. How exactly has it changed?

It’s dramatic, the change. In the early days, it was a terminal diagnosis, without question. But for the last 20 years or so, we give people combination therapy, often in one tablet, and that means that the virus can be managed for decades and decades. Nowadays, if you’re diagnosed when you are well with HIV, you can live a normal life expectancy, completely normal.

Currently, HIV treatment, when taken well, can also mean your viral load isn’t detectable, and that means you also can’t pass on the virus to anyone else.

What’s the state of HIV in Sheffield today?

At least 40% of the people who are newly diagnosed in Sheffield are heterosexual and more than half of those are women. If you’re heterosexual, you’re much more likely to be diagnosed late. That’s partly because gay men are often connected into their local service that texts them regularly, but heterosexual people might go to sexual health care providers that don’t think to test for HIV. What worries me is that people who are living with HIV in Sheffield, even if they are diagnosed, will have significantly worse outcomes unless they’re engaged in a service and get diagnosed early.

I’ve heard that Sheffield is about to introduce a new programme to help get more HIV-positive people the treatment they need. How will it work?

Just after April in Sheffield, we will be offering a new opt-out HIV test service in A&E. People won’t be asked at the door of A&E, ‘Are you having an HIV test?’ If they’re having a blood test anyway, they’ll have an HIV test done. We’re hoping we’ll be able to identify people with HIV in Sheffield who don’t come to sexual health services but perhaps do have ongoing illness that they haven’t been tested for yet.

Are there any myths about HIV that you feel really need to be dispelled here in Sheffield?

We still need people to understand that just because you’ve had sex with somebody once and you haven’t got HIV doesn’t mean they don’t have HIV. So unless you know someone has had an HIV test that was negative recently you can’t assume that they don’t have HIV.

Also, we need people to know that if you come for a test and you’re negative, there are treatments we can offer you. Taking the preventative medicine tablet PrEP, which anyone can access [without prescription charge] from a sexual health service, will prevent 97% of HIV infections.

I wanted to talk about the stigma around HIV. Long gone are the days where HIV and AIDS were a death sentence, but fear and judgement remain. There have been increasing efforts to reduce the stigma and to shift some of the assumptions about who gets HIV. What do you think we’d need to do to eradicate the stigma by 2030?

Oh my days, there’s so much that needs to happen. Stigma really thrives in the shadows, and the only way to really address stigma is to have education and information about it.

For a start, we need to make sure that sexual and reproductive health education in schools is better than it is. But we also we need a programme of work to make sure people are educated in all settings – in workplace settings too. Stigma is absolutely going to work against us if we want to eradicate the virus by 2030.

How far has Sheffield come towards realising the eradication of new HIV cases?

We’ve come a very long way. Sheffield is very good at managing the people that we know have HIV. The problem is that in the last ten or so years, the funding of sexual health was disentangled from the delivery of HIV care. The budget for sexual health care has been massively underfunded. Our budgets have gone down somewhere in the region of 35%, so we of course have less staff and less capacity.

So if you can’t get in to get a test when you think you might need one, you might put it off and say, ‘Oh, I just won’t bother,’ and the next time you think about it is when you’re ill and have HIV. That’s a massive problem. Unless it gets addressed, we won’t meet the 2030 goal.

We need real focus to get this done. The city of Sheffield deserves the best, and that means we’re going to have to pull together to make it work.

Learn more

Continue the discussion at How Do We End New Cases of HIV by 2030?, a Festival of Debate panel of public health experts, activists and people living with HIV on how radical reform can end an epidemic – and what could jeopardise this historic goal being achieved. Sign up here to attend on 18 April at the Millennium Gallery.

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