There is a quiet optimism around meeting the HIV Action Plan goals but funding remains and issue
As the 2030 target date looms closer, there is a quiet optimism over the chances of meeting the key goals of the HIV Action Plan: to reduce new HIV infections and AIDS-related deaths by 90% on 2010 levels.
Katie Clark, head of policy at the Terrence Higgins Trust, is ‘optimistic’ but believes momentum needs to increase. ‘It’s really about ensuring the golden trio: everyone who needs PrEP is aware and can access it easily, everyone living with HIV who doesn’t know gets a test, and everyone living with HIV who does know needs to be accessing treatment.’
There are simple concrete steps that ‘would make a real difference’, says Anne Aslett, CEO of the Elton John AIDS Foundation. She cites the example of adding HIV testing to every routine blood sample taken (see chapter 2), and ensuring stronger links between GPs and HIV specialists (see chapter 5).
Ultimately, the HIV Action Plan is ‘a test of whether our health system can move from analogue to digital, from hospital to community, and most importantly, from treatment to prevention,’ Ms Aslett says.
Looking to 2030 and beyond, there are also key developments and challenges to consider – including funding, pharmaceutical developments and messaging.
Funding challenges
Funding is repeatedly mentioned as a constraining factor in the ambitions to improve HIV care. In the roundtables with stakeholders – one of which was held solely with ICB leads – particular concerns were raised over the funding of treatment.
Roundtable attendees called for clearer responsibilities and funding guidance for ICBs to deliver HIV services, as well as greater transparency and accountability in how funding is allocated and used at local and national levels.
In response, the DHSC pointed out the plan is backed by over £170 million in new funding until March 2029, and made clear that ICBs are responsible for the commissioning of adult HIV services.
The question will be how that funding is allocated – and whether it will be sufficient. The plan puts a greater emphasis on primary care in HIV prevention, testing and treatment. So, GPs are naturally concerned about the availability of funds to deliver those goals.
Those concerns are voiced by Dr Samantha Preston, a salaried GP at The Group Practice at River Place, Islington, and a GP champion at Fast Track Cities London. ‘I think the most important thing is having primary care representation in these decisions – especially now the funding has moved into ICB control,’ she says.
The RCGP also says general practice ‘must be adequately resourced’ to realise its potential in delivering HIV care.
Voluntary organisations similarly highlight the importance of funding. ‘The action plan will only succeed if we can engage and work with the communities most affected, and that is where the voluntary sector has the most expertise,’ says Fast Track Cities London co-chair Professor Jane Anderson.
However, funding for voluntary organisations is ‘under threat’, she says. ‘The current state of affairs means the funding isn’t necessarily reaching the people who are best placed to do the work, so ICBs must ensure the money flows to the right people and organisations,’ Professor Anderson stresses. She suggests making voluntary organisations the lead budget holder on projects – which involves using the same amount of money but ‘the control is different and the ability to do things changes’.
Pharmaceutical developments
Pharmaceutical developments could, in theory, help achieve improved HIV outcomes.
PrEP is one area of innovation. Lenacapavir, a medicine for the prevention of HIV-1 in adults and adolescents, was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) in December 2025. It can be administered as six-monthly injections – offering a long-acting alternative to tablets.
In a similar vein, the cabotegravir injection is being made available to around 1,000 people who cannot have PrEP tablets, following approval by NICE in October 2025.
On the treatment side, a study published in The Lancet in February 2026 revealed a new daily tablet – combining bictegravir and lenacapavir – might be able to effectively replace more complicated HIV treatments for people living with HIV on a long-term basis.
However, the ability to deliver these pharmaceutical improvements at scale will hinge on the amount of funding available. BHIVA’s Mr Barber believes there could be an uphill struggle at play as HIV prevalence decreases.
‘As we get fewer and fewer people undiagnosed, and we chase the last mile, there’s a question over what happens now with new drug developments,’ he says.
That’s particularly true when new treatments, such as the daily bictegravir and lenacapavir tablet, do not improve viral suppression. Instead, they offer greater convenience and wider benefits, such as metabolic improvements.
Similarly, the idea of a twice yearly injection for prevention will be ‘hugely beneficial’ – but a wider rollout will be a ‘cost issue’, Mr Barber says.
Clear messaging
Finally, the BHIVA’s Mr Barber believes we need to look at consistent messaging around HIV, if England is to improve prevention, treatment and care in the long term.
‘Historically, I think we’ve talked about HIV in a binary way and given what could be perceived as mixed messages,’ he says. ‘On one hand, we’ve said, ‘protect yourself from HIV, don’t get it’. On the other, we’ve said, ‘test regularly, you can have a normal life expectancy with HIV and, treatment is much better’.’
‘I think we should be using joined-up language to say there many ways to protect yourself from HIV. But if you do happen to acquire HIV, and you’re testing regularly, you’ll be diagnosed early, you’ll be on treatment, and you can have a normal life expectancy.’
‘In a similar way, I think we often celebrate the successes around falling new diagnosis rates,’ Mr Barber adds. ‘But actually, we don’t always celebrate so much the positive changes today’s transformative treatment has for the life of people who have had their entire life course altered by HIV, who’ve had very complex care, and who took very toxic treatment in the early years. So I think we also need to celebrate the benefits now available to those people and put them in the spotlight a little bit.’’
If the HIV Action Plan 2025 to 2030 reaches its goals, the gains made since those early days will continue to snowball – through a mix of preventing infections, ensuring timely testing, providing the right treatment to individuals, tackling stigma and working to improve local collaboration.
As Ms Aslett of the Elton John AIDS Foundation sums up: ‘We believe it can happen. But it is going to take all of us.’
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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