Stakeholder Engagement Report - London Councils

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“Settings for work with African people is important – the church is a singular place you can engage a large audience at a single time. The role of faith leaders is crucial – people look up to them and this is a way to impact, but they have to be on board - and not all of them are.” It was felt that targeted work is required with ‘very hidden populations’. These include discrete communities of, for example, African and other Black, Asian and minority ethnic (BAME) MSM who are married and would never identify as gay, sex workers, recent Eastern European migrants, some of whom are finding themselves in exploitative situations, either coerced into the sex industry, or at risk of abuse and violence. “I wish people would stop talking about gay men and Africans as if they were just one sort of group with one set of needs. If only it was that easy! Not only that, it totally demeans the different cultures and experiences of the individuals who just so happen to be at higher risk because of all sorts of reasons” Suggested Approaches “Invest in some good old sexual health promotion – invest in services, provide information for ALL people who need the services – the real thing is about keeping HIV prevalence low.” “The current methods favour the larger organisations who are not delivering and they are not picked up on it, whereas the smaller African and gay men’s groups that are being innovative do not get funded. Why?” Creating consistent support within local communities at risk of HIV is seen by the majority of stakeholders to be an important part of an effective HIV prevention programme. Given the chaotic or difficult challenges some gay men and African communities face on a day-to-day basis, this one to one and/or group support is seen to be highly valued. Stakeholders welcomed more to be done in order to tackle ‘head on’ the issues of lack of disclosure, lack of consistent condom use and, for many women, domestic violence associated with HIV disclosure. Stigma and discrimination continues to play a major role in late diagnoses. For African communities, this may involve community and religious leaders in a robust evidence based approach to tackle these issues. A note of caution was expressed that the traditional approaches of outreach and work within faith and/ or religious communities only reaches those who attend. Organisations working with African and other BAME communities particularly emphasised the need for a range of approaches due to the diversity of the populations with which they were working. There were some stakeholders who believed that if one to one interventions were to be commissioned, then there needed to be increased transparency about how effective the interventions are, and a sense that individuals need to be encouraged and supported to embrace a “personal responsibility” to change their risk behaviours. “There are core groups of people fuelling this HIV epidemic in London, and they need to be targeted! Not in ‘blame’ sort of way - but they definitely need some serious input!” 14
4.1.3 HIV testing and Treatment as prevention “HIV testing should be seen as the pathway to support and prevention not an end in itself” Key Issues The Public Health Outcomes Framework (PHOF) sets a clear direction for health protection. Reducing the number of late diagnosis of HIV is a key objective. London boroughs will need to examine their late diagnosis figures on a regular basis and ensure that targeted work is in line with their local epidemiology. Given the positive impact of early diagnoses on HIV related morbidity and onward transmission, there is consensus that HIV testing is an effective intervention to attempt to halt the progress of HIV. The arguments put forward were clear and unambiguous - that testing, and getting those who test HIV positive onto effective treatment, is an essential and evidence based HIV prevention intervention. “New medications – we never thought through the consequences of their arrival and impact. What does safer sex actually mean? Us providers and commissioners now have to work within the new landscape, and how can we effectively do that if it’s all done locally - it doesn’t make sense?” There was a view from many stakeholders that access to HIV testing across the capital is patchy and inconsistent. This is despite London being an area of high HIV prevalence, and routine HIV testing in a wide range of settings (including primary care and in general hospital admissions) being recommended by BHIVA since 2008, (HIV testing guidelines 2008). Interestingly, there is little consensus on the clinical/medical model of HIV testing as a prevention tool alone. Some concerns were raised that seeing HIV testing as the means to an end is a limited intervention, without the back up of a behavioural change interventions to add value and support the individual. Stakeholders were concerned at the perceived lack of HIV testing undertaken by London GPs, especially where patients are repeat attendees or show symptoms. Some expressed reservations on increasing GP involvement in HIV and sexual health, noting the massive increases in their workload and the fact that many had previous experience of GPs’ reluctance to be involved in sexual health and HIV work. Home sampling, where individuals can take an HIV test at home and send it off for analysis, is now available. This is a cost effective and confidential mechanism, and pilots have illustrated that it is popular. Home sampling ensures an individual with a positive result is linked straight into services. Stakeholders were more concerned about the introduction of home testing kits where an individual can take the test and get the result at home with no links specifically into care and support services. “There are real problems with that - I mean; what if they have a mental health problem and the HIV + diagnoses is the last straw. How can that be a benefit and how are we to measure the prevalence if they remain anonymous and don’t come forward for treatment?” Many stakeholders commented that many HIV negative diagnoses were missed opportunities, suggesting that more attention needs to be given to health promotion 15
Page 1 and 2: Future Commissioning of London HIV
Page 3 and 4: The Future Commissioning of HIV Pre
Page 5: Contents Executive sumary----------
Page 8 and 9: and ad hoc. There is no consensus o
Page 10 and 11: There was a clear message from stak
Page 12 and 13: 2. Introduction 2.1 Commissioning r
Page 14 and 15: 3. methodology Stakeholder engageme
Page 16 and 17: This stakeholder engagement program
Page 18 and 19: “I have seen massive changes in p
Page 22 and 23: interventions and supporting indivi
Page 24 and 25: Some work undertaken by the Nationa
Page 26 and 27: 4.2. The how 4.2.1 the strategic di
Page 28 and 29: This structure would: • Provide a
Page 30 and 31: • The competitive tendering finan
Page 32 and 33: There was universal consensus on th
Page 34 and 35: It was felt that service user voice
Page 36 and 37: Given the known epidemiological evi
Page 38 and 39: 32 The future commissioning for HIV
Page 40 and 41: Naz Project London: Marion Wadibia,
Page 42 and 43: 36 Simon Mercer Assistant Commissio
Page 44 and 45: Appendix B: Call for Evidence submi
Page 46 and 47: Opportunities for boroughs to integ
Page 48 and 49: Appendix C: Values and Principles f
Page 50 and 51: Increase the number of HIV tests in
Page 52 and 53: The Public Health Outcomes Framewor

Stakeholder Engagement Report - London Councils

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