Ending new HIV transmission in the UK by 2030 is within our grasp — we must not fail
It’s World AIDS Day again. For those of us who lived, loved and lost through the 1980s and 1990s, it is an opportunity to recall the lives of those who didn’t make it through that hell.
It matters that we remember the dead. The past is not a foreign country. It is a place we inhabit still. But it is also a moment to think about the living and renew our call to change the future.
The public health challenges we face across the UK are huge and can seem intractable. But ending new HIV transmission by 2030 — the clarion call of HIV organisations north and south of the border — is absolutely within our grasp. If we turn aspiration into action.
Transmission can seem a clinical concept. Abstract too for those with no lived experience of it. So let me take you back 40 years and make it real.
Spring 1984. On a sunny Sunday morning in Clapham, Lawrence is lazing in bed with his boyfriend, Michael. After a late night, first at the Colherne in Earls Court, and then at Heaven, they are in no hurry to get up.
Lawrence is 26, Michael just a few years older. Lawrence is smitten, and as they embrace, he wants Michael to fuck him. Michael seems reluctant but Lawrence persists, and he relents. When it’s over, Michael pulls away. Nothing is said, but something has changed.
Autumn 1984. Lawrence develops large swollen glands in his neck and groin. At St Stephen’s Hospital in west London, he is diagnosed with persistent generalised lymphadenopathy (PGL).
PGL is a condition associated with the early stages of HTLV III, the retrovirus which scientists in the US had isolated earlier that year and believe to be the cause of AIDS. A positive blood test result follows. Lawrence has the virus.
All that happened long ago when even though thousands of gay men had already perished in the US, news travelled at a different pace. Knowledge of the virus was only just emerging. Testing was scarcely in its infancy.
Lawrence and I met a year later. He always believed that Sunday morning had been the moment of transmission. What little conversation he had with Michael about what had happened confirmed as much. Michael’s reluctance had been based on a hunch that AIDS was heading for him fast.
They had both known of Terry Higgins who had died two years earlier. They had heard about public meetings organised by concerned activists the previous year. They were aware of early exhortations by those same activists to practise safer sex. But they were living their lives too, as young men do.
A friend asked me a couple of years ago, how I had escaped the clutches of the virus. My answer was as truthful as it could be while sparing the detail. Quite a lot of judgement and an awful lot of luck.
Lawrence never blamed Michael, and they remained firm friends. Their mutual understanding about what had happened that Sunday morning was, to my knowledge, never spoken of. What was done was done. And could not be undone. ‘Ain’t that the truth,’ Michael would have said.
Michael died during the Christmas of 1991. Not our first funeral together, nor our last. And then there were the ones we were denied the opportunity to attend at all. Just three and half years later I sat beside Lawrence at our home in Stoke Newington as he breathed his last breath.
That was then. And this is now. A few short years after Michael and Lawrence died, combination therapy — the miracle pills — arrived. They keep still more friends alive.
More recently, we hailed the arrival of PrEP, a sweet pill to swallow. HIV is different now. Not the virus itself — it’s still the bastard it always was. It’s not that it couldn’t kill if left untreated. But we have the means to prevent it doing so. Lives are not just saved. They are lived. To the full. Long may that continue.
We have come so far. But we have so much more to do. The most recent UK-wide estimate is that around 107,000 people are living with HIV in the UK. Of these, around 5,000 are undiagnosed and do not know they have the virus.
From their peak in 2005 to 2021, new diagnoses were declining. Since then, they have been on the rise. In 2023, there were 6,512 HIV diagnoses including 6008 in England, 385 in Scotland and 119 in Wales. New diagnoses were up by 15% in England, 10% in Scotland and 16% in Wales.
Transmission — whether through sexual contact or sharing equipment for injecting drugs — is still happening. Concealed in the everydayness of people’s lives.
That figure of 6,512 is more than 17 people a day. It may not sound like a lot. But it’s 17 too many. And still some communities remain more at risk than others. Same as it ever was.
It is not that those people can’t live a normal life with HIV. But quite simply that they shouldn’t have to. Even though the means to halt the virus are staring us in the face, that entirely achievable goal to end new transmission by 2030 is off track. But it doesn’t have to be that way.
We know what needs to be done. We have the tools. Test, test, test. Find the undiagnosed. Get PrEP to everyone who needs it. End stigma. With political will, with investment — all utterly doable.
I love my red ribbon. I wore it quietly and proudly on my running vest yesterday as I battled through the mud at the Scottish East District cross country championships. And on again it went this morning as I headed out for my Sunday run.
So, of course, I’m glad to see wall to wall coverage of politicians adorning their own red ribbons on social media. Glad too, to see the Prime Minister inviting HIV organisations and activists into Number 10, and Parliamentarians welcoming them to Holyrood. And in doing so, underlining their commitment to that 2030 goal. Symbols matter.
But what makes change happen is action. The opportunity to ‘fix’ a public health crisis in short order is a rare thing. If we fail there will be no excuses. Enough of the talking now. Let’s get it done.