Late last year, London sexual health clinic 56 Dean Street made the headlines. Statistics revealed that, over the course of three years, recent HIV infections among gay and bisexual men being treated at the clinic had fallen by around 90 percent. Similar reports showed that these rates were being echoed across London, the take-away being that transmission rates had dropped among the city's LGBT+ community despite a series of clinic closures.
But now, new obstacles have been introduced. Gay Star News recently revealed that 56 Dean Street's Express service had slashed its number of bookable appointments from 350 per day to just 75.
An apologetic official statement was quickly released, alongside an explanation that London’s sexual health services are commissioned by Local Authorities rather than the NHS. These authorities have been instructing a shift towards online home testing. In response, 56 Dean Street has been "redesigned" to include a number of walk-in services (some of which are HIV-specific, others of which aren't), as well as Hepatitis and HPV immunisations.
Despite these outlined services, the huge drop in check-up slots is worrying – HIV diagnosis is crucial to treatment, and the stereotypes which still linger mean that women and patients above 50 are often not advised to get tested. This has led to increased transmission rates among older people and the wider invisibility of women living with HIV, despite the fact that one in three UK patients are women. A recent campaign, "Invisible No More", aimed to highlight this statistic, as well as others which show that almost half of these women live below the poverty line.
Funding is undeniably crucial, but these are likely problems which run deep. When VICE reached out to 56 Dean Street, the clinic was unable to offer more than the original press statement, which ends with an apology: "Demand for our services is significantly higher than the number of appointments we are funded to offer. We're aware of some of the frustration that our users are experiencing. We are really sorry about this and want to reassure the community that we are doing all we can to maintain access to those who need us the most and are at the highest risk."
These cuts are also impacting HIV+ people outside the UK; last year, the government was criticised for its decision to cut global HIV prevention spending by 22 percent, just as transmission rates were finally starting to drop.
It's taken a while, but medical breakthroughs have spawned preventative drug PrEP, as well as PEP, a kind of HIV morning-after pill. Better still, ART (antiretroviral therapy) is now so effective that viral load can be suppressed to "undetectable". Essentially, this means those living with HIV can't transmit the virus, even through unprotected sex.
Victories like these have been hard-fought. The commissioning of last year’s landmark PrEP trial was prefaced by widespread anger driven by conservative commentators, most of whom foamed at the mouth and dubbed it a "lifestyle drug" enabling The Gays™ to fuck freely without consequence. This nasty, insidious claim rehashed homophobic stigma written across early discussions of the virus, and shows that these funding decisions aren't just medical – they’re political.
Still, there is hope – testing at home has never been easier. Leading charity Terrence Higgins Trust (THT) have invested in a "self-test programme" (funded by Public Health England's Innovation Fund) to get more people involved. But really, how likely are we to go through the online process? Most of us find it hard to tear ourselves away from Instagram long enough to order a food shop, let alone a home testing kit.
But Taku Mukiwa, THT's Head of Social Marketing, argues that we need to feel galvanised and actually take action to protect ourselves against the risk of HIV: "One in eight people living with HIV in the UK remain undiagnosed, which means they're not accessing the treatment they need to protect their immune system. If we're to end the epidemic in this country, then tackling our rates of undiagnosed HIV is key."
Mukiwa also points to the ease and variety of home testing kits, arguing that they’re being encouraged simply because they offer new options. "There are self-sampling kits and self-testing kits. With a self-sampling kit, you take a sample of blood, send it to a laboratory and they send you the results. With a self-testing kit, you test yourself at home and read your own results within a few minutes. We're currently offering free HIV self-test kits via our website."
Small steps like these might seem inconvenient, but if the government won’t fund appointments then we need to resist complacency and work to uphold the progress that has already been made. Even a few years ago, it would have seemed unthinkable that HIV would become treatable to the point that it couldn’t be transmitted even through unprotected sex. With the right medication, the virus is no longer a death sentence – the magnitude of this fact cannot be underestimated.
"We have seen significant funding cuts for HIV services over the last few years across the entire sector, which makes what we do even more challenging," admits Mukiwa. "But last year we saw the biggest drop in new HIV diagnoses on record, and the first ever decline in new diagnoses amongst gay and bisexual men. This is a crucial time, and we must maintain momentum to end the epidemic in the UK. Now is not the time to be making cuts and jeopardising progress."