Stakeholder Engagement Report - London Councils

Appendix B:
Call for Evidence submissions
Submissions containing over-arching or strategic perspectives
Nineteen submissions focused on strategic priorities or overarching considerations
with regard to commissioning HIV preventative services in London. Fourteen were from
organisations and five were from private individuals. Common elements ran throughout
the submissions and these are abstracted and presented here.
Integrated and Strategic Commissioning
The strongest theme to emerge from these submissions is that the commissioning of
London’s HIV prevention services should be integrated and strategic rather than piecemeal.
Submissions pointed out that the HIV epidemic in London is driven by a range of factors
that are interrelated in complex ways. These include structural factors (social inequality
and deprivation, inequality between genders), social factors (for example homophobia,
racism, stigma and discrimination, community norms that support or undermine
protective behaviours, lack of knowledge or information etc.), interpersonal factors
(for example psychological morbidities) etc. Commissioning of HIV prevention services
should seek to address all of these factors in a strategic and intelligent way. Moreover,
the provision and promotion of clinical services is only one (albeit important) element in
addressing the epidemic.
Integration of approaches
The different approaches identified (clinical approaches, interpersonal approaches,
community approaches, mass-media, condom distribution) should not be seen as
competing or mutually exclusive, but should be interdependent and mutually reinforcing.
Moreover, no one approach is likely to be sufficient in isolation to reduce HIV transmission.
Therefore, clinical approaches (for example, testing and treatment, secondary prevention)
cannot be effective without community approaches that target those for testing, remove
the barriers to testing and support those in treatment. The interdependence of such
approaches is illustrated well in a submission by NAM: an info graphic showing the
‘treatment cascade’ and the submission from the Tuke Institute. [NOTE – Neither are
available for inclusion as appendices or referencing in draft report as they are paper
submissions, but have been requested in electronic format for subsequent versions]
However, the aim of community approaches should not be solely to increase access
to clinical services but also, to address the factors contributing to HIV exposure and
transmission. The latter cannot be addressed by clinical services.
The range of approaches available to reduce HIV transmission might therefore be
articulated under a strategic plan that states overarching aims, for example facilitating
access to clinical interventions and addressing the factors that drive HIV exposure and
transmission. The plan might also specify the role of each approach in meeting these
aims and how these approaches should work together.
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With and by communities
Another common theme was that HIV prevention should be carried out with the consent
of the communities involved. That is, community interventions need to emanate from
communities; be owned by communities and not focused on communities by others.