Stakeholder Engagement Report - London Councils

Suggested Approaches
There was consensus that there needed to be a focus on the relationships between all
providers in order to enhance the visibility of effective interventions that can be procured
on a local or London-wide basis.
There was a perceived need to capitalise on the relationship with the clinical services,
resulting in more robust pathways for patients and service users, and improved
partnership work with third sector organisations.
There was a view that wider recognition that a ‘combination prevention’ approach will
be more effective in the longer term, enhance partnership work and value the different
contributions made to support the individuals in their health challenges.
There needs to be far greater partnership work developed to address the complexity of
drug and alcohol use amongst gay men.
“We need to inspire gay men to develop ideas – commissioners can help them do this
– rather than just creating a specification and going for tender.”
4.3.5 A future approach
“HIV prevention is an out-dated model. We cannot look at this in isolation from all the
other public health priorities and the broader determinants of people’s health! It surely
must now be called “risk prevention?”
There was general agreement amongst stakeholders that the HIV prevention services
currently provided are based on historical models, partially dating back to pre-HIV
treatment days. There was enthusiasm for a more holistic approach to public health
interventions, which need to encompass a broader range of health determinants,
including substance misuse, smoking cessation and alcohol use.
In terms of the future model, many stakeholders cited the Marmot enquiry into health
inequalities stating that it gave a much broader and more relevant context to risk. The
majority of stakeholders were clear that there were missed opportunities by having such a
narrow definition of HIV prevention for people’s health seeking behaviour.
Acknowledging Marmot, there was much discussion about the broader determinants,
which impact on people’s health, and the fact that a discrete funding model actually:
“Misses the point of supporting effective health seeking behaviour”. ‘Making it Count’ (a
gay men’s HIV prevention Framework) and ‘Knowledge the Will the Power’ (an African HIV
prevention framework), were cited as previous HIV prevention models that should not be
lost and should be built upon in the future.
Stakeholders saw narrow definitions as responsible for stopping collaborative
partnerships and introducing elements of competition and hierarchy into service
provision. Creating unhelpful silos with discrete funding streams offered little opportunity
for proactive and innovative risk prevention strategies to be developed and financially
supported.
“Can public health support themselves and us and please implement Marmot...it’ll
really help us look at the individuals in the context of their lives”
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