On 10 January 2018, The Mayor of London, Sadiq Khan, signed the Paris Declaration on Fast-Track Cities Ending the AIDS Epidemic, along with London Councils, Public Health England and NHS England. The ambition is to cut rates of new HIV infection in the capital and eliminate discrimination and stigma associated with the condition.

London has already made great strides towards achieving the primary 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:

• 90% of people living with HIV infection diagnosed
• 97% of people diagnosed receiving treatment
• 97% of people receiving treatment being virally suppressed.

Why this initiative is important

London carries a high proportion of the national HIV epidemic, with 43% of the total of the new diagnoses in the England in 2017 being made in London.
In 2017, 36,436 people were living with diagnosed HIV in London in 2017, 35% higher than in 2008. The diagnosed prevalence rate of HIV in London in 2017 was 5.7 per 1,000 residents aged 15-59 years. This was two and a half times the rate of 2.3 per 1,000 observed in England as a whole. All (33) local authorities in London had a diagnosed HIV prevalence rate in excess of 2 per 1,000 population aged 15-59 years in 2017. In 2017, 63% of all new diagnoses in London were in men who have sex with men, and the second largest exposure route for new diagnoses was heterosexual contact (33%). Thirty-four percent of those newly diagnosed were diagnosed late.

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 amongst black and ethnic minority (BAME) communities in poorer areas of the city.
The needs of people living with HIV in London are changing and becoming more complex. Effective anti-retroviral therapy means that more people are now living with HIV and are growing older. Improving the health, quality of life and wellbeing of people living with HIV in the capital is vital. The UK Stigma Index 2015 found that, despite some shifts in public attitudes, many people in the UK still hold discriminatory views towards people living with HIV.

What is involved in the initiative

The Mayor and representatives from NHS England, 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 wellbeing of people living with HIV across the capital

The next steps for the capital include establishing a Fast-Track City leadership group and drafting an Action Plan which will outline 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 (https://www.fast-trackcities.org/cities/london).

The Mayor has made tackling the stigma attached to living with HIV a key priority in his draft 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. Currently, there is wide variation in the rate of late diagnosis across London and among different demographic groups.

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