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Tory Cuts Are Causing a Sexual Health Crisis

England's sexual health services have had their funding slashed by 25% in the past five years, leaving clinics and other services severely understaffed. It is an avoidable crisis – entirely caused by Tory government policies.

2020 has seen the start of one pandemic as another stretches into its fifth decade. There’s still no cure for HIV, but a positive diagnosis is no longer the death sentence it once was. The latest statistics from Public Health England revealed another drop in new cases of HIV in 2019, marking a fall of 10% from the previous year.

Since 2015, there’s been a drop of 34% across all populations, with cases among gay and bisexual men down by nearly half (47%) in that time. 98% of people diagnosed with HIV are now on life-saving treatment, which means the overwhelming majority cannot pass on the virus, and can enjoy healthy, normal lives.

In fact, progress has been so transformative that England now has a target to end new cases of HIV by 2030. Now, I appreciate that praise for the present administration is not something usually found in the pages of Tribune, but this leadership should be recognised. A target that was until recently thought unachievable was just last week endorsed by Boris Johnson and Rishi Sunak.

Readers will be relieved to know that that’s where the praise for this government ends. Because if you want to see the some of the worst consequences of the Tories’ public policy, look no further than your local sexual health clinic.

The handling of sexual health services matters because these services are the bedrock of the fight against HIV. They play a key role in HIV testing and will be crucial to identifying the 5,800 people living with HIV in England who remain undiagnosed – and who therefore risk unknowingly damaging their own health and passing on the virus to others.

Back in 2012, the much-derided Andrew Lansley reforms to the NHS shuffled responsibility for public health, including frontline sexual health services, over to councils – the logic being that councils know the needs of their communities better than ministers in Whitehall. It’s a reasonable assumption, but one that would only work if it was backed with the proper funding from central government, which accounts for the bulk of cash councils receive. The opposite happened. Budgets for local councils were hollowed out.

According to the Local Government Association, core funding from central government has been slashed by nearly £16 billion over the last decade. Money for the NHS has increased year-on-year between 2015 and 2020, so ministers have batted aside concerns about healthcare in England by pointing at graphs showing upward-moving lines, but funding for public health in the same period has been cut over £531 million, with money for sexual health services specifically slashed by 25%.

The scale of the financial black hole councils are now facing is alarming. The Kings Fund estimate that it would require an additional £1 billion to just return public health spending to levels in 2015/16. The impact of cuts isn’t confined to council spreadsheets. It’s evident in the waning ability of local services to cope with demand. In 2018, the Royal College of Nurses warned that sexual health was at a ‘tipping point’, with clinics and other services severely understaffed.

Trying to get a sexual health screening now requires the patience and fortitude of someone trying to get a Glastonbury ticket. In just one London Borough, up to 600 people per week are being turned away from oversubscribed clinics. 56 Dean Street, in the heart of Soho, estimates that every day as many as 1,500 people are trying to book just 300 available slots – slots often snapped up in just minutes when they’re released online at 7pm each night.

The same thing is happening right across the country. The British Association for HIV and Sexual Health found over half (54%) of its members reported decreases in the overall level of service access to patients between 2017 and 2018. Every person turned away from a sexual health clinic is a missed opportunity to screen, detect, and potentially treat an STI or HIV. It’s not just about the economic imperative to fix this scandal; there’s a clear moral reason to do so.

The unsurprising consequence of all this is that the nation’s sexual health is in a bad way. In 2018 a new STI was diagnosed every 70 seconds in England; syphilis is now at its highest levels since the Second World War, and overall STIs climbed by 5% in 2019. It’s young people who are shouldering the biggest burden of the sexual health crisis: half of all new STIs diagnosed are in under-25s.

It would be remiss of me to talk about young people’s sexual health without acknowledging the toxic legacy of Section 28, which effectively gagged schools on LGBT+ issues. The law was ushered in at the height of Thatcher’s reign, when press scaremongering about HIV was a daily occurrence, and finally repealed in 2003 – but debates about the ‘morality’ of schools teaching inclusive lessons continue to play out on TV talk shows nearly two decades later. If young and older people alike lack information about HIV in 2020, it is in part down to this.

Even structures that the Tories themselves created to tackle health inequality now face the axe. Public Health England, which is responsible for improving the health of the nation and, crucially, collecting data—including on new HIV and STI infections—is set to be pulled and replaced with the National Institute for Health Protection. The Institute will be led by Dido Harding – the same Dido Harding who has presided over an NHS Test and Trace programme which has cost the Treasury upwards of £12 billion so far, and which has told just 60% of potential Covid infections to self-isolate.

The above, of course, hardly scratches at the surface of the last ten years of public service decimations and widening health inequalities. Sir Michael Marmot, who conducted a review on health outcomes earlier this year, said that ‘England has lost a decade’, and that austerity policies are likely the principal cause.

All this makes it even more remarkable that significant progress has been made in the fight against HIV. This success is a tribute to HIV activists and campaigners, who forced the government to introduce the anti-HIV drug PrEP when ministers sat on their hands and NHS England dished out homophobic messaging to the press. And it’s a tribute to the medical experts who spoke out about the impact of the Home Office’s hostile environment on migrants’ ability to access lifesaving HIV treatment.

The 2030 goal to end new HIV cases is achievable – but it will take a lifeline to our frontline public services to make it a reality.