Frequently asked questions
Fast-Track Cities first launched worldwide on World AIDS Day 2014 in Paris. London signed up on January 2018. It focuses on translating global goals, objectives, and targets into local plans and actions. The initiative builds upon strengthens and adds leverage to already existing HIV related programmes and resources.
What is Fast-Track Cities?
On 10 January 2018 London signed the Paris Declaration on Fast-Track Cities Ending the AIDS Epidemic. Fast-Track Cities is a global initiative to end the HIV epidemic by 2030.
The ambition is to cut rates of new HIV infection in the capital and eliminate discrimination and stigma associated with the condition.
By signing up to this initiative the Mayor of London has committed to work with London Councils, NHS England, Public Health England and London’s HIV community to:
- Build on the amazing work London has done to reach and exceed the United Nation (UN) AIDS targets of 90:90:90 – 90 per cent of people living with HIV knowing their status, 90 per cent of people living with HIV on treatment and 90 per cent of people on treatment with suppressed viral loads
- End AIDS by 2030
- End HIV-related stigma and discrimination
- Stop preventable deaths from HIV-related causes
- Work to improve the health, quality of life and well-being of people living with HIV across the capital
How is London doing?
London has exceeded the UN’s targets of 90:90:90 and the more challenging ambitions of 95-95-95, with 2017 figures now confirmed at 95-98-97:
- 95 per cent of people living with HIV infection diagnosed
- 98 per cent of people diagnosed receiving treatment
- 97 per cent of people receiving treatment being virally suppressed
Nevertheless HIV remains an important problem in London, with the infection impacting on Londoners more than any other part of the UK.
2017 facts and figures:
- Estimated 38,600 people were living with HIV in London (diagnosed and undiagnosed)
- 2,000 people are unaware of their infection
- Estimated 1,549 Londoners were newly diagnosed with HIV (39 per cent of new diagnoses in England)
- Diagnosed prevalence rate of HIV in London was 5.7 per 1,000 residents (aged 15-59 years) compared to 2.3 per 1,000 in England as a whole
- 63 per cent of all new diagnoses in London were in men who have sex with men, followed by heterosexual contacts (33 per cent)
- 34 percent of those newly diagnosed were diagnosed late
If London is already doing well, why do we need to do more work?
For many Londoners HIV remains a stigmatising condition that negatively impacts on quality of life. The UK Stigma Index 2015 found that despite some shifts in public attitudes, a considerable number of people in the UK still held stigmatising attitudes towards people living with HIV. Internalised stigma was common, with around half of participants reporting negative feelings related to their own diagnosis of HIV in the last year.
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.
Late and undiagnosed infection rates in London remain unacceptably high (34 per cent and 10 per cent respectively) and with considerable geographical variability across the city. Currently, there is wide variation in the rate of late diagnosis across London and among different demographic groups, with disproportionately high rates among black and ethnic minority (BAME) communities in poorer areas of the city.
The number of people living with HIV in London is growing, effective treatments (anti-retroviral therapy) mean that more people are now living with HIV and are growing older, this coupled with ongoing new infections means that the numbers of people living with HIV in London has never been higher; many are getting older and have specific and complex health and care needs. Improving the health, quality of life and well-being of people living with HIV requires significant additional work. Quality of life for people with HIV is below that of the general population, mental health problems are more frequent and HIV associated stigma continues to blight the lives of many people with HIV. Delivering effective models of care for HIV in the longer term is becoming increasingly important and is so far poorly understood.
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.
How will Londoners benefit from the Fast-Track Cities Initiative?
The Fast-Track Cities Initiative will bring together all the organisations and communities with roles to play around HIV to work together to agree a joint action plan on what more London needs to do to address HIV. The action plan will recognise and complement all the work that is already in progress across London on HIV and where it might be useful to link programmes and projects up to share good practice.
London will also join the global network of cities, all working to a common purpose. This will be a major opportunity to share expertise and learning to further accelerate progress locally and globally. Having a shared vision and strategy for London may also help to galvanise additional funding to support additional HIV efforts.
What has the London Fast-Track Cities initiative done since signing the declaration?
We have established a Fast-Track City Leadership Group that includes membership from all of the partners and the HIV community and voluntary sector. We have begun to engage with a wide range of organisations to develop a roadmap and an action plan which will outline how London will reach the Fast-Track City targets.
London also has 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.
What are the recent ‘large falls’ we have seen in new HIV diagnoses in some London clinics?
The number of MSM resident in London newly diagnosed with HIV fell by 30 per cent between 2015 and 2016. Within London, the decline in new HIV diagnoses was most apparent in five large clinics where the number of MSM testing HIV-positive fell by 35 per cent (not all were London residents). Collectively, these clinics have been referred to as ‘large fall’ clinics and comprise Dean Street, Mortimer Market, Homerton, St Mary’s and St Thomas’s. These five clinics reported 28 per cent of all the new HIV diagnoses made in MSM in England in 2016. Elsewhere in London, HIV diagnoses made in MSM fell by 18 per cent in 2016. Within London, the steepest decline was observed among MSM aged 15 to 24 years.
Who is most at risk of HIV in London?
In 2016, 64 per cent of all London residents with a new diagnosis of HIV were men who have sex with other men and people of black African heritage represented 21 per cent of all newly diagnosed London residents. A small proportion of new diagnoses in 2016 were in black Caribbeans (4 per cent).
It is estimated that in London, 2,100 MSM and 600 people of black African heritage living with HIV Infection remain undiagnosed. Heterosexual contact was the second largest infection route for HIV among London residents in 2016 (33 per cent). Londoners born in Africa accounted for 51 per cent of all heterosexually acquired infections in 2016 compared to 70 per cent in 2007. Infections in Londoners born in the UK accounted for 21 per cent of all heterosexually acquired infections in 2016. Injecting drug use accounted for only a small proportion (<1 per cent) of new diagnoses in London. The number of people newly diagnosed with HIV was highest in the 25-34 year age groups in men and the 35-44 year age groups in women in 2016.
How is the Fast-Track Cities initiative supported and funded?
Healthy London Partnership acts as the host and provides the support to deliver the Fast-Track Cities initiative. The International Association of Providers of AIDS Care (IAPAC) provides technical and logistical support to all cities that join the initiative, and will work closely with London to provide development support.
NHS England (London) has provided £6 million funding to deliver on the priorities in the strategic roadmap. This funding is in addition to, and not to replace or duplicate, statutory funding that supports existing HIV services and programmes.
London Councils have also extended funding for the London HIV Prevention Programme for a further 3 years to the value of £3 million. This will secure the continuation of the ‘Do It London’ campaign, free condom distribution, an outreach and rapid testing service for MSM (men who have sex with men), and online sexual health outreach and advice.
Why is funding for Fast-Track Cities not being used to expand PrEP access in London?
The NHS England (London) funding stream is only available for the Fast-Track Cities London roadmap work (improvement projects and anti-stigma) and could not have been used for PrEP roll out. Decisions on PrEP roll out are taken at a national level by government, and the NHS in London cannot deviate from these decisions. However, our NHS England (London) colleagues are very keen to play an active, supportive role in the Fast Track Cities partnership via this funding initiative. This represents a great achievement by securing funding to support the wider HIV agenda, prevention and supporting people living with HIV from a wide variety of communities.