Elton John welcomes expansion of opt-out testing for HIV to 46 Accident & Emergency sites across England and calls on all political leaders to do more to end AIDS in a speech at Speaker's House

Elton John was honoured at a reception hosted by the All Party Parliamentary Group on HIV/AIDS at the Speaker's House today in recognition of his enduring commitment to ending the AIDS epidemic, both personally and through the work of the Elton John AIDS Foundation.

APPG Officers with Sir Elton John photo by Dave Bennet

Earlier today, Victoria Atkins, Secretary of State for Health and Social Care outlined how the UK Government will be expanding the hugely successful NHS opt-out blood-borne virus testing programme for HIV and Hepatitis to 46 new emergency departments across England. Expansion of the programme, from the current 33 sites to every high prevalence area, could identify a significant proportion of the estimated 4,500 people living with undiagnosed HIV, prevent new transmissions and save more lives.

Addressing a packed Speaker's House, Elton John welcomed the UK Government's further roll-out of opt-out testing: "My Foundation and partners did a three-year pilot (2018-2021) in the South London boroughs of Lambeth, Southwark and Lewisham. This pioneering approach showed beyond a doubt that opt-out testing works in A&E. Automatic testing gets to people earlier, which means less HIV transmission, less illness, less death and by the estimate of health economists, £50 million saved for the NHS. So, to hear today from the Secretary of State that this work will be expanded to every high HIV prevalence area…46 new Accident & Emergency departments in local hospitals across England…more than doubling the number of HIV tests, is truly wonderful news." 

He also shared his personal reflections on the long fight to end the AIDS epidemic and called on all political leaders to do more: "Whoever wins the next general election can help to end AIDS worldwide by 2030. Starting right here at home. In the UK, new HIV diagnoses are down 46% since their peak in 2015.[1] We can be the first country in the world to defeat this awful virus. Playing our part, fulfilling the United Nations goal and showing other nations how it's done." 

"In the 1990's, I visited far too many homes where people were dying of AIDS. I remember the helpless, suffocating feeling as one after another they succumbed, not knowing if it would ever end. These memories are etched on my soul, and they taught me a lot. I saw, as millions did, images of my friend Princess Diana publicly shake the hand of a man dying of AIDS and realised a simple act of compassion is a force to be reckoned with."

"My Foundation was born the year after Freddie died. Spreading love and compassion was our compass. Leaving no one behind was our practice. 31 years later, we have achieved so much. We've raised close to half a billion pounds, funding thousands of programmes around the globe. We've funded almost every HIV charity in the UK and every major place in the NHS where you can get treatment for HIV. We've reached 100 million people globally and we've saved 5 million lives. Never did I think my Foundation's work would turn into a lifelong commitment or that so many people would need our help."

"I implore you not to waste your allotted time as political leaders. Take action and push things a little further than might feel comfortable. And as you do, I can promise you this: I will be there with you. Fighting for equal access and fair treatment. Giving everything I can for the rest of my life to ending HIV/AIDS. Because we must stay the course. I long to applaud a room like this, after this epidemic has gone."

Sir Elton John photo by Dave Bennet

With 39 million people around the world living with HIV and 1.3 million people newly infected last year, Elton John also spoke about the need for the UK to do more internationally: restoring the UK's full commitment to The Global Fund to fight AIDS, TB and Malaria, establishing new models of partnership and engagement, and protecting civil liberties.

"Abandoning ending AIDS wouldn't just be a failure for the 39 million people living with the disease. We'd be failing to prepare for whatever global virus comes next, because we know that fighting AIDS is pandemic preparedness in action. So, we should be increasing our commitment to the Global Fund, not cutting it. And if the Government is serious about ending AIDS, I call on it to fully restore the UK's commitment, to pledge £1.46 billion pounds this current three-year cycle and ensure the Global Fund is fully financed."

World AIDS Day will be commemorated on 1st December and despite advances in treatment, 630,000 people died of AIDS related diseases in 2022. Worldwide, HIV rates are rising faster among young people than in any other group and more than half of people living with HIV are women and girls. Over nine million people are not currently accessing treatment that could save their lives, all too often because shame and stigma is holding them back.

Sir Lindsay Hoyle, Speaker of the House of Commons, welcomed guests from all the major political parties and leading HIV/AIDS organisations to the event, and stated: "It is an honour to host this reception for Elton John in recognition of his work to end HIV and AIDS. Sir Elton has been an unwavering advocate in the fight against HIV and AIDS for four decades. His efforts have helped destigmatize the disease, promote education, and provide crucial support to those affected, making him a true champion in the goal to end AIDS."

Florence Eshalomi MP, Co-Chair of the APPG HIV/AIDS, also welcomed the Government's announcement and praised Elton John for his ongoing work: "We are delighted that the Government today has taken concrete steps to increase and normalise HIV testing in the UK. The APPG believes that as Parliamentarians, we should play our part in addressing this epidemic and this is something we have been calling for following the successful roll-out of opt-out to extremely high prevalence areas. We also echo Elton John's comments that whilst this will have a very real and significant impact, there is still a huge amount that needs to be done to end the AIDS epidemic both here in the UK and abroad."

Anne Aslett, CEO of the Elton John AIDS Foundation, said: "The Elton John AIDS Foundation was set up by Elton at his kitchen table in Atlanta, Georgia in the 90's when all we could do for people living with AIDS was to provide food and comfort and ultimately end of life care. Thirty years on and the Foundation has raised more than $565 million for HIV/AIDS grants globally and funded more than 3,000 projects in over 90 countries. Spreading love and compassion has always been our compass; leaving no one behind our practice. We are delighted by the UK Government's announcement today to further expand opt-out testing – an approach we first piloted with our partners in Londonboroughs in 2018. This policy will keep people in care, save lives and is a crucial step towards meeting the goal of ending new HIV cases in the UK by 2030."

Sir Elton John, David Furnish, Anne Aslett photo by Dave Bennet

David Furnish, Chairman of the Elton John AIDS Foundation, said: "We have come so far towards an AIDS free future and the UK Government's decision to expand opt-out testing will ensure more people get the right care and treatment they need to live full and healthy lives. If politicians on all sides commit to the actions outlined by Elton John today, we have a real chance of achieving something incredible by becoming the first country to stop new HIV transmissions."

Victoria Atkins, Health and Social Care Secretary, said: "Less than three decades ago, HIV could be a death sentence. It was often - and wrongly - considered a source of shame, and diagnoses were hidden from friends, family and society. But today, thanks to effective treatments, it is possible to live a long and healthy life with HIV.  

Secretary of State for Health and Social Care Victoria Atkins MP with Sir Elton John photo by Dave Bennet

"The work of the brilliant campaigners and charities, including the Elton John AIDS Foundation, whose efforts have helped us get where we are today rightly deserve to be celebrated. As well as promoting prevention for all, the more people we can diagnose, the more chance we have of ending new transmissions of the virus and the stigma wrongly attached to it. This programme, which improves people's health and wellbeing, saves lives and money."

Keir Starmer, leader of the Labour Party, said: "The tireless work of campaigners, survivors, scientists, medical staff and others has meant that, for the first time, we can say that the end of the HIV/AIDS epidemic is on the horizon. We now have a world where HIV positive people can live freely and love freely, something so many people were once too scared even to dream. The incredible progress made so far, resulting in the expansion of the NHS opt-out blood-borne virus testing programme, should be widely celebrated."

Keir Starmer and Sir Elton John photo by Dave Bennet

"Sir Elton John has been a constant voice championing this cause throughout his life. He has raised millions of pounds for frontline services and saved lives by breaking down the stigma that sees lives lost in the dark. We are forever grateful for his dedication to public service, and his life-saving work. But if we are to leave no one behind, there is much still to do. An incoming Labour government will hit the ground running, because we must meet our target of ending new HIV cases in the UK by 2030. That's why the Labour Party will commission an update to the HIV Action Plan as soon as we come to government."

Winnie Byanyima, Executive Director of UNAIDS and United Nations Under-Secretary-General, said: "Over 40 million lives have been lost to AIDS. Even now, AIDS claims another precious life every single minute. The AIDS pandemic is not over, but it can be. Elton John has fought tirelessly for four decades to bring an end to this terrible disease and to the injustices which drive it; now it is politicians who must act and put in place the programmes and policies needed to support communities both domestically and internationally to end AIDS for all."

For further information, images and b-roll, please contact:

mary.pavlu@eltonjohnaidsfoundation.org; jess.ord@eltonjohnaidsfoundation.org

Co Chair - Florence Eshalomi MP speech honouring Sir Elton John

Good evening everyone and thank you to the Secretary of State for those words. I’m Florence Eshalomi, the Member of Parliament for Vauxhall since 2019. I’ve been Co-Chair of the All Party Parliamentary Group on HIV and AIDS since 2021.

Co chair Florence Eshalomi MP speaking in honor of Sir Elton John

It’s such an honour to be here in Speaker’s House and to be joined by a true pioneer of global HIV campaigning. Thank you to Sir Elton for being here and to Mr Speaker for hosting us. 

You’ll forgive me for starting with some acknowledgements of the people that have made tonight possible.  

My co-Chairs of the All Party Parliamentary Group – the Rt Hon David Mundell MP, Steve Brine MP and Baroness Liz Barker.  

I would also like to thank our Senior Policy Advisor for his incredible work in putting this event together. Thank you Mark Lewis.

Lastly, members and supporters of the APPG – past and present – for their commitment and dedication to our shared cross-party goals. Because of them, the Group is a positive force for raising awareness, promoting understanding, and influencing policy on issues related to HIV and AIDS. 

As part of this work, I visited University Hospital in Lewisham last year with Parliamentary colleagues and the Terrence Higgins Trust. That day we saw the work of the Elton John AIDS Foundation in action, during an opt-out HIV testing pilot in its emergency department.  

It was clear from my conversations with clinicians that opt-out testing is a simple and effective way of reaching people who would not get tested through any other route. 

They told me about the range of people that had taken up the offer whilst in A&E. The oldest of these was an 85 year old woman who tested positive. This shows that opt-out testing works.

By reaching these demographics we will gain a deeper insight into HIV prevalence than we’ve ever had before.

I’m a proud South Londoner, and I’m even prouder to represent my home constituency of Vauxhall. I have been an advocate on HIV issues for many years, and I first took up the work because I could see that misinformation and stigma were causing undetected harm in my local area.

The facts show that HIV in South London has a majority black, majority female, face.  More than 50% of all HIV cases in the pilot came from black communities. And within heterosexual transmissions, over two thirds were women.

But black, heterosexual women are not likely to think of themselves as being at risk. This is partly because of the outdated stereotype which still associates HIV in the UK with white homosexual men.

Heartbreakingly, over 60% of cases in the pilot were in people with advanced HIV. They were unaware that they needed immediate treatment. But through the power of opt-out testing, they were found.

photo by Dave Bennet

And in the years to come, hundreds more will be found across the country. That is why this work remains so important.

So I welcome the announcement by the Secretary of State, that this program will be further expanded in England, not just for HIV but for Hepatitis B and C too.  

Together, these three diseases are hiding in plain sight. Their consequences are devastating. Treatment is costly and often highly complex.  

But finding people early, getting them onto lifesaving medication, and preventing further infection benefits people everywhere.

I will end by saying that we must keep up the momentum started by the efforts of so many people in this room. By doing so, we will continue to save lives.

Our next speaker is my boss – so please be nice to him. He was also the first UK Party Leader to endorse the HIV Commission’s call for opt-out HIV testing in all high prevalence places.

It is my immense pleasure to introduce the Leader of the Opposition, Sir Keir Starmer. 

APPG visit to Cardiff

The All Party Parliamentary Group (APPG) on HIV and AIDS paid a special visit to Cardiff to meet clinicians on the frontline of sexual healthcare.

Baroness Liz Barker (centre), a member of the House of Lords, travelled to Cardiff Royal Infirmary (CRI) on Friday, June 23 to find out more about the innovative work of colleagues in Cardiff and Vale University Health Board and the Fast Track Cardiff and Vale programme.

After being given a tour of the clinic, Baroness Barker spoke to team members in HIV and AIDS treatment and prevention and learnt about some of the pioneering initiatives making a difference to patients in Wales, including Texting for Testing (T4T).

T4T began as a pilot in one GP cluster in south Cardiff and involved sending a text message to all adult patients, encouraging them to find out more about HIV testing and offering them a free test to do in the privacy of their own homes.

It was found to be effective in increasing testing rates, particularly among people who were at identifiable risk of HIV transmission but had never tested previously, or not recently.

The APPG also heard about the work of clinical director, Dr Rachel Drayton, who has been instrumental in reducing the health board’s carbon footprint through successful new initiatives.

One innovative scheme she helped implement involves patients being given the choice of having their bi-annual routine HIV monitoring blood tests taken at their local GP surgery, rather than at Cardiff Royal Infirmary, to minimise unnecessary travel and empower patients at the same time.

Following the clinical conversations between Baroness Barker, the HIV consultants and Cardiff and Vale University Health Board’s executive director of public health, Fiona Kinghorn, the group travelled from CRI to the Pride Cymru offices for a round table event featuring some of the most influential people in HIV treatment and prevention.

The round table discussion featured many prominent figures on HIV and AIDS treatment and prevention

Those in attendance included Fast Track Cardiff and Vale Secretary, Lisa Power, Pride Cymru chair Gianpiero Molinu, Rhys Goode Welsh Director and THT, leading clinicians, Zoe Cousins from Public Health Wales and vice president of the Royal College of Physicians, Dr Olwen Williams.

Baroness Barker, co-chair All Party Parliamentary Group HIV and AIDS, said: “To hear first-hand at what is happening in Wales when it comes to its response to HIV was encouraging. The expansion of HIV testing free all year round and access to PrEP outside of Sexual Health Services were specifically interesting.

“The dedication and the hard work of the clinical staff at Cardiff Royal Infirmary, Public Health Wales, Fast Track Cymru, THT Cymru, Pride Cymru and others shows what can be done in ending new transmissions of HIV. The HIV Action Plan shows that.”

The forgotten 50% living with HIV.

The forgotten 50% living with HIV.

Women make up a third of people living with HIV, with an estimated 31,000 women living with HIV in the UK and 20 million world wide.

As a group, women do not experience the best HIV outcomes. 43% of women diagnosed in England in 2020 for the first time were diagnosed with HIV late. Late diagnosis of HIV is associated with poorer health and outcomes. Women are also not experiencing the same rates of decrease in new diagnoses as other population groups.  

In 2021, 556 women were newly diagnosed with HIV for the first time in England, accounting for 27% of all new first-time diagnoses. Excluding unknown exposure risk, the vast majority of these cases (96%) were likely due to exposure during heterosexual contact. The number of new diagnoses dropped by just 1% compared to 2020.

Black African women accounted for 38% of all women diagnosed (new diagnoses increased by 6%), followed by White women accounting for 15% (new diagnoses increased by 9%, 7 cases). All ethnicities saw small increases in new cases, apart from Black Other and ‘Any other’.

Take the HIV prevention pill, PrEP. It’s a game-changer, yet it’s not on the radar of the majority of women. Cisgender women accounted for just over 1 per cent of the more than 26,000 people enrolled, with very few Black women – who account for almost 40 per cent of new HIV cases among women. 

In a recent report “NotPrEPared” published by National AIDS Trust, Terrence Higgins Trust, PrEPster, Sophia Forum and the One Voice Network, found that not a single local authority in England reported more than five women using their PrEP services. If we are to end new transmissions of HIV by 2030, this must change.

Globally, the picture is much harsher.

New infections occurred disproportionately among young women and adolescent girls, with a new infection every two minutes in 2021 as reported by UNAIDS. The gendered HIV impact, particularly for young African women and girls, occurred amidst disruption of key HIV treatment and prevention services, millions of girls out of school due to pandemics, and spikes in teenage pregnancies and gender-based violence. In sub-Saharan Africa, adolescent girls and young women are three times as likely to acquire HIV as adolescent boys and young men. 

We know what works.  That is community-led, people-centred services; the upholding of everyone’s human rights, the removal of punitive and discriminatory laws, the tackling of stigma; the empowerment of girls and women; equal access to treatment including new health technologies; and health services, education, and social protection for all.

This is the time we must step up not only at home but globally.  If we are to win this prize of no more AIDS related deaths and new transmissions of HIV by 2030, the UK Government along with Governments around the world must show courageous leadership.

Together we can end this epidemic that started 40 years ago.

Baroness Barker, Co-Chairs All Party Parliamentary Group HIV and AIDS

Lecture by Lord Norman Fowler on the Challenge of AIDS. UNAIDS, Geneva, November 2022

For me this is something of an anniversary . It is almost 40 years to the month that I came to Geneva to discuss an issue causing increasing alarm and concern  throughout the World – HIV and Aids. I still have the records of that meeting . As my wife will confirm I do not throw away papers lightly . At that moment in 1986 some 36,000 cases of Aids had been reported from 75 countries – but as the excellent Jonathan Mann said (with considerable understatement ) many reports were not reliable .  The WHO’s estimate of the scale of the epidemic was 100,000 cases and forecast a toll of anywhere between 5,000 to three million deaths within five  years . We were at the foothills of one of the worst epidemics to effect the world .

What I remember most clearly of those years was our impotence in helping people who had contracted HIV. There were no drugs; no medicines. Contracting HIV was almost certainly a death sentence. I remember at the beginning of December going to Berlin and meeting a consultant who had lost 8 patients in the last 2 weeks.  Everywhere I went I met doctors and nurses working under the strain of knowing that there was nothing they could do but provide the best possible care- care not cure .

The United States who had one of the most serious challenges  was a prime example of what was  happening . In Los Angeles I went to the leading hospital there. There was one large ward which was  full to  capacity with young men all of whom were infected.  I was introduced there to a shipping clerk and for the benefit of the television cameras we were pictured shaking hands.  The idea was to show that Aids was not infectious and could not be contracted in the same way as the common cold. It was the prelude to a much more influential photograph which went around the world of Princess Diana doing the same a  month or two later in a London hospital. The aim was to fight some of the ignorance and prejudice which surrounded this whole area.

For those who were already infected the challenge was to provide the best possible care and I pay tribute to the doctors and nurses who so often provided this . The much bigger task in terms of numbers was  to prevent the many millions of others in the public from contracting it . You might have thought that such a policy of prevention – using all the devices of modern communications then available  –television, posters, newspaper advertisements - would have been universally welcomed.  Not so I fear. There were counter arguments . A popular argument was that this was not a public health crisis but a so called moral one . Homosexuality  was condemned ; and much of the public health measures with it . The chief Rabbi in Britain said the campaign “tells people not what is right but how to do wrong and get away with it – like sending people into a contaminated atmosphere but providing them with gas masks and protective clothing, or instructing thieves how to escape being caught”.  A   much supported solution on both sides of the Atlantic was that all those infected should live in total isolation – flying in the  face of everything we knew even then about how HIV was passed on .

Another policy was to ignore that there was a problem at all. When I went to the United States no one I met could recall a single word that President Reagan had uttered about the challenge of Aids. In Britain Mrs Thatcher was better than that but was not an enthusiast of my health campaign – I could put it stronger than that.   In the main we managed to go around the Prime Minister.  Broadly she took the view that the publicity was introducing the subject to many teenagers who new nothing of it.  If in the implication was that this would lead to an increase in infection it was wide of the mark – not only HIV came down but so did sexually transmitted disease generally.  Giving some proof oft the effectiveness that advertising can have.

Now the easiest thing for me to say at this point is that all this is just history . But it would not be true . First and most obvious the prejudice - not just of the public but of political leaders and politicians - continues to this day . Why else do we have a position where  68 countries criminalise gay men - a disastrous policy if your aim is to reduce infection.   It is an obvious barrier to men coming forward for testing.

But for those of us campaigning against such restrictions seem some encouraging signs.   I remember being in India a few years ago and being told that Britain was responsible for the prejudice against the gay population and there was some justice in the charge then.  But look at the position in Britain today.  The laws against homosexuality have been long-scrapped but what is significant is how rights have been extended most notably to enable equal marriage.  The position is not perfect but a small revolution has been achieved with overwhelming political support.  What we now need are many more small revolutions.   

So let us be frank .   Although we have made fantastic progress since those days, thanks to the efforts of clinicians, nurses, researchers and organisations crossing national borders like UN AIDS we face today fresh crises.

AIDS is the deadliest pandemic of our time. 36 million people have so far died from AIDS-related illnesses – 36 million.

AIDS is an emergency with deaths continuing at a rate of 650,000 people a year. Every minute a life is lost to AIDS.

The fallout from COVID-19, and from the war in Ukraine, have hit the AIDS response worldwide.

The result is progress against the HIV pandemic has stalled, risks have increased, and resources for the response have shrunk.

The Global Fund for AIDS, TB and Malaria reported that HIV testing fell by 41% across 502 health facilities in Africa and Asia. Harm reduction services for people who use drugs were disrupted in nearly two thirds of 130 countries UN AIDS surveyed.

Over 168 million children have lost access to school for at least a year. 11 million girls may never return to school. Surges have been reported in gender-based violence, forced child marriages, and teenage pregnancies. In a UN Women Survey, 7 in 10 women said they think the COVID-19 pandemic has increased domestic violence.  Almost 1 in 2 women reported that they or a woman they know experienced violence since the COVID-19 pandemic. Calls to helplines have increased five-fold in some countries during the pandemic. These factors increase girls and women’s risks of acquiring HIV.

Violence against and harassment of LGBT people has increased, as has stigma and discrimination against marginalised communities. In such a context, LGBT people are pushed further away from vital health services. These factors increase LGBT people’s risk of acquiring HIV.

As the HIV response still reels from the COVID-19 crisis, now the war in Ukraine has dramatically increased across the world the cost of living including food prices, worsening food insecurity for people living with HIV, making them much more likely to experience interruptions in HIV treatment.

Debt repayments for the world’s poorest countries have reached 171% of all spending on healthcare, education and social protection combined, choking countries’ capacities to respond to AIDS. Domestic funding for the HIV response in low-  and middle-income countries has fallen for two consecutive years.

In 38 countries, new HIV infections are actually rising.

Eastern Europe and central Asia, Middle East and North Africa, and Latin America have all seen increases in annual HIV infections over several years. In Asia and the Pacific – the world’s most populous region – UNAIDS data now shows new HIV infections are rising where they had been falling. Climbing infections in these regions are alarming. In eastern and southern Africa rapid progress from previous years significantly slowed in 2021.  There is some positive news, with notable declines in new HIV infections in western and central Africa and in the Caribbean, but even in these regions, the HIV response is threatened by a tightening resource crunch.

Stalled progress meant approximately 1.5 million new infections occurred last year – over 1 million more than the global targets.

Progress in ensuring all people living with HIV are accessing life-saving antiretroviral treatment has also stalled. The number of people on HIV treatment grew more slowly in 2021 than it has in over a decade.

That is some list of what is going wrong.  But it is not a counsel of despair, it is call to action. We have come a very long way in the last 40 years.  No longer is HIV something like an automatic death sentence.  The advances in antiretroviral drugs mean that people who are infected can live long lives like the rest of us.  We can end AIDS.  We know how this can be done.

So we are not remotely in the same position as we were when I was a minister.  But let me pick out three challenges where today the need for progress is particularly urgent. 

The first is the education of girls and young women.

One thing which has certainly changed since the early days is the position of girls and young women One key component required for the end of AIDS is the education and empowerment of girls. For years past we have been used to conduct much of the political discussion in terms of men = when in fact it is a challenge which effects women just as profoundly – a position that goes little recognised in the general discussion.

Right now, around the world, an adolescent girl or young woman acquires HIV every two minutes. Six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among girls. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%. When this is reinforced further with a package of empowerment support, their risks are also reduced.

It’s key that all children – including those who dropped out in COVID and those who were out of school even before COVID – get to complete a full secondary education, and that this includes comprehensive sex education and girls’ empowerment. Yet as countries struggle with the current fiscal challenges, education and health are too often amongst sectors that worldwide are suffering the biggest budget cuts.

That is why the Education Plus initiative, co-convened by UNICEF, UNESCO, UNFPA, UN Women and UNAIDS, with governments, civil society and international partners, is pressing leaders to accelerate the actions and investments needed to ensure that every African girl is in school, safe and strong. 

That is point one – point two is to recognise that marginalisation and discrimination perpetuate pandemics. Laws that punish consensual same sex relations, in addition to contravening the human rights of LGBT people, are a significant obstacle to improving health outcomes, including in the HIV response. Such laws help to sustain stigma and discrimination against LGBT people and are barriers to LGBT people seeking and receiving healthcare for fear of being punished or detained.

When people fear the state, many will hide from it. When people fear public shaming, many will seek to prevent themselves from being seen.

68 countries still criminalise gay men. The repeal of all such laws worldwide will help the world end AIDS.

The data proves that the maintenance of punitive laws is hurting countries’ ability to end the AIDS pandemic.

In countries whose laws criminalise them, gay men have at least twice the risk of acquiring HIV compared to countries which do not. This applies even when such laws are not operationalised into arrests.

Countries that criminalize gay men saw less progress towards HIV testing and treatment targets over the last five years — with significantly lower percentages of people living with HIV knowing their HIV status and achieving viral suppression than in countries that avoided criminalization.

In times of crisis, some in power have shown a tendency to treat human rights as “in the way”. But the evidence is clear: human rights are not only intrinsic, but they are also the very means by which governments can successfully beat a pandemic.

Vibrant independent human rights organisations are vital as advocates for reform, in bringing rights violations to judicial, political and public attention, and in strengthening accountability. We will beat AIDS by valuing the rights and dignity of every person. Decriminalisation saves and changes lives.

So my third point is that we can end AIDS, if leaders act courageously.   On current trends, we will miss the UN target of ending AIDS as a public health threat by 2030, resulting in additional AIDS-related deaths. But there is no inevitability that we stay on current trends. We can end AIDS, by 2030, as promised. Last year leaders agreed a roadmap, set out in the Political Declaration on HIV and AIDS.

The manifesto to achieving  success includes the empowerment of girls and women, and it includes the removal of punitive and discriminatory laws.

But it also includes international cooperation and support. But sadly at this moment too many high-income countries are cutting back aid, and resources for global health. In 2021, international resources available for HIV were 6% lower than in 2010. When you exclude the United States (whose contribution has been the most generous) international assistance for the AIDS response from other bilateral donors has plummeted by 57% over the last decade.

And wealthy countries need to remember what is at stake. What is at stake is hundreds of thousands of deaths and millions of new infections - all preventable. What is at stake is end of a pandemic at the end of this decade not a pandemic that goes on and on.

Beating pandemics is ultimately a political challenge. We can end AIDS by 2030 but only if we are bold in our actions and our investments. We need courageous leadership. And we need people worldwide to insist that their leaders be courageous. Whether we end AIDS is up to all of us.  It is ultimately an issue of life and death.

Note

Lord Fowler was Health and Social Security Secretary in the UK from 1981 to 1987.  He led the Don’t Die of Ignorance campaign in 1986/87 and is a past Chairman of the Conservative Party and Lord Speaker of the House of Lords.  He is now a Crossbench peer and an Ambassador for UNAIDS.

Courageous political leadership is needed to end AIDS

We have come a long way. In the mid 1980s, when I started to work on the campaigns to respond to HIV and AIDS, there were no medicines.

We were able to warn the public of the dangers. Hence the public education campaign “Don’t Die of Ignorance” which used all the means of communication which were then available, including television, posters and newspaper advertisements. That campaign helped bring down new cases.

But, at that time in the mid 1980s, HIV was an almost certain death sentence. My abiding memory of that period is of my conversations with patients who were in the last weeks of their lives and with despairing doctors and nurses who knew that at that moment there was nothing they could do to halt the infection for those who had already contracted it. All that we could provide was care.

For millions of people across many countries today, that position has been transformed. Treatment is now available and, with that treatment, people living with HIV can lead long and successful lives, and will not transmit HIV.

We have the tools. All over the world there are examples of good practice that can increase the uptake of HIV prevention, testing, and treatment services.

We can now say this: We can end AIDS.

And yet, in just the last year alone, 650,000 people died of AIDS-related illnesses and 1.5 million people became infected with HIV. So why are people still dying of AIDS? And why are there so many new HIV infections year after year?

The COVID-19 crisis, the Ukraine crisis, and all the financial challenges that have resulted, have knocked the response off track - impacting services and increasing risks.

The deeper challenge is that the world has not sufficiently addressed the inequalities which drive the pandemic.

That is why UNAIDS has put tackling those inequalities at the heart of its strategy to end AIDS as a public health threat by 2030 and is calling on countries to equalize access to life-saving HIV testing, treatment and prevention services.

One of the inequalities standing in the way of ending AIDS is inequality in access to education. Six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among girls. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%.

All children – including both those who dropped out in the COVID crisis and those who were out of school even before COVID – should get to complete a full secondary education, including comprehensive sexuality education. Yet as countries struggle with the current fiscal challenges, education and health are too often amongst sectors that are suffering the biggest budget cuts.

That is why the Education Plus initiative, co-convened by UNICEF, UNESCO, UNFPA, UN Women and UNAIDS, with governments, civil society and international partners, is pressing political leaders to accelerate the actions and investments needed to ensure that every African girl is in school, safe and strong.

Another inequality standing in the way of the end of AIDS is inequality in the realization of human rights. Some 68 countries still criminalise gay men. Laws which punish same sex relations, in addition to contravening the human rights of LGBT people, help to sustain stigma and discrimination against LGBT people. Such laws are barriers to LGBT people seeking and receiving healthcare for fear of being punished or detained. The repeal of all such laws worldwide is vital to helping the world end AIDS.

In Singapore, the Prime Minister made the point in his annual policy speech when he announced the repeal of laws that criminalized sexual relations between men: Gay people, he said, were fellow Singaporeans who wanted to live their own lives, participate in the community, and contribute fully to Singapore.

The evidence is clear—protecting the safety and human rights of marginalized people expands access to HIV services, accelerating progress in the response to HIV by increasing the number of people on treatment, widening access to prevention tools and reducing new infections.

Decriminalisation saves and changes lives.

I am disappointed that the football authorities who have chosen to showcase the World Cup in Qatar, and the political leaders taking part, are not highlighting more directly the important public health and human rights case for decriminalisation.

Just as there is a need for courageous political leadership in advancing girls’ and women’s empowerment, and the human rights of gay people, so too there is a need for courageous political leadership in international cooperation in the fight against AIDS. Currently, at a moment when international solidarity and a surge of funding is most needed, too many high-income countries are cutting back aid for global health. In 2021, international resources available for HIV were 6% lower than in 2010. And when you exclude the United States whose contribution to the global AIDS response has been the most generous, international assistance for the AIDS response from other bilateral donors has plummeted by 57% over the last decade. I do not underestimate the challenges faced by donors, but wealthy countries need to remember that ending AIDS is far less expensive than not ending AIDS.

What is at stake is hundreds of thousands of deaths and millions of new infections - all preventable. What is at stake is end of a pandemic at the end of this decade, in contrast to a pandemic that goes on and on. Current trends indicate we will miss the UN target of ending AIDS as a public health threat by 2030 but there is no inevitability in that.

Beating pandemics is ultimately a political challenge. We can end AIDS by 2030 but only if we are bold in our actions and our investments. We need courageous leadership. And we need people worldwide to insist that their leaders be courageous. Whether we end AIDS is up to all of us.

/ENDS

Lord Norman Fowler, an ambassador for UNAIDS, former Health Secretary, former Lord Speaker and current Vice Chair of the APPG on HIV and AIDS.

Quality of life and for those living with HIV.

38.4 million people living with HIV and growing – But what’s does quality of life mean for them.

Today the All-Party Parliamentary Group HIV and AIDS publishes its report “ HIV and Quality of Life – What do we mean? And how to we achieve it?” during the HIV Outcomes World AIDS Day 2022 event, launch of HIV Outcomes Policy Asks.

Since the discovery of HIV at the beginning of the 1980s, it has been one of the greatest global health problems. HIV and AIDS places an increasing burden on the health of the population, and causes further socioeconomic problems for individuals, families, communities, and governments in many countries.

Thanks to significant improvements in scientific understanding, medical innovation and clinical management of HIV for many people in the developed world, HIV is now considered a manageable chronic condition. With increasing numbers of people with the condition living into older age than ever before, HIV is now recognised as one of the greatest health success stories in recent times.

In 2020 it is estimated by UNAIDS that 38.4 million people world wide are living with HIV, with 6.1 million people living without knowing their status.  It is also estimated that three quarters of all people living with HIV have access to antiretroviral treatment, approximately 10 million people do not. Only half (52%) of children living with HIV have access to life-saving medicine, and the inequality in HIV treatment coverage between children and adults is increasing rather than narrowing. 

The AIDS pandemic took a life every minute in 2021, with 650 000 AIDS-related deaths despite effective HIV treatment and tools to prevent, detect and treat opportunistic infections.  

The following main measures should be introduced to make progress on global targets:

o   People living with HIV are not a homogenous group; it is important that individual concerns and needs are considered when implementing measures and actions.

o   Data collection should be improved to include a greater cross-section of society, including lesbian and bisexual women, transgender and non-binary communities, ethnic minority groups, people who use drugs and people who are homeless.

o   Specific measures should be introduced to tackle areas of concern for people living with HIV such as mental health, social care, stigma and discrimination and education for healthcare professionals.

o   Universal recognition and agreement on how we define quality of life for HIV
- alongside clear national target setting to drive improvements.

o   Universal recognition and agreement on the tools that should be used and implemented to drive improvements in quality of life.

o   Annual measurements to assess improvements on a population basis.

o   Technology appraisal bodies must ensure that their appraisal methods consider the role of technological innovation in delivering improved Health Related Quality Of Life and Quality Of Life outcomes, so that their true value can be recognised and so that patients can continue to receive access to them.

o   Adopt an integrated, outcomes-focused, and patient-centred approach to long-term HIV care.

o   Combat stigma and discrimination within health systems.

Steve Brine MP Co Chair All Party Parliamentary Group HIV and AIDS

“We have come a long way in the past 40 years and with 2030 so close, now is the time to double our efforts to eliminating new transmissions of HIV, the stigma that surrounds HIV and to ensure the 38.4 million people living with HIV can live the same quality of life as those who don’t live with HIV.

As the response to ending AIDS and HIV continues into its fourth decade, our work is not just about prolonging the lives of people living with HIV. It is about ensuring that those lives are healthy, happy and fulfilled. Quality of life is not a ‘luxury’ or ‘optional extra’. It is a human right – one that is more important than ever. “

Rt Hon David Mundell MP Co Chair All Party Parliamentary Group HIV and AIDS

“Particular attention should be given to the needs of key populations. These are vulnerable or most-at-risk groups that may face specific challenges requiring targeted responses from policy makers and care providers.

Public health goals are not served by denying people their individual rights have been shown to block HIV service access and increase HIV risk.

We must reform these discriminatory laws if we are to win the fight against HIV.”

Jeff Lazarus - Barcelona Institute for Global Health (ISGlobal), Spain and HIV Outcomes Europe Co-Chair

“Whilst 2022 represented a landmark year for health-related quality of life among people living with HIV as it was included as an outcome in the new World Health Organisation 2022-30 Global Strategy for HIV, no indicator has been proposed to measure it.

Without institutionalised targets, health systems may not recognise the significance of reporting on health-related quality of life of people living with HIV. Governments should, therefore, determine how they will best gauge it and decide to do just that. I hope the UK will continue doing so, because it boasts the resources, knowledge and experience as a leader in the field.

I welcome this report with the desire that the many recommendations made will be implemented and serve beyond the borders of the four nations. The vision set out in the report underpins our current path towards a much-needed transformation of health systems into person-centred healthcare delivery models that promote optimal well-being.”

ENDs

Notes to Editor

The APPG put out a call for written evidence on 10th February 2021 and we received 23 submissions. This inquiry deals with Quality of life globally.

We understand that every country has a different health care system and therefore the recommendations will be generic that each country could adopt.

The APPG held three oral evidence session to hear from a wide range of organisations who are working on difference aspects of quality of life.

o   28.2 million people were accessing antiretroviral therapy as of 30 June 2021.

28.7 million people were accessing antiretroviral therapy as of 30 June 2021.

• 38.4 million people globally were living with HIV in 2021.

• 1.5 million people became newly infected with HIV in 2021.

• 650 000 people died from AIDS-related illnesses in 2021.

• 84.2 million people have become infected with HIV since the start of
  the epidemic.

• 40.1 million people have died from AIDS-related illnesses since the start of the epidemic.

HIV Stigma

There have been remarkable advances in HIV treatment, prevention and care in the UK. Most people on HIV treatment have normal life expectancy, and live with the knowledge that they cannot transmit HIV. Rates of new infections are falling. Yet while there is much to celebrate, people living with HIV are still twice as likely to experience poor mental health as the general population.

Stigma ruins lives. It can make us feel isolated, ashamed and worthless. It can stop us from building relationships or accessing work. It can prevent us from seeking help or treatment. It can deny people living with HIV the opportunity to live their lives to the full.

We must address the ignorance in healthcare when it comes to the U=U message. This is a strong message and all healthcare workers should be educated. It is crucial for the Faith Based Community to root out HIV stigma. That requires us to have conversations with faith leaders to preach support beyond tolerance.

These initiatives are really important, bringing more attention to the structural drivers of stigma, discrimination in different settings, and of course the multi-level interventions that we need to address them.

Information is power. The more we know and understand about stigma and what we are up against, the easier it will be to fight it.

There is still a long way to go, particularly for those who may be experiencing stigma for other reasons too.

Stigma continues to have a pervasive impact on the lives of people living with HIV, many of whom will also have a mental health problem. It’s hard enough for people to be living with a long-term health condition and experiencing a mental health problem, without having to face the judgement, shame and isolation that often surround them.

People with HIV very often come from communities already significantly affected by social and health-related disadvantage. Needs assessments should recognise the diverse experiences and needs of people with HIV, and be sensitive to the way HIV interacts with other structural needs and inequalities.

National Fertility Week

Current legislation means many people living with HIV in the UK are banned from using fertility treatment to start a family.

The law discriminates against people living with HIV when seeking fertility treatment. This is despite modern science meaning there is now no risk of passing on HIV for those with undetectable viral loads.

Many LGBTQ+ people will rely on surrogacy for starting a family and those living with HIV who want to start a family are therefore disadvantaged. These restrictions also apply to heterosexual couples with different HIV statuses in cases where they require fertility treatment AND whenever a donor is involved.

Wherever an egg is transferred from one woman to another, and wherever a man gives sperm to someone who is not their partner, the gamete provider is a donor under the Human Fertilisation and Embryology Act rules.

Due to modern HIV treatments, there is now no risk of a person with an undetectable viral load passing HIV on sexually to someone else.

Starting a family through fertility treatment is completely safe for people living with HIV. HIV medication is now so effective that people on treatment cannot pass the virus on, and have babies born without HIV. There is no medical reason for this law to exist.

Co-Chair Speaks at HIV Prevention England conference

Today (30th September 2022) Co-Chair Florence Eshalomi MP represented the APPG at the HIV Prevention England conference.

Florence Eshalomi MP spoke at the opening of the conference with Ian Green CEO of Terrence Higgins Trust, Minister Dr Caroline Johnson MP and Professor Kevin Fenton Chief HIV Advisor to the UK Government.

Read Florence Eshalomi’s speech here:

Good morning everyone and thank you Ian for that kind introduction – on behalf of everyone here, can I say thank you for your remarkable 7 years of service as the Chief Executive of Terrence Higgins Trust.

In your last six months at the helm, I know that those who are not in denial about the news will mark your massive achievements.

The way you ensured THT were the first organisation globally to take the U=U message to the masses with ‘Can’t Pass It On’ took guts and courage.

Equally, your leadership in creating the first home self-test postal service and the HIV Commission were both second to none. They will stand the test of time and be key to ending new cases of HIV. Well done.

And thank you to the team at HIV Prevention England for organising this conference today and for the invaluable work you do year-round.

HPE is a core pillar of our HIV prevention work in this country. I for one – and I know my parliamentary colleagues too – am always amazed at the impact you make during HIV Testing Week and beyond. All with such a small team.

Congratulations Caroline on your new Ministerial role. At the APPG we’re looking forward to working with you and the rest of the new Health team to take on the challenges ahead. You may be aware that the APPG was formed in 1987 bringing Parliamentarians together across the political divide to fight for the rights of people living with HIV, ensuring everyone has better access to testing and HIV prevention tools.

We’re coming together at a moment when there is a huge amount to celebrate and a huge amount more to do on HIV prevention.

I was elected as Co-Chair of the APPG on HIV and AIDS in November last year and in those 9 months, we have had many collective victories. That includes:

·     Changes to blood donations rules – first for gay and bisexual men, but then ­– with a lot more work ­– together we removed the ban on those who had had sex with people from quote “high prevalence countries”. This has allowed additional donors from Black African communities to give blood and in particular, helping people experiencing sickle cell and the like. 

·     £20 million for opt-out HIV testing in some cities

·     Ending the ban on serving in our military.

·     AND the end to the restrictions on people living with HIV working as commercial pilots.

I’m proud that members of the APPG were part of lobbying for all those changes. I know Terrence Higgins Trust, National AIDS Trust and many of you in this room were all part of these efforts.

This all contributes to the progress towards the goal of ending new HIV cases by 2030.

But HIV is not yet yesterday’s story. It is with us today in the UK and still affecting families all over the world.

The APPG believes that as parliamentarians, we should play our part in addressing this epidemic. We have an important role in ensuring that laws and policies are respectful of human rights, promote public health and to try and increase the dialogue between politicians and people living with HIV in the UK and around the world.

There are too many people lost to care, too many missed opportunities to test and the good practice we know about – opt-out testing or ‘click and collect’ in postal HIV testing services – are just not being rolled out everywhere.

Why it is only in HIV Testing Week that postal HIV testing is available to everyone in England – what about the other 51 weeks of the year?

So, going forward what do we need:

1.   Action on monkeypox.

We must do everything to prevent monkeypox from becoming endemic; Both in its own right – we cannot accept that gay and bisexual men will have to tolerate getting monkeypox and legions. But also because monkeypox is causing havoc in sexual health services, displacing vital appointments for PrEP and long-acting contraceptives. The chaos of the summer means preventable HIV transmissions and unwanted pregnancies. These will cost more than the £51 million we all urgently said were needed by sexual health services. The government cannot hide behind the public health grant – it is worth £1 billion less than in 2014 and local government has many burdens.

2.   Get opt out testing into all high prevalence areas

This week, Prof Kevin Fenton confirmed that in just 100 days HIV opt-out has diagnosed 102 people – more than one a day. A further 60 people have been returned to care. The fact it has also found 328 people with Hep B and 137 with Hep C proves the model.

But it is only in London, Blackpool, Brighton and Manchester, Minister. There are 30 high prevalence areas without this innovation. That is 100s of people not diagnosed. How is that ok? Considering A&E testing is more likely to find women, people of Black ethnicity, those who are old and those with late-stage HIV - all this costs the NHS money and exacerbates health inequalities.

3.   PrEP in primary care

Still, the HIV prevention drug PrEP is only available in sexual health services. This totally fails gay and bisexual men from rural areas, women, heterosexual Black African and Black Caribbean people and many more.

The change needed is not complex, but because it is important but never urgent for anyone in the DHSC, the need never happens, the decision is never made. Minister – if you want a quick win with little additional cost call together all those dealing with PrEP, prescription charges and GP contracting. With your political leadership, you could get this done by Christmas.

4.   Finally, get the Sexual Health Strategy out the door and get more funds to sexual health services.

As our report, ‘Nothing About Us, Without Us’ shows, Black Britons are four times more like to have an STI than the population, but much less likely to get a clinic appointment. They are also most likely to be diagnosed late with HIV. This cannot continue.

I remain an optimist. Four decades of endeavour have changed so much. The prize is within touching distance. Everyone in this room is already working hard and there is nothing we cannot do together.

As an MP elected at the last general election, I didn’t join this APPG to write reports that would sit on shelves, but to make change for my constituents, and other people living with HIV around the country.

We could be the first country in the world to end new HIV cases.

This is a prize worth winning and I’m not leaving the House of Commons until we have ended new cases of HIV.

Thank You.