Twenty five years ago today, Terrence Higgins, who worked as a Hansard reporter at the House of Commons and as a barman in the London nightclub Heaven, died isolated in his room at St Thomas' hospital, south London. He succumbed, finally, to a frightening and fatal combination of symptoms. The medics who fought to save him had no idea what they were battling, or its future global significance. The virus HIV had yet to be discovered and given the name we now know so well.
Worried friends started the Terrence Higgins Trust to disseminate quickly what information there was, and to support those affected. In the years that followed, thousands more died, and tens of thousands became infected with HIV in the UK. In the late 1980s, the Conservative government, through the leadership of health secretary Norman Fowler, launched a mass public health campaign, the scale of which has not been seen since. The whole of Britain knew of the threat of Aids.
Combination therapy
And then, 10 years later, the drugs arrived that stopped many people dying. By 1997, combination therapy was responsible for an unprecedented 70% drop in Aids-related deaths in the UK. So, job done? Actually, no.
Today, there are 70,000 people living with HIV in the UK and it's our fastest-growing serious health condition. Those most affected are gay men and African people living in the UK and diagnosed here, but probably infected in sub-Saharan Africa. A third of those living with the virus do not yet know they have it. These are the people most likely to pass it on to others.
This might seem an apt moment to reflect on what, 25 years on, we have learned and achieved. But it's not. Instead, we must focus on the next 25 years, and the 25 after that. It has become clear that, despite the best efforts of scientists and repeated optimistic predictions, it may yet take a century to discover a vaccine and a cure for HIV.
Let's spend a moment looking at our future, assuming we carry on much as we are today. Should recent epidemiological trends continue, in 25 years there will be at least 400,000 people living with HIV in the UK. Large numbers can mean very little, but think of it this way: there are 70,000 people in the UK with HIV today, and one in nine gay men in London is infected. Imagine the impact on gay men and African communities when prevalence increases. Imagine, too, the impact HIV will have on the wider population if it is allowed to take advantage of the foothold it has today. And we can be sure that it will if we carry on as we are.
We must plan to invest far greater resources than we do today on targeted prevention for those most at risk; on diagnosing those who are unaware they have HIV; on health promotion for those living with the virus; on HIV social care; and on providing the best available treatment to improve the health of people with HIV.
For those planning health services, the treatment issue is about to explode. It is true that drugs have become cheaper, and it has been argued that HIV treatment is the second most cost-effective intervention after smoking cessation. Nevertheless, new diagnoses are increasing by 10% each year, so it is of little surprise that, last year, more than half of HIV clinicians said their drugs budgets would be overspent. We won't have to wait 25 years for this particular bomb to go off.
Less than a decade ago, treatment regimes for HIV were complicated, strict and often debilitating. These days, treatments have improved immeasurably and, for now at least, clinical criteria govern their use, not cost. This must remain the case, even as demand increases, or we will rob those infected of their productivity as well as precious years of life.
Someone diagnosed with HIV today might be able to take two tablets a day and carry on with an economically useful and personally rewarding life. It's a far cry from the days when an HIV diagnosis often came with the advice to give up your job, sell your home, and go and live a little while you could. In fact, life expectancy has improved so much that for someone diagnosed now, there could easily be another 25 years of life with HIV.
If that's the reality for individuals, why are we still collectively thinking short-term? It is unlikely that HIV will remain confined to those groups most at risk today. The high prevalence of sexually transmitted infections among sexually active young people - one in nine has chlamydia, for example - exposes our achilles heel. Britain has forgotten Lord Fowler's warning, and we've largely stopped having safer sex. The Facebook generation wasn't even born the last time those tombstone ads were on TV. They know little about HIV and how to avoid it.
Once again, ignorance is threatening to drive this epidemic forward, fuelled by political anxiety over voter condemnation. Will Gordon Brown's government, or any other in the next 25 years, be brave enough to put sex and relationships education on the national curriculum? It may spark a heated debate today, but future generations will thank them for it. When there is no cure, prevention is all the more worth fighting for.
What is the likely future for HIV social care? If the drugs are getting better, and many people are living healthier lives for longer, does it really matter that HIV social care budgets are being cut all over the country?
Very much so. HIV hits hardest when it hits the poorest, and for many people it is extremely hard to live with. Sticking to a drug regime is often the last thing on the minds of people with employment, family, housing or immigration problems. This is not just a health condition, this is HIV, and prejudice and stigma still abound. As the epidemic changes, so do the needs of those affected. We should be anticipating those needs, not removing our means to meet them.
Long-term diagnosis
Consider, too, the mental health of people diagnosed long term with such a difficult and stigmatised condition. People who have lived with HIV for many years are often severely depressed, and yet HIV mental health services have already all but disappeared. This is a trend we must reverse, and fast.
What of the first generation of openly gay older people who are about to arrive at the doors of care homes? Are their staff ready to welcome them into services designed with their particular needs in mind? Add HIV into the mix, and it's a fairly safe bet that they're not. Only one agency has, so far, contacted the Terrence Higgins Trust for advice on planning and delivering elder care services. People with HIV weren't supposed to live that long, were they?
The fact is, HIV is here to stay. The good news is that we know what we need to do to manage it and minimise its impact on the UK. The question is, are we going to do it? We can't afford not to.
· Nick Partridge is chief executive of the Terrence Higgins Trust
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