Stakeholder Engagement Report - London Councils

London-wide AND Borough commissioned services
A further strong theme to emerge was that both London-wide and borough level
commissioning were appropriate and could be considered to have complementary
roles. Some suggestions were made regarding the complementary role of each level of
commissioning.
• Strategic development could be carried out on a London-wide level
taking into account the specificity of the epidemic in various regions and
boroughs. This might include setting strategic aims and methods as well as
commissioning/specifying integrated monitoring and evaluation provision.
• There may be opportunities to specify a range of approaches on a
London-wide level, but for these approaches to be applied differently
in different areas/boroughs to meet/reflect specific needs, populations
or target groups. For example, one-to-one interventions in community
settings (like outreach or health trainers) may share a common aim,
but the venues visited will depend on local epidemiology, socialising
patterns and need as will the approach taken in these venues.
Several submissions advised against boroughs acting entirely in isolation around HIV
prevention stressing that there should be a clear rationale for carrying out prevention on a
local level and that local work should reflect overarching London-wide approaches and goals.
Finally, one of the priorities for London-wide/borough level commissioning is to make
referral pathways between services as clear, direct and secure as possible.
Granularity
Related to the previous theme is the theme of granularity, that is, that London can be
seen as a whole or a collection of various communities and populations and responses
need to take account of the many facets of the city.
London can be seen in terms of its position as a capital city and a global city attracting
visitors and migrants from all over the country and internationally. This will have a major
impact on epidemiology (in terms of sexual mixing patterns etc.) as well as the burden
of HIV on the city. These considerations would need to be incorporated into any HIV
prevention plan.
There is a need for general population campaigns targeted at all Londoners that seeks
to change attitudes towards HIV, normalise HIV testing and seek to integrate those living
with HIV into the life of the city, that is, reduce stigma associated with HIV.
Within the overall population of Londoners most at risk for HIV (MSM and African
communities), specific sub-groups are at greater risk for a range of factors. In strategic
planning, there is a need to consider whole population approaches alongside more
intensive approaches for these sub-groups.
The different populations affected most by HIV (MSM and African communities) are
concentrated, in terms of residence, in different localities. However, their social
networks and social activities are diffuse. Certain boroughs contain centres for social
and recreational activities that are used disproportionately by different groups (for
example MSM commercial scene use). Therefore, boroughs may differ markedly in their
prevention activities but all local activities might reflect on how they contribute or relate
to prevention across London.
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