Roadmap to Zero
Journey to Fast-Track Cities
Consultant Connect
Ending stigma
Improvement community
Evolving HIV care
Blood testing in London A&Es
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.
London aims to end new HIV infections, stop preventable HIV deaths and eliminate the discrimination and stigma associated with HIV.
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 Nations' 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 HIV 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
Why is this initiative important?
London carries a high proportion of the national HIV epidemic, with 40% of the total of the new diagnoses in England in 2019, being made in London.
In 2019, 37,710 people were living with diagnosed HIV in London, 35% higher than in 2008. There are approximately 2,110 people living with undiagnosed HIV.
The diagnosed prevalence rate of HIV in London in 2017 was 5.7 per 1,000 residents aged 15-59 years. This was two and a half times the rate of the rest of England as a whole. All (33) Local Authorities in London had a diagnosed HIV prevalence rate in excess of 2 per 1,000 population aged 15-59 years in 2017.
In 2017, 63% of all new diagnoses in London were in men who have sex with men, followed by heterosexual contact (33%). Thirty-four percent of those newly diagnosed were diagnosed late.
How is London doing?
London has exceeded the United Nations' targets of 90:90:90 and the more challenging ambitions of 95-95-95, with 2019 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.
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. Internal stigma was also common, with around half of participants reporting negative feelings related to their own diagnosis of HIV in the previous year.
Not only is it important to make sure people living with HIV can live their lives without discrimination, but the fear of stigma can stop people getting tested. This leads to more late diagnoses, which 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 are differences in the rate of late diagnoses 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 mean that more people are now living longer with HIV. This, coupled with ongoing new infections, means that the number of people living with HIV in London has never been higher; and many people have 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. Therefore, we are working with our clinical colleagues, people living with HIV and the HIV sector to develop a vision for HIV care for the future. Find out more about this work in Evolving HIV care.
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 has brought together all the organisations and communities with roles to play around HIV to agree a joint action plan, the Roadmap to zero.
The roadmap recognises and complements all the work on HIV that is already happening in London 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 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.
Who is most at risk of HIV in London?
In 2017, an estimated 38,600 (39,820 in 2019) people were living with HIV. 63 per cent of all London residents with a new diagnosis of HIV were men who have sex with men. Heterosexual contact was the second largest infection route for new diagnoses (33 per cent of all cases) and 52 per cent of all heterosexual cases were people of Black African heritage.
White populations represent 72 per cent of London residents newly diagnosed with HIV and Black Africans 18 per cent, which is a fall from 35 per cent in 2008.
Injecting drug use accounted for only a small proportion (2 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 2017.
Worryingly, there is still a large proportion – 34 per cent – of Londoners being diagnosed late with HIV. People who are diagnosed late have a tenfold risk of mortality within one year of diagnosis, compared to those diagnosed promptly. In London, heterosexuals were more likely to be diagnosed late, and Black Africans were more likely than the white population.
You can read the annual spotlight on HIV data from Public Health England here.
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 works 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 three 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 men who have sex with men, and online sexual health outreach and advice.
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