Our recommendations

Person with beard looking straight ahead

‘Ending HIV transmissions in England by 2030’ is not just a government target but has the potential to change lives for many . At the moment nearly 3,000 people a year are newly diagnosed . Achieving this goal will prevent tens of thousands of new infections and all the complications that can follow – mental  health  challenges,  medical  complications,  living with stigma and discrimination . This is such a worthwhile aspiration, it requires urgent government action.

To meet the ambition to end new HIV transmissions in England by 2030, the government should reaffirm this target, but also adopt the new interim milestone recommended by this commission to see an 80% reduction by 2025 . This will ensure we are on track . We should seek to build on positive progress made to date and ensure that the government commit to England being the first country to achieve a goal that will change so many lives.

The worryingly high number of late HIV diagnoses is bad for patients, results in more progressed disease, leads to new preventable transmissions and impacts public finances . Every late diagnosis must be viewed as a serious incident requiring investigation, lessons being learned and a report produced to drive change in local health systems.

From the evidence received by this commission, it is clear that the  single  most  important intervention to meet the 2025 and 2030 goals is widespread HIV testing, made routine across the  NHS and delivered as opt-out – not opt-in – provision . The fragmentation of the system makes this more challenging, but no less important . The health system must, over the next decade, make every contact count . Every blood test undertaken that is not also used as a chance to test for undiagnosed HIV, is an opportunity missed . No longer should people leave a sexual health clinic without being offered an HIV test . But to achieve this ambitious goal our attention must be wider, with a whole health system approach to testing . People presenting at A&E, registering for a GP and accessing other health services should be tested for HIV, with the default approach being an opt-out – not opt-in – for an HIV test . The success of this approach in maternity services shows us what is possible and how impactful it can be . Changes in HIV testing are urgent and national funding to enable this is key.

Finally, in a system so fragmented, leadership is necessary and accountability crucial . This is a role only national government can take on – the more it does the more our success is assured.

England should take the necessary steps to be the first country to end new HIV transmissions, by 2030, with an 80% reduction by 2025. Jointly the Department of Health and Social Care and the Cabinet Office should report to parliament on an annual basis the progress toward these three goals.

National government must drive and be accountable for reaching this goal through publishing a comprehensive national HIV Action Plan in 2021.

HIV testing must become routine – opt-out, not opt-in, across the health service.

The success in ending HIV transmissions lies in tackling HIV-related  stigma  and health  inequalities . The building blocks of this report – and any future HIV Action  Plan  – are service  transformation, equity for HIV affected  communities,  increased  resources,  bold  leadership  and  effective partnerships . The report addresses each of these and sets out actions and calls for change.

Address stigma and health inequalities

Build a health and care system which can take advantage of innovation.Address social and structural barriers to HIV testing and treatment access.Ensure there are the right resources to meet the 2025 and 2030 goals.Make HIV a national and local priority, and set a desire for England to be the first country to end new transmissions.Strengthen alliances within and beyond the HIV community.