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Ending the Epidemic - Changing lives

Ending the HIV Epidemic

Ending the HIV Epidemic

The HIV epidemic is changing. How can policy evolve to tackle its most significant challenges, and end the epidemic once and for all?

The HIV epidemic in England, France, Germany, Spain and Italy (Europe5) today is unrecognisable from a few decades ago. The number of people dying from HIV-related illnesses has declined, while more and more people are on anti-retroviral  therapy (ART), and virally supressed. Their life expectancy is close to that of the general population and they cannot pass the infection to others.

However, the epidemic has not ended, it has only changed. New and continuing challenges threaten the HIV response. In order to tackle these, policies across Europe5 must evolve.

In this report, compiled by KPMG in the UK, a group of experts in HIV (Steering Group) have assessed HIV-related policies from the Europe5. This report looked at the HIV care continuum of awareness; prevention; testing and screening; HIV-specific clinical treatment; as well as long term holistic health. They identified areas of strength, along with areas to develop, and made a set of recommendations to help improve the lives of those living with and at risk of HIV.

Summary of insights

Recommendations from the Steering Group to improve the lives of those living with and at risk of HIV in England

To drive improvements in the lives of those with, or at risk of HIV, the Steering Group put forward a number of recommendations:

  • Develop a national plan for HIV addressing strategic areas of focus as a matter of urgency: Department of Health and Social Care (DHSC) should lead a multi stakeholder panel including national (e.g., NHS England, Public Health England: PHE), local and community organisations to create a national strategy to provide leadership, direction and clarity to tackle key challenges of the epidemic.
  • Raise awareness of HIV among healthcare professionals: NHS England should lead in the development and implementation of training for the health workforce, particularly those in primary care, to improve awareness and tackle stigma.
  • Address high rates of late diagnosis through widening access to testing: PHE should work with community organisations to increase the delivery of highly targeted campaigns that raise awareness of HIV and provide access to various testing offers that are culturally appropriate and effective.
  • Use HIV as a model for person-centred treatment and care of long-term conditions: NHS England, working through Clinical Reference Groups (CRGs) and building on existing frameworks, should integrate HIV into policies and initiatives (NHS Long Term Plan) under development, using lessons learnt from HIV to elevate long-term care as a whole.

Recommendations from the Steering Group to improve the lives of those living with and at risk of HIV in Italy

To drive improvements in the lives of those with, or at risk of HIV, the Steering Group put forward a number of recommendations:

  • Enable implementation of PNAIDS as a matter of urgency – allocated dedicated funding and incorporate policies into Livelli Essenziali di Assistenza (or essential level of care, LEAs) to help ensure implementation and consistent resourcing across Italy
  • Develop integrated awareness and testing interventions for HIV and STIs – combine broad awareness approaches with targeted campaigns for high risk populations to encourage testing
  • Make condoms free for high risk populations – increase availability by approving the draft bill or by ministerial decree, to remove barriers to access for high risk populations, especially young people
  • Develop a network of multidisciplinary centres for long-term holistic care of people living with HIV - enable consistent, high quality care of people living with HIV by establishing a broad network of centres, extending and linking to those currently embedded in specific areas of healthcare services such as geriatrics, mental health and cancer. Existing good practice can be studied and scaled up to ensure good models are put in place

Recommendations from the Steering Group to improve the lives of those living with and at risk of HIV in France

To drive improvements in the lives of those with, or at risk of HIV, the Steering Group put forward a number of recommendations:

  • Develop an understanding of the scale of chemsex4 by mandating data collection – creating evidence on patterns and risks to support policy development
  • Establish more detailed testing guidelines on repeat testing for high risk populations – including guidance on roles and responsibilities for testing, and how to promote repeat testing behaviour
  • Formalise the assessment of mental health for people living with HIV – including annual mental health checks with nurses during HIV check-ups
  • Expand HIV/STI community sexual health clinics - providing easy and inclusive access to all populations for awareness, testing and prevention (e.g., PrEP programmes)

Recommendations from the Steering Group to improve the lives of those living with and at risk of HIV in Germany

To drive improvements in the lives of those with, or at risk of HIV, in Germany, the Steering Group put forward a number of recommendations:

  • Tackle HIV related stigma through national level interventions – Run more campaigns targeting stigma, distributed throughout the year to maintain momentum.
  • Increase inclusive, community-based testing centres – Apply lessons from successful models in other countries and adapt them to Germany, expanding the number and capacity of facilities to cover a wider population
  • Improve harm reduction services in prisons – Develop policy to mandate and provide guidelines on harm reduction in prisons, to ensure coverage throughout the Länder
  • Allow ART to be provided to undocumented migrants - Update policy to allow long term ART therapy for undocumented migrants
  • Focus more on chronic care for people living with HIV - Conduct a study to assess the gaps in chronic care services required to address the long term needs of people living with HIV, to support evidence based discussions on policy change

Recommendations from the Steering Group to improve the lives of those living with and at risk of HIV in Spain

To drive greater improvements in the lives of those with or at risk of HIV, the steering group put forward a number of recommendations:

  • Strengthen the office of the National Plan on AIDS – increase human and financial resources to dedicate sufficient effort to developing and implementing plans and policies in Spain.
  • Address low rates of testing in primary care – generate greater awareness of existing guidelines on universal screening, combined with programmes to minimise missed opportunities, such as education of GPs, alert systems.
  • Develop a comprehensive, national level framework for combined prevention of HIV (or HIV and other STIs) – bring together a framework of biomedical, behavioural, and structural prevention interventions at a national level, allowing for consistent and effective implementation at a regional level.
  • Implement more community based sexual health clinics - create convenient and inclusive environments, improve links to care (e.g., establish direct referrals to HIV clinics) and develop cost effective means of delivering long term HIV and STI care and services
  • Include sexual health education in the school curriculum - mandate changes to school curriculums to ensure consistent programmes across the regions, with the aim of developing greater awareness of HIV and STIs among young populations.
Ending the epidemic: full reports

Follow the links to view the complete reports in English or your national language.

Executive Summary   EN | DE | FR | ES
Country chapter: Germany   EN | DE
Country chapter: France   EN | FR
Country chapter: Italy   EN
Country chapter: Spain   EN | ES

This report has been commissioned and paid for by Gilead Sciences Europe Ltd (Gilead).

The reports were compiled by KPMG LLP UK (KPMG in the UK) and guided throughout by an independent Steering Group comprising of policy, clinical and patient experts in HIV. 

The Steering Group had editorial control of the report. 

If you have any questions around the content of these reports please contact Laura Mace.