The HIV Action Plan’s ‘thrive’ pillar seeks to improve the quality of life of people living with HIV
One in seven people living with HIV fear being treated differently in their care, according to the HIV Action Plan. Tackling stigma is therefore a key part of its ‘thrive’ pillar, which seeks to improve quality of life.
Training plays a crucial role here. The action plan points to a 2024 European survey, which showed HIV-related stigma and discrimination were less prominent among healthcare workers with good knowledge of HIV.
That education push is backed by a whole system focus. ‘Linking mental health, long-term condition pathways and HIV care, while tackling structural inequalities through multi-agency support, is essential for longer, healthier lives,’ the report says.
In the case of ICBs, key points to bear in mind include the successful local training on offer, and the need to provide peer support.
Key takeaways for ICBs
- Mandatory training has delivered strong results
- ICBs must ensure local peer support is available
- Over half of people living with HIV are over 50, and may face co-morbidities
Training
The HIV Action Plan calls for successful local training initiatives to be scaled up on a national basis, to promote greater understanding of the condition and tackle stigma. Katie Clark, head of policy at the Terrence Higgins Trust, points out stigma can still exist outside of specialist HIV settlings.
‘We hear of people being pushed back on operating waiting lists and double gloving, and we need to play ‘whack a mole’ in the system,’ she says. ‘The key is ensuring staff have the most up-to-date information and the mandate on training is one ICBs should definitely assume responsibility for.’
The Terrence Higgins Trust has its own Can’t Pass It On training programme, which is designed to tackle misconceptions around HIV transmission among social care and healthcare professionals. However, training can take many forms. Ms Clark points to the success of the mandatory HIV training in Manchester.
Manchester Foundation Trust – part of the Greater Manchester Fast Track City initiative – developed an HIV stigma training module in partnership with George House Trust and Dibby Theatre. Once the module was made mandatory, 25,500 staff members undertook the training in 12 months.
Participants reported greater understanding as a result. The proportion who understood stigma rose by 25%, the proportion who felt confident talking about HIV care rose by 34%, and the proportion who felt confident about what language to use around HIV rose by 36%.
Another important example is the HIV Confident project. The national initiative, led jointly by National AIDS Trust, aidsmap, Positively UK and Fast Track Cities, seeks to increase understanding of HIV and eliminate stigma within organisations including healthcare settings.
Participating organisations – one of which is Newcastle Hospitals NHS Foundation Trust – receive tools such as a dedicated contact person, eLearning modules, and staff resources. Their participation allows them to bear the HIV Confident Charter Mark.
Dr Samantha Preston, a salaried GP at The Group Practice at River Place, Islington, was an early participant in the HIV Confident project as part of her role as a GP champion. ‘My colleagues and I also ran education sessions that weaved in stigma reduction across GPs, pharmacists, nurses and mental health teams,’ she says.
For her, the use of the HIV Confident Charter Mark can offer reassurance to patients, who could feel ‘more confident about opening up about their status’.
Integration of care for HIV and co-morbidities
More than half of people living with HIV are now over 50, the HIV Action Plan states. While some enjoy healthy lives, others may experience challenges such as co-morbidity, economic hardship and lack of access to good housing.
‘Holistic and integrated support should be provided to cater for complex needs so people living with HIV can age well,’ it says.
The plan calls for updated guidance to support the integration of care for HIV and co-morbidities, plus the sharing of best practice to ‘highlight and increase awareness of primary care’s role in providing support for people living with HIV’.
Fast Track Cities London co-chair Professor Jane Anderson points to the North Central London HIV GP Champions pilot as proof of the power of primary care. As part of the pilot, prescribing of statins – which should be offered to all people living with HIV aged 40 years or older, according to BHIVA guidelines – increased at GP level.
‘People living with HIV are getting older and the care for their other conditions sits with GPs,’ says Professor Anderson. ‘So the pilot changed not just the prevalence of testing, but also improved treatment and care.’
Peer support
Peer support is named as another vital component in improving quality of life. The HIV Action Plan calls on ICBs to ensure commissioning arrangements are in place with local providers for peer support provision.
The ‘thrive’ element of the strategy puts a particular focus on women, and sets out a goal to help them ‘manage their physical, mental and social needs through tailored care pathways, peer support and access to psychological services’.
However, peer support also plays more widely into the ‘treat’ pillar of the strategy. Tristan Barber, chair of the BHIVA, says it can be a vital tool in encouraging people to re-engage in their care (see chapter 3). ‘Rather than phone calls from doctors, hearing from someone in a peer support organisation can be really reassuring,’ he says.
Anne Aslett, CEO of the Elton John AIDS Foundation, backs up that point. ‘Outreach nurses and peer support workers can reach those who have disengaged and bring them back in,’ she says.
This report has been initiated and funded by MSD. MSD has had no input into the content of this non-promotional report.
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