One of our strategic goals is to achieve effective HIV prevention in order to halt the spread of HIV.

Hepatitic C and HIV co-infection

9% of people with HIV in the UK are co-infected with HIV and hepatitis C.  Having both conditions complicates each disease in the co-infected individual.  Liver disease arising from co-infection with hepatitis B or C has become a significant cause of death amongst people with HIV. 

NAT has produced a report on Hepatitis C and HIV Co-infection looking at this issue, with a particular focus on the recent growth of sexually transmitted hepatitis C transmission amongst HIV positive gay men.  The report calls for a strategic approach to hepatitis C prevention for HIV positive gay men, drawing on and integrating the skills of clinic and health promoters; improved testing in clinics; more research into co-infection; and anti-stigma work around hepatitis C.

Prevention priorities

Significant numbers of people continue to be infected with HIV in the UK.

More must be done to address the HIV epidemic and reduce incidence.  The NHS and public health reforms provide an opportunity in England to consider how we should develop our prevention work.

Read NAT's views in our paper 'HIV Prevention in England: A vision for the future'.

Treatment as prevention 

In November 2010, NAT hosted an expert seminar on ‘treatment as prevention' – the idea that the significant impact that effective HIV treatment can have in reducing infectiousness means that  HIV treatment is itself a form of HIV prevention.

We have written a report HIV Treatment as prevention, discussing the main issues emerging from the seminar and some NAT conclusions and recommendations. 

You can also see what presenters at the seminar were saying:

Treatment as prevention: why? (Gus Cairns)

Transmission risk between couples: the “science” (Martin Fisher and Gus Cairns)

The current efficacy of ARV in keeping viral loads down – the population perspective (Valerie Delpeche and Alison Brown)

What do models estimate to be  the impacts on HIV incidence of various percentages of people with HIV on ART? (Andrew Phillips)

TAP and sexual health advice (Ceri Evans)

We also commissioned a briefing paper from Edwin Bernard on the key scientific findings and possible policy implications of treatment as prevention to stimulate discussion at the seminar - Towards a UK consensus on ART and HIV transmission risk. 

Partnership patterns and HIV prevention amongst MSM

There is broad agreement that numbers of partners and patterns of sexual partnership have an important impact on how HIV spreads in a population and on risk of HIV transmission for an individual.  NAT's report 'Partnership patterns and HIV prevention amongst men who have sex with men (MSM)' recommends that there be greater consideration in the UK of how partnership patterns amongst MSM can be appropriately and effectively addressed in HIV prevention work.  

NAT's thinking on this issue was informed by an expert seminar held in June 2009.  Below are some of the presentations made at that meeting.

Partnership Patterns and HIV: Transmission among MSM - Yusef Azad June 2009

Partner numbers, partnership patterns and sexual practices in MSM - implications for HIV incidence and appropriate prevention responses - Prof John Imrie, PhD
June 2009

Epidemiology of HIV Acquisition & Transmission in MSM - Prof Graham Hart June 2009

Beyond 'epidemiology': the psychosocial and cultural context of partnership patterns amongst MSM - Paul Flowers PhD June 2009

Commissioning prevention services

A 2006 survey conducted by NAT and the Health Protection Agency showed a need for increased investment in HIV prevention in Primary Care Trusts to meet a growing need and better access to information and support for Commissioners.  We are working with the English HIV and Sexual Health Commissioners Group in order to address these needs.  The survey also examines prevention activities for gay men and black Africans, looking at expenditure, services provided and evaluations undertaken.

You can read the survey report Commissioning HIV Prevention Activities in England.

The future of prevention

In 2007 we held an expert seminar to discuss the future of HIV testing and prevention in England. The recommendations from this report highlight the importance of better funding for prevention, new approaches and more accessible services.

Read the seminar report Updating our Strategies. See the seminar presentations.

HIV prevention and the wider UK population

Although the groups at highest risk of HIV remain men who have sex with men and black Africans, we are seeing a gradual increase in the number and percentage of heterosexuals being diagnosed with HIV, having been infected in the UK, who are not African.

Research carried out by NAT over recent years shows that knowledge in the general population of the key ways in which HIV can be transmitted is declining.  For example, in 2000, 91% of respondents knew that sex without a condom between a man and woman could result in HIV being transmitted but by 2010 it was 80% (for more information on public knowledge and attitudes to HIV in 2010 click here). 

Despite declining knowledge and increasing infection rates there are no national or local HIV prevention programmes which target the wider heterosexual population.

Under the principle of universal access to appropriate HIV prevention, NAT believes it is important that measures are taken to meet the prevention needs of the wider heterosexual, non-African population.  We have produced a paper outlining these issues and the measures which should be taken to address this need.  

HIV and black Caribbean communities in the UK

Black Caribbeans make up 1% of the UK population but account for 3% of people living with HIV. In the past decade there has been a five-fold increase in the number of black Caribbeans accessing HIV care in the UK. However, there is no dedicated national HIV prevention strategy for black Caribbean communities, and very few Caribbean-specific support services.

For this reason NAT has produced a report looking at HIV prevalence within black Caribbean communities, major trends and risk factors. The report highlights key policy issues and priorities for action to inform targeted and culturally-sensitive strategies for HIV prevention in black Caribbean communities.

Review of helpline advice

In 2007 we published a review of the advice being given by sexual health advice lines on HIV transmission through sex. As a result of this we have published a review and made recommendations for helplines to help them continue to maintain a valuable service to the public. See the review  Risks of Sexual Transmission of HIV: A review of advice in the UK.

To share your thoughts on HIV prevention please contact policyandcampaigns@nat.org.uk