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Community Chests for Social Prescribing

We’re on a mission to ensure that London’s social prescribing system is not only sustainable but thriving. However, we know that this can’t be achieved without a well-funded voluntary sector to deliver the activity which people are prescribed.

That’s why we’ve developed a community chest model for social prescribing, bringing together resources to create an accessible, local funding pot for the voluntary and community sector to support local activities.

Community chests are more than just pots of money; they’re rooted in a collaborative, needs-led approach to funding that taps into the strengths and insights of a wide range of partners from across the local community.

We’ve piloted the community chest model across the seven boroughs in North East London and have ambitions to roll out the model across the remaining London ICSs.

We’ve partnered with the London Health and Care Leaders Group to help embed the vital work of community chests in north east London and support the scale up across London’s most deprived areas. We’ll be sharing this journey on Twitter at #LDNCCFund.

The community chest model

A Community Chest for social prescribing is a shared investment fund which supports the voluntary and community sector to deliver local activities:

  • It takes a “needs-led” approach to commissioning; responding to both the unmet needs of residents and the strengths of local groups and initiatives to address them.
  • It’s co-produced and co-owned; with a wide range of stakeholders developing the approach and setting priorities. This includes: link workers, Voluntary, Community and Social Enterprise (VCSE) representatives, clinicians, public health teams and residents. Community chests build on the existing partnership infrastructure to enable these groups to work together locally.
  • It’s equitable; ensuring funding is inclusive and accessible to previously under-served groups.

Why are community chests for social prescribing important?

  • They can foster integrated ways of working through place-based Partnerships (convening and combined investments by the NHS, local authorities and other stakeholders).
  • They are designed to address health inequalities at both local and hyperlocal levels, responding to community intelligence and promoting sustainable outcomes for communities.
  • They support the evolution of social prescribing through better data and investment in, and empowerment of, the VCSE sector.

Further information about community chests

Maternal mental health in London

As part of its commitment to improving Maternity and Neonatal Services, the NHS Long Term Plan outlined the introduction of the Maternity Outreach Clinics (subsequently renamed Maternal Mental Health Services) to: “integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience”. The target is to have MMHS in every area of the country by 2023/24.

Who can access maternal mental health services?

The MMHS is intended to treat moderate to severe mental health difficulties presenting in four main pathways:

Four key pathways for maternal mental health - 1. PTSD following birth trauma 2. Perinatal loss 3. Loss due to safeguarding issues 4. Tokophobia


Maternal Mental Health Sites within London –  there are four sites accepting referrals in London including The Maple Team based in North Central London, Maternity Trauma and Loss Care Service (M-TLC) in North West London, The Ocean service and the Tulip Service in North East London.

Please note that the sites in South East London and South West London are preparing to open services in 2023.

How to make a referral

Referrals can be made by any health or social care professional and self-referrals are being accepted by some sites. Not all pilot sites are offering all four pathways.

Partners are also able to be referred to an MMHS for assessment only, after which they will be signposted appropriately to other support services within their areas.

Each pilot site has its own referral form and criteria. Please see links and contact email addresses for each service.

Support across London

Below you’ll find a list of services available across London.


Maternity Trauma and Loss Care Service (M-LTC) for women and birthing people who live in North West London. Please view the following links for more information:

The Maple service for women and birthing people who live in the boroughs of Barnet, Enfield and Haringey.

The Tulip service for women and birthing people who live in the boroughs of Barking and Dagenham, Redbridge, Waltham Forest, and Havering.

The Ocean service for women and birthing people who live in the boroughs of City, Tower Hamlets, Newham, and Hackney.

The Helix service is for women and birthing people who live in the boroughs of Lambeth, Southwark, Bexley, Bromley and Greenwich who are experiencing emotional distress, or mental health difficulties following a perinatal loss.

To make a referral to Lambeth or Southwark please access referral and leaflets here: Service Detail – South London and Maudsley ( or contact the team directly here:

To make a referral to Bexley, Bromley, and Greenwich please access referral and leaflets here: Our services | Oxleas NHS Foundation Trust or contact the team directly here:

*The service will be opening in Lewisham and Croydon boroughs in 2023, please watch the SLAM Helix website for updates.


Regional Evaluation of The London Pilot of Maternal Mental Health Services

February 2023

In 2016, the independent Mental Health Taskforce published its Five Year Forward View (FYFV) on behalf of NHS England, which stipulated that women required access to specialist perinatal mental health services at the local level. NHS England recognised there was a gap in service provision for those requiring psychological intervention specifically related to their birthing experience. 

In 2019, NHS England published its Long Term Plan, which set out the need to provide appropriate care to women and birthing parents who develop moderate to severe mental health difficulties due to certain maternity experiences (birth trauma, tokophobia, loss, and child removal due to safeguarding concerns) through the development of Maternal Mental Health Services (MMHS) as this had not previously been provided within existing services.

In 2020 MMHS came into being, to address the gap in provision between specialist services designed to address severe and complex maternity-related psychological difficulties on the one hand, and generalist services designed to address common mental health problems on the other.

This regional evaluation was undertaken by the McPin Foundation and was commissioned and supported by the London Regional Perinatal Mental Health Programme. Mcpin is a research charity specialising in mental health research using peer research methodology. The evaluation focuses on the personal experiences of staff working in the London pilot MMHSs and the women and birthing parents using these services. It draws on in-depth, semi-structured interview data – collected between February and May 2021 – in order to answer key questions around the needs of staff and women/birthing parents, the extent to which those needs are being met, and the lessons that can be learned from their experiences.

Read the full MMHS Evaluation Report here. 


Perinatal mental health in London

What is perinatal mental health?

The perinatal period is usually defined as the time between conceiving a baby and one to two years after giving birth. About one in every five women experience mental health problems during this time, making this a relatively common experience. Women may experience mental health problems prior to pregnancy and/or develop mental health problems during pregnancy or in the postnatal period.

Videos: Vaccines explained

In the below playlist of videos, taken from a recent series of webinars, expert speakers use clear and simple terms to explain some of the most complex issues about COVID and about the vaccinations that can protect us against it.

To skip onto the next video, simply hit the icon in the top right-hand corner and select which video you’d like to watch.

COVID-19 made simple

This section brings together a range of resources that use clear and simple terms to explain some of the most complex issues about COVID and about the vaccinations that can protect us against it.

  1. How to have confident COVID-19 conversations: This is for any person who needs to discuss the issues relating to COVID-19 vaccinations with others such as work colleagues, family, friends, or patients. It has a range of guides to having confident COVID-19 conversations that will give you the facts you need to have these conversations with confidence,
  2. COVID-19 made simple videos: These are recording from webinars featuring leading experts that explain some of the key concerns colleagues have about COVID-19 vaccinations – such as vaccine side effects, the impact on having a child, and how the effectiveness of immunisation. Ideal for anybody who has hesitations or unanswered questions about how vaccines work.
  3. BSL COVID-19 videos for Deaf people: These are BSL videos specifically developed with leading BSL for both colleagues and the public in the Deaf community, which adapt and build on the original COVID-19 made simple playlist. Ideal for anyone living with hearing loss who has hesitations or unanswered questions about how vaccines work.


Explore COVID-19 made simple content

London Health Podcast

The London Health Podcast looks to tackle specific issues affecting health and care, so that we can make London the world’s healthiest city.

Latest episode

Jump to playlist

  1. Homeless health
  2. Personality disorders
  3. Good Thinking
  4. #AskAboutAsthma

Homeless health

People experiencing homelessness are among the most vulnerable and isolated in our society, with the poorest health outcomes. Traditional systems of health and care often struggle to meet their needs. Consequently, they are more likely to die young, with an average age of death of 45 for men and 43 for women (ONS, 2019).

Transformation Partners in Health and Care works with our regional partners with the aim of improving access to healthcare and the capacity and capability of the system to respond to the needs of people who are homeless, to improve their health and reduce their hospital admissions.

Browse this playlist of podcast episodes exploring homelessness and health, produced by the Transformation Partners in Health and Care Homeless Health programme team.

Personality disorders

Personality disorders have been called the most misunderstood mental health condition. They have a legacy of confusion and controversy around diagnosis, language, what it means and how it impacts on individuals, even what they should be called.

Yet it is estimated that worldwide, around 8% of the general population report having complex emotional needs These figures rise to around 25% of people accessing primary care services and 50% accessing community mental health services will experience symptoms or behaviours related to the formally diagnosed.

This podcast series talks to people living with them – aiming to raise hope and understanding.

Good Thinking

Good Thinking supports Londoners to look after their mental health and wellbeing in a way that works for them. Since its launch in 2017, more than half a million people have used our digital service to tackle anxiety, stress, low mood, sleep problems and other concerns.

Their podcast series captures the thoughts, feelings, and experiences of Londoners directly or indirectly affected by coronavirus. They ask them about the approaches they are taking to stay mentally well and share with you top tips on what you can do to stay mentally healthy.


The #AskAboutAsthma campaign encourages children and young people, their families, and those involved in their care, to ensure four simple and effective measures to help them control their asthma.

Their podcast below talks to people about their connection with the condition.

Understand personality disorders: Communications toolkit

Personality disorders have been called the most misunderstood mental health condition. Now a team of people who have mental health and social difficulties commonly associated with a diagnosis of personality disorder, supported by Healthy London Partnership, is launching a campaign on Wednesday 25 May 2022 to raise awareness of a condition which affects an estimated 10-13% of the population, but which can result in rejection and stigma, rather than support.

The campaign centres on a series of podcasts, devised, produced and led by those with lived experience of personality disorder, to increase awareness and understanding, and raise hope regarding support and treatment options. In the first podcast, available from Wednesday 25th, three people diagnosed with personality disorders discuss what it is like to live with the condition.

On this page is a campaign toolkit including an article for your own publications/websites, a shorter article for websites and social media assets. The assets link to a web page which hosts the podcast and more information about personality disorders.

We hope you can use the resources on your own social media pages – using #UnderstandPersonalityDisorders – and with your own contacts and networks.

Learn more

Meet the HCIC team

See below to meet our fantastic team, find out their experience and strengths, and how to contact them.

The information is arranged in order of the main projects or programmes that people work on, however in reality our team is multi-faceted, and our work is linked, meaning that everyone does more than what they are listed under!

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  1. Programme Director
  2. Analytics/Business Intelligence
  3. Community Services
  4. Enhanced Health in Care Homes
  5. Discharge and Length of Stay
  6. Digital Social Care
  7. Anticipatory Care
  8. Better Care Fund

Programme Director

Briony Sloper

Briony is leading the Health and Care in the Community programme, overseeing a range of improvement programmes supporting the national Ageing Well programme including enhanced health in care home, urgent community response and anticipatory care, alongside reducing in-hospital length of stay and a range of digital transformation initiatives for community services and social care. A nurse by background, Briony has extensive experience of senior operational leadership in emergency care, quality improvement methodology and delivering whole system transformation programmes. She is on secondment from the London Ambulance Service where she has been Deputy Director of Nursing and Quality since 2014.

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Analytics/Business Intelligence

Phil Wilcock – Senior Programme Manager

Phil has been in the NHS and DHSC for over 35 years, working primarily has an analyst.  He has worked at local, regional and national levels including spells at the CQC and a health consultancy.  Phil helped develop the national RightCare programme which aims to improve patient pathways, and health outcomes, whilst optimising the use of taxpayer’s money.  He currently supports the Urgent Community Response programme and provides analytical advice to the rest of the team.

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Community Services

Pauline Fahy – Community Services Lead

Pauline is the London regional lead for Community Services, working with the National Aging Well Team and London Integrated Care System partners to enhance and improve the safe delivery of high-quality community services across London. Currently the significant focus is on the development and delivery on the Urgent Community 2-hour Crisis Response service. Pauline is a registered nurse/district nurse and has worked in the NHS for 34 years with a wealth of experience in senior Clinical. Operational and Strategic roles.

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Lorraine Taylor – Senior Programme Manager

Lorraine leads, with Dan Heller, PMO activities for the programme; and supports the Community Services and Urgent Community  Response & Restoration; and Digital Community Health workstreams. Lorraine has over 30 years experience working in the NHS. She also managed the Operations teams at Transformation Partners in Health and Care and was deputy lead for the Adult Mental Health programme. Previously, Lorraine worked at NICE, leading various guideline programmes, the corporate office and commissioning and managing social care and public guideline activities. ​

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Isabel del Arbol Stewart – Digital Community Health Services Programme Lead

Isabel is the London lead for the Digital Community Health Services Programme.  Her role sits across the London Health and Care in the Community Cell and the Regional Digital Team.  Working closely with ICS Digital, Community and Transformation leads, Isabel supports systems to bring Community Health Services up to the same level of transformation that Acute and Primary Care services have seen. Prior to this role, she worked in the national Communities and Ageing Well team and the London Digital Programme.

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Ravi Ravendran – Programme Manager

Ravi supports the Community Services and Urgent Community  Response & Restoration. Ravi also leads on the SEL UCR accelerator Programme. At present Ravi works with London Region UEC team for two days a week as an Operations Manager to ensure the delivery of safe and quality oriented UEC services to patients across the region. Ravi’s substantive role is Contracts and Performance Manager, Specialised Commissioning, London Region.

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Qura Saeed – Project Support Officer

Qura is a Project Support Officer on the Digital Community Health Services Programme. Qura previously worked as a Governance Facilitator in the Patient Safety Team at Barnet, Enfield & Haringey Mental Health Trust, where she was responsible for incident and risk management, Serious Incident and Board Level Panel Investigations. She also provided support to the Trust’s corporate division on data analysis and reporting. Her past roles include working with patients who have mental health difficulties to support with providing CBT therapy and care coordination.

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Enhanced Health in Care Homes

Corinne Moocarme – Senior Programme Manager

Corinne has been in the NHS for over 30 years, primarily in a commissioning role.  She has worked all that time in South East London and has a background in Continuing Health Care – developing policy and implementation, also Personal Health Budgets and End of Life Care. Corinne led the commissioning and quality assurance of Domiciliary Care Providers in the Borough of Lewisham.  Her role in the Team will be to Lead the Enhanced Health in Care Homes Programme.

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Discharge and Length of Stay

Sophia Hashmy – Senior Programme Manager

Sophia is the regional lead for Discharge and Length of Stay programme. She has a variety of experience working in different healthcare settings including provider, community and CCG, leading on complex large scale strategic transformation programmes in cardiovascular, respiratory and same day emergency care across the system. Sophia has a clinical background and has also worked as an operations lead in community. Improving patient care is a priority in her programmes with a clear commitment to innovation, learning and improvement.

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Seena Saeed – Project Support Officer

Seena is a project improvement support manager for Length of Stay & Discharge and Care Homes. Seena has worked with a range of organisations such as Acute, Community, Specialist and Ambulance Trusts to drive values, improve patient care and reduce variation. She has provided strategy planning, coordination and oversight activities support to several programmes in North West London ICS which includes Outpatients Transformation Programme, MSK Clinical Network, Out of Hospital (Local Care) Programme.

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Digital Social Care

Harpreet Shergill – Health & Care Digital Programme Lead

Harpreet is a pharmacist with a background in community pharmacy. He has expertise on change transformation in Health using digital as an enabler to deliver change. He has delivered programmes across Community Pharmacy, Clinical Homecare, Community Diagnostics, GP practices, Outpatients and Community Services. He is working on enabling out of hospital digital pathways in the community and to increase the digital maturity of health and care organisations across London.

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Jennifer Ntiamoah – Digital Project Manager

Jennifer has worked in the NHS for over 12 years and has a rich portfolio of both clinical and operational experience. Her time spent working as midwife grew her passion for ensuring high standards of care for patients and a positive working environment for staff. She has worked at both regional and national level and also has experience from NHS Supply Chain. Jennifer has ample experience of project management and is working on the Digital Social Care programme.

Tyler Smith – Improvement Support Manager

Tyler is a Digital Improvement Support Manager currently project managing the implementation of the Proxy Ordering of Repeat Medications in Care Homes project, as well as supporting the implementation of other regional Digital Social Care Programmes and the London COVID Remote Monitoring Programme. Tyler has a background in health, having trained as a Dietitian and has previously worked in management consulting on various health, ageing and human services projects across the Australian Federal Government.

📧 Email:

Sarah Sandiford – Improvement Support Manager

Sarah currently works in the Health and Care in the Community Cell as a Digital Improvement Support Manager for the DSPT Programme. Sarah has extensive experience in a range of settings including primary care, Trustees, charities, CCGs, and non-departmental public bodies in healthcare. Consequently, she has a comprehensive understanding of multiple systems. Sara’s expertise in stakeholder management and facilitation enables system partners to resolve issues together.

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Anticipatory Care

Dan Heller – Senior Programme Manager

Dan is the regional lead for Anticipatory Care, part of the national Ageing Well programme. He is also one of the team’s PMO leads. Dan has worked on several programmes within the team, and still supports our care homes and domiciliary care workstreams. Dan has performed operational and strategic roles in the NHS, working with a range of non-NHS partners such as local authorities, schools and the voluntary sector, so has a broad understanding of systems. His stakeholder management and facilitation skills enable system partners to address issues together.

📧 Email:

Yasir Saleem – Project Support Officer

Yasir is a Project Support Officer working on Anticipatory Care, Catheter Pathways and vaccination information for Care Homes and Domiciliary Care providers, as well as PMO for the team. Yasir previously worked at St George’s Hospital for 5 years within Oncology, Breast and Cardiology in service management.

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Better Care Fund

Andre Lötz – Better Care Fund Manager

Andre leads on London region’s Better Care Fund (BCF) Programme, which runs in partnership with Transformation Partners in Health and Care’s UEC Improvement team, as well as London ADASS, and other regional programmes. The BCF supports integration between health and social care at local level. Andre worked with Surrey Council in Adult Social Care and Public Health. Prior to this he’s worked as a researcher at Greenpeace, a monitor for African conflict, and fleet operations at Streetcar in its early days (now Zipcar). He’ll happily talk you at length about health and care integration.

📧 Email:

Nicole Valenzuela-Sotomayor – Better Care Fund Support Manager

Nicole is one of London’s Better Care Fund Managers.  With 14 years health and care design thinking and service transformation experience at borough, HWB and regional level.  Having worked on programmes across health and care integration, Emergency Planning, mental health (prevention through to acute), 3rd Sector development, estates refit/ relocations, community services development and system upgrades.  She continues to be a strong advocate for staff and system empowerment, enjoys bringing colleagues together to harness the energy and skills that exist within, to develop sustainable changes for the benefit of both those that use and deliver services.  She is also a Mental Health First Aider.

📧 Email:


Transforming Mental Health

At Transformation Partners in Health and Care (TPHC) we want every Londoner to stay emotionally, mentally and physically well at all ages.We want to transform the way that mental health services are delivered, so that every Londoner receives high quality care, with good outcomes, which fully meets their needs as an individual. We want to improve prevention and early intervention to support Londoners to stay mentally well and thrive in their communities. We want to tackle the inequalities faced by some Londoners in their access to and experience of mental health services. We also want to support London’s health and social care workforce, by expanding the mental health workforce itself, and increasing access to dedicated mental health support for staff in all services.Our mental health programme has a broad focus across perinatal and maternal mental health, children and young people, adults, and urgent and emergency care. We also link very closely with other programmes at TPHC and have a range of resources to support our partners, which can be explored below.

If you require mental health support now, please click here.

Fast-Track Cities initiative

What is Fast-Track Cities?

Fast-Track Cities is an international initiative to end new cases of HIV by 2030. Over 200 cities across the world are part of this movement to get to zero new cases of HIV, zero preventable deaths, zero stigma and discrimination and a better quality of life for people living with HIV.

In January 2018, The Mayor of London, Sadiq Khan, signed the Paris Declaration on Fast-Track Cities Ending the AIDS Epidemic, along with London CouncilsPublic Health England and NHS England.

Jump to section

  1. An introduction to Fast Track Cities
  2. Targets of the programme
  3. Why is this initiative important?
  4. What are the challenges?
  5. What is involved in the initiative?

An introduction to Fast Track Cities


Targets of Fast-Track Cities

London has already made great strides towards achieving the United Nations (UN) targets for the Fast-Track Cities initiative. In 2016, for the first time in London, all the UN’s 90:90:90 targets were met. London is only the third city to achieve this target so far – joining Amsterdam and Melbourne. We have now reached:

  • 95% of people living with HIV infection diagnosed
  • 98% of people diagnosed receiving treatment
  • 97% of people receiving treatment being virally suppressed.

Why is this initiative important?

HIV remains an important problem in London, with the infection impacting on Londoners more than any other part of the UK.

In 2020, there were 955 new cases of HIV, with an estimated 35,966 people living with HIV in London – almost 40 per cent of all those in the UK. Of these new cases, 349 of new diagnoses were reported among gay and bisexual and other men who have sex with men, 324 cases were among men and women who reported heterosexual sex as their probable route of infection, 14 cases were among people who inject drugs, 257 cases were among people with an undetermined exposure group and the remaining 11 were through pregnancy.

Recently, London has seen a significant fall in people newly diagnosed HIV positive, particularly in men who have sex with men. However, this fall is neither uniform across all population groups nor in all areas of the city, and rates of late diagnosis, although showing improvement, remain stubbornly high at 35 per cent. Late diagnosis significantly impacts people who are who are disproportionately affected by HIV like African, Afro-Caribbean and migrant women, trans women, gay men living with HIV who are also migrant men, men of colour and men who don’t have English as a first language.

People diagnosed late are at increased risk of developing an AIDS-defining illness and continue to have a more than 7-fold increased risk of death in the year following their diagnosis. The rate of one year mortality was 31 per 1,000 among those diagnosed late compared to 4 per 1,000 among those diagnosed promptly.

What are the challenges?

For many Londoners HIV remains a stigmatising condition that negatively impacts on quality of life. Late and undiagnosed infection rates in London remain unacceptably high (34 per cent and 10 per cent respectively) and with considerable geographical variability across the city. Prevalence varies by ethnicity and by place of residence, with disproportionately high rates among black and ethnic minority (BAME) communities in poorer areas of the city.

Read the national HIV public knowledge and attitudes survey results and blog.

What is involved in the initiative?

The Mayor and representatives from NHS England, UK Health Security Agency and Office for Health Improvement and Disparities (formerly Public Health England) and London Councils, have committed to work with partners to:

  • Continue work to exceed the UN’s 90:90:90 HIV targets (90 per cent of people living with HIV knowing their status, 90 per cent of people with diagnosed HIV on treatment, 90 per cent of people on treatment with suppressed viral loads)
  • End new HIV infections in the capital by 2030
  • Put a stop to HIV-related stigma and discrimination
  • Stop preventable deaths from HIV-related causes
  • Work to improve the health, quality of life and well-being of people living with HIV across the capital

The next steps for the capital include delivering the action plan developed with all the partners and the HIV community, working with the support of the Fast-Track Cities London leadership group. The action plan is a roadmap, which outlines how London will reach the Fast-Track City targets.

London also has a Fast-Track Cities dashboard through which all cities report their progress against the initiative’s targets as well as locally set objectives and goals.

The Mayor has made tackling the stigma attached to living with HIV a key priority in his Health Inequalities Strategy. Not only is it important to ensure those living with HIV can live their lives without discrimination, but the fear of stigma can be a barrier to early diagnosis, which in turn negatively impacts the quality of life of those living with the condition.

Signing up to the Fast-Track Cities initiative will bring together all those already working to tackle HIV across the capital. More joint working will help to ensure that communities affected by HIV can access the prevention, testing, treatment and support they need.

Find out more