SLH0092

Written evidence from Terrence Higgins Trust follow up evidence: Health Select Committee inquiry into sexual health

Terrence Higgins Trust is the UK’s largest HIV and sexual health charity, with service centres across England, Scotland and Wales. We are a campaigning organisation which advocates on behalf of people living with or affected by HIV or poor sexual health.

On 5th February 2019, Terrence Higgins Trust provided oral evidence to the Health Select Committee inquiry into sexual health. This note provides additional evidence to the oral evidence and Terrence Higgins Trust first evidence submission.

Getting to zero HIV transmissions

1. On 30th January 2019, the Secretary of State for Health and Social Care, committed England to a target of ending new HIV transmissions by 2030.
2. The Secretary of State announced that an expert group would be formed who will draft an action plan on how to achieve the commitment. There are currently no further details on the expert group, no clarity on the timings around the action plan.
3. This commitment was welcomed by Terrence Higgins Trust. However, we are clear that this important target can only be achieved if PrEP is made available to all who need it, and if there is increased investment in public health to ensure that sexual health services can meet current and future HIV prevention demand.

HIV Pre-Exposure Prophylaxis

4. PrEP is a pill taken to prevent HIV infection and when used as prescribed, PrEP has been shown to be 100% effective at preventing HIV.
5. In England, PrEP has been made available for 13,000 people through the three year IMPACT Trial, which commenced in October 2017.
6. The size of the trial is not meeting demand. As of 12/02/19, the official Trial website[1] indicates that 43% of trial sites are closed to gay and bisexual men. Reports[2] are now indicating that there have been a number of people who have been unable to get on the PrEP trial and have gone on to become infected with HIV. The Minister for Public Health, Steve Brine MP in response to a parliamentary question[3] said that “it is expected that most of the larger clinics and many of the smaller clinics will have filled the places allocated to them for gay, bisexual and other men who have sex with men by March 2019".
7. On 11th January NHS England put out a statement endorsing a request from researchers leading the PrEP Impact Trial to double the number of places on the Trial. NHS England subsequently issued a statement following the Trial Programme Oversight Board meeting on 15th January detailing that the Board only approved 'in principle' a proposed increase in places. However Secretary of State for Health and Social Care, Matt Hancock, also committed to doubling the number of places on the PrEP Trial during his speech to the AIDSFree Global Summit in London on 30thJanuary 2019.
8. However, there is still no clarity on when those extra places will be made available locally to potential trial participants. England heads towards the cliff-edge, as set out by Steve Brine, with all trial sites being full for gay and bisexual men by March – less than three weeks away.
9. Terrence Higgins Trust and partners are urging the Department for Health and Social care and Public Health England to expedite the availability of additional trial places to local clinics.
10. There remains issues with six sites still not live, as of Feb 2019, (2 in Yorkshire & Humber , 3 North West and 1 West Midlands) this is despite assurance from DHSC that they would be live by April 2018. In response to a Parliamentary Question by Dr Lisa Cameron MP, last year Steve Brine incorrectly said that all trial sites were open: “A reallocation of spaces took place in May 2018 meaning 139 of the clinics are open to recruitment for gay and bisexual men with a number of the reallocated places being held centrally by the trial sponsor, so that clinics can request more if they are approaching their full allocation of places.”[4]
11. There has been low uptake on the trial by groups other than gay and bisexual men. This reflects the limited money that has been allocated for community outreach and engagement.
12. Routine commissioning of PrEP – as part of comprehensive sexual health services - is the only viable option for PrEP long-term. A long-term funding arrangement and timetable towards routine commissioning needs to be agreed as a matter of urgency.

National sexual health action plan

13. There is currently no system-wide national strategy or action plan setting out England’s ambition to tackle new HIV and STI infections and how this ambition can be achieved.

14. Terrence Higgins Trust would like to see the Government commit to cross-system sexual health strategy/action plan that:
1. Sets out ambitious targets (with ongoing monitoring targets) to tackle STIs in England
2. Provides detail on how England can meet the STI targets
3. Sets out CLEARLY the responsibilities of each statutory (and non statutory) organisations in working towards the STI targets and how the system can, and should collaborate to tackle STIs

Public health funding

15. Since Terrence Higgins Trust submitted original evidence to the Inquiry, the Department of Health and Social Care has announced on 20th December 2018, that £85 million of cuts will be made to local authority public health budgets for 2019-2020.

16. This budget includes funding for sexual health services which are vital to tackle both HIV and other sexually transmitted infections.

17. Terrence Higgins Trust is clear that the Government must include an uplift in funding for local authority public health services as part of the upcoming Government Spending Review.

Governments Green Paper on Prevention

18. Since Terrence Higgins Trust submitted initial evidence to the inquiry. The Department of Health and Social Care released its prevention vision “Prevention is Better than Cure”, within which the Government  committed to release a prevention green paper in 2019.

19. We would like to see in the green paper:
1. Acknowledge the important role that public health services have in preventing ill-health and keeping people well
2. Include a commitment on a multi-year uplift in funding for public health
3. Include HIV and sexual health – with commitments to end new HIV infections and tackle STIs.

Relationships and Sex Education

20. Terrence Higgins Trust’s main concerns about RSE can be found within the November 2018 consultation response[5]. In summary:

• Weak content on HIV and sexual health
• Still no promise of funding for teacher training
• No defined role for Ofsted in inspections
• Confusing and likely unworkable proposal on amending parental withdrawal
• No requirement on primary school lessons to be LGBT-inclusive