The Mayor of London, Sadiq Khan, signed the Paris Declaration on Fast-Track Cities Ending the AIDS Epidemic, along with borough leaders, Public Health England and NHS England on Wednesday 10 January. Their ambition is to cut rates of new HIV infection in the capital and eliminate discrimination and stigma associated with the condition.
London has already made great strides towards achieving the primary United Nations (UN) targets for the Fast-Track Cities initiative. In 2016, for the first time in London, all the UN’s 90:90:90 targets were met1 with 90 per cent of people living with HIV infection diagnosed, 97 per cent of people diagnosed receiving treatment, and 97 per cent of people receiving treatment being virally suppressed.
London is only the third city to achieve this target so far – joining Amsterdam and Melbourne.
During an event held at City Hall, the Mayor and representatives from NHS England, Public Health England and London Councils, agreed to support the initiative.
As London signs up as a Fast-Track City, the Mayor is committing to work with partners to:
- Continue work to exceed the UN’s 90:90:90 HIV targets (90 per cent of people living with HIV knowing their status, 90 per cent of people with diagnosed HIV on treatment, 90 per cent of people on treatment with suppressed viral loads)
- End new HIV infections in the capital by 2030
- Put a stop to HIV-related stigma and discrimination
- Stop preventable deaths from HIV-related causes
- Work to improve the health, quality of life and wellbeing of people living with HIV across the capital
London carries a high proportion of the national HIV epidemic. In 2016, an estimated 38,700 people were living with HIV in London1, which represents 43 per cent of all people living with HIV in England. These figures include both those diagnosed and undiagnosed. The population groups most affected by HIV are gay and bisexual men and people of black African heritage.
In 2016, the number of gay and bisexual men in London newly diagnosed with HIV fell for the first time in many years, falling by 30 per cent to an estimated 1,266 in 2016. The largest falls were seen in five specialist clinics in the capital – Dean Street, Mortimer Market, Homerton, St Mary’s and St Thomas’s – all of which deliver high rates of HIV testing and rapid access to effective treatment.
Despite this progress, there is still much more to do. For many Londoners HIV remains a stigmatising condition that negatively impacts on quality of life. Late and undiagnosed infection rates remain unacceptably high (34 per cent and 10 per cent respectively) and with considerable geographical variability across the city. Prevalence varies by ethnicity and by place of residence with disproportionately high rates amongst black and ethnic minority (BAME) communities in poorer areas of the city.
The needs of people living with HIV in London are changing and becoming more complex. Effective anti-retroviral therapy means that more people are now living with HIV and are growing older. Improving the health, quality of life and wellbeing of people living with HIV in the capital is vital. The UK Stigma Index 2015 found that, despite some shifts in public attitudes, many people in the UK still hold discriminatory views towards people living with HIV.
London’s HIV response to date includes Do It London, the pan-London prevention campaign funded by London boroughs as well as high-quality HIV treatment services delivered by the NHS. Community organisations have also been at the heart of the response to HIV. Since its launch in 2015, Do It London has promoted HIV testing and good sexual health across the capital. The current campaign phase informs the public of the variety of options now available for avoiding transmission of HIV through sexual contact.
This reflects how London is embracing effective combination preventative treatment – including innovative approaches to HIV testing, diagnosis and treatment, drugs for pre-exposure prophylaxis (PrEP) and condom distribution.
Mayor of London, Sadiq Khan, said: “Over the past year, we’ve seen a dramatic decline in the numbers of new HIV diagnoses and, for the first time in decades, ending new HIV infections in the capital is a real possibility – but we cannot be complacent. Reducing new infections is a complex issue which requires continued education, expanded testing, prompt access to treatment and the availability of preventative HIV treatment, including PrEP on the NHS.
“By signing London up as a Fast-Track City, we are taking on the challenge to end new HIV infections in the capital by 2030. We must be ambitious, and I am confident that by working together we can achieve this goal.
“As well as putting an end to new infections, I am clear that HIV-related stigma and discrimination must end too. Improving the quality of life and wellbeing of those living with HIV in London is a priority for me, which is why I’m proud to sign this commitment today.”
Cllr Kevin Davis, London Councils’ Executive member for health, said: “Improving residents’ health and wellbeing is a priority for London boroughs, which is why we are delighted to sign up to the HIV Fast-Track Cities initiative to spur on London’s fight against HIV.
“By working with colleagues across the capital we can be even more ambitious and build on the success of Do It London, the London borough-led HIV prevention campaign, and the remarkable 40 per cent decrease in HIV diagnoses seen in central London clinics last year.”
NHS Regional Director for London, Professor Jane Cummings: “London is doing very well in HIV prevention and treatment, however there is still more work to be done which is why I’m delighted to pledge our support and sign up to the Fast-Track Cities Initiative.
“We are committed to working together to improve the health, quality of life and wellbeing of people living with HIV and to eliminate stigma and discrimination.”
Professor Yvonne Doyle, London Regional Director for Public Health England, and Statutory Health Advisor to the Mayor of London, said: “I am delighted that London is joining forces with other global cities to draw on our collective expertise and keep the pressure and focus on HIV. London has a proud history of innovative approaches to prevention together with excellent treatment and care for people living with HIV.
Whilst we have seen a significant drop in new HIV diagnoses in gay and bisexual men in London there is still work to be done to ensure that this trend is seen in other population groups. To this end I am committed to work with and involve all populations in London to realise our ambition of ending new HIV infections by 2030.”
Following London’s commitment to the Paris Declaration, the next steps for the capital include establishing a Fast-Track City Steering Group and drafting an Action Plan which will outline how London will reach the Fast-Track City targets. London will also receive a Fast-Track Cities dashboard through which all cities report their progress against the initiative’s targets as well as locally set objectives and goals (www.fast-trackcities.org).
The Mayor has made tackling the stigma attached to living with HIV a key priority in his draft Health Inequalities Strategy. Not only is it important to ensure those living with HIV can live their lives without discrimination, but the fear of stigma can be a barrier to early diagnosis, which in turn negatively impacts the quality of life of those living with the condition.
Signing up to the Fast-Track Cities initiative will bring together all those already working to tackle HIV across the capital. More joint working will help to ensure that communities affected by HIV can access the prevention, testing, treatment and support they need. Currently, there is wide variation in the rate of late diagnosis across London and among different demographic groups. In 2015, black African people were more than twice as likely as white people to be diagnosed late.