UK National Policy on HIV/AIDS
HIV/AIDS is one of the diseases that attract the most attention of the 21st century scientists. It still has no cure and the numbers of HIV-positive people are growing world wide. Although the United Kingdom proudly states that it has one of the lowest HIV/AIDS levels in Europe due tom some positive measures introduced at the earlier stages of the disease development, the National Government is still concerned with the constantly growing numbers of HIV-positive citizens. This report focuses on the current UK policies on the issue, both internal and external. Special attention is given to the historical background for the current policies and comparison with different nations implementing their approaches to HIV/AIDS. Due to the sensitive nature of the disease, special attention is given to the social background of HIV/AIDS. This study not only reviews the existing policies and studies their backgrounds, but also pays special attention to the drawbacks that are recognized on the national level.
AIDS as the disease of the 21st century. Facts and Statistics.
AIDS is sometimes named the “plague of the 20th century” due to two reasons: firstly, from the very first cases of the disease it has rapidly spread throughout the world; secondly, because there is still no ultimate cure (Department of Health 2011). It is essential to understand the ultimate difference between HIV and AIDS, where HIV (human immunodeficiency virus infection) is a name of the virus that causes the disease commonly known as AIDS (acquired immunodeficiency syndrome) (Aerhihenbuwa & Obregon 2000). HIV/AIDS infects the immune system of people. There are three main ways to acquire HIV: sexual intercourse, through contaminated blood transfusions, and from infected mother to a child (Centers for Disease Control & Prevention 2003; WHO 2012; NAT 2011a). Although there is no vaccine that can cure a person from AIDS, there are numerous ways of decreasing the hazard of acquiring HIV, the major being safe sex and programmes for needle exchange (Health Protection Agency 2008).
The rates of HIV/AIDS infected UK citizens have been constantly growing (Boseley 2011). Since the beginning of the 21st century the number of HIV positive UK citizens has more than tripled (Health Protection Agency 2012). HIV/AIDS is a disease that had spread worldwide. Although it is most common in the developing countries (with African continent being under the main pressure), all the countries in the Western World are also trying to tackle the HIV infection. In 2011 in the UK there were almost 100,000 people living with HIV (National Aids Trust 2012). What is dangerous, around of ¼ of all people with HIV are not aware of their condition and thus can unintentionally spread the disease.
The HIV-positive population is not gender balanced. More than 2/3 of all infected people are males, which females comprise only 33% of all people with HIV/AIDS (Department of Health 2012). On the contrary to the common perception that HIV/AIDS is a disease must commonly transmitted between same-sex partners, statistics show that in 2011 49% of people receiving HIV acquired the disease from heterosexual intercourse, while only 43% was caused by the homosexual one (National Aids Trust 2012; NAT 2011).
This report focuses on the United Kingdom as a whole, although statistics of different UK nations show dramatic differences. The citizens of England have comprised the vast majority of those receiving HIV in 2011 with more than a half of the whole UK HIV-positive population (NAT 2011). Nevertheless, this report focuses on the United Kingdom as a whole because the majority of programmes are implementing nation-wide. This happens because HIV/AIDS is considered to be one of the national healthcare priorities.
Social context of the disease
AIDS is a complex disease not only from the medical point of view, but also from the social one (Navarro & Shi, 2001). It is one of the sicknesses that are widely stigmatized by the society (Herek & Glunt 1988). While medical practice impartially identifies symptoms, as well as theories of origin, transmission, and prevention are being introduced. All these factors form the social context of a disease and identify if sick people should be pitied or stigmatized; supported or blamed (Herek, 1990; Sharp 2010). Basing on this social context countries form their healthcare policies.
The social nature of a disease plays a very important role in the formation of policies regarding AIDS. From the very beginning those with HIV/AIDS were socially ostracized, discriminated, and there were even cases of physical violence (Herek, Capitanio & Widaman 2003). There are two main ideas that form a solid background for negative attitudes towards HIV/AIDS and people with the diseases: on one hand, there is a constant fear of a fast HIV transmission; secondly, HIV/AIDS is a disease that is commonly attributed to socially deviant groups, such as drug users and people with multiple sexual partners, or homosexuals (Herek & Capitanio 1999). Therefore, while analyzing state policies regarding AIDS it is essential to take into account social context of the disease.
There are two ways in which state policies on AIDS can develop: either the nation-wide strategies are protecting those who are ill from the negative attitudes formed by stereotypes, or, on the contrary, they are enhancing discrimination (Deutz, Pitt & Joseet 2000). Both types of attitudes can be seen throughout the history of national AIDS health policy development in different countries. For example, in the UK needle exchange for injecting drug users was introduced at the earlier stages of the policy development, thus the main aim was to consider the deviant population and prevent the further spread of the disease. This policy was aimed at protection of the population despite different social statuses of people. On the other hand, in the 1980s USA conservatives were trying to eliminate anonymous HIV testing, which was only one of the discriminative policies introduced at that time (Aragón & Myers 1999).
Historical Context
The first response of the UK government to HIV and AIDS dates back 25 years, although at that point there was still not enough information on the disease and its’ possible evolvement (Berridge & Strong 1991). Despite the lack of research and information on HIV, some of the first steps towards the minimization of harmful consequences, such as the introduction of needle exchange for drug users, have proved to be successful (AVERT 2013).
In the 21st century UK HIV/AIDS policies went in a strong contradiction with those introduced in the United States. While the US national plans stated that sexual abstinence should be considered as the main way to decrease the spread of HIV, the UK policies focused on the reproductive rights of women as well as condom funding (Boseley 2004). Therefore, the UK officials stand against the conservative approach to the HIV/AIDS prevention and treatment, choosing liberal approaches that are oriented towards the support of the population rather than introduction of various limitations.
International Policies
The Government of the United Kingdom is not only supports the HIV/AIDS treatment and prevention on its’ national territory, but also supports the introduction of corresponding programmes in the developing states worldwide. In 2004 UK financed 490 million of the overall one billion of condoms distributed in the developing world (Boseley 2004), while national authorities recognized that even this contribution is not significant enough for the global ballet against HIV/AIDS.
The National Government of the UK recognizes the significant role of international organizations and volunteer-based institutions in tackling HIV/AIDS worldwide. Therefore, one of the international UK policies is the finance of Aids Relief and various organizations working with ill people and promoting prevention programmes worldwide (Consortium on AIDS and International Development 2012).
Internal Policies
While analyzing AIDS policies in the United Kingdom one should study not only those related to healthcare sphere, but also those in social sphere. Due to the significance of the social context of AIDS, national policies on this disease include regulations in the sphere of workforce, human and civil rights, etc. Moreover, within the UK medical policies there are those tackling the disease, as well as various prevention programmes.
It is recognized by the UK Governmental authorities that HIV prevention should become the top priority of the national policy in order to ensure not only the decrease of HIV/AIDS in the country, but also to secure financial stability of the healthcare industry. Costs of treating people with HIV are much higher than those spent on disease prevention. The Health Protection Agency stated that prevention of almost 4000 HIV infections in 2010 would have saved more than 32 million pounds a year, which would have become more than a billion of lifetime costs (Department of Health 2011).
Currently the HIV/AIDS national strategies are outlined in the White Paper Healthy Lives, Healthy People. The UK Department of Health is the nation’s main contributor on the governmental level to various HIV charities in the United Kingdom. It is recognized on the national level that the contribution of the third sector in tackling AIDS and especially HIV prevention is a truly significant one.
As it was already stated, the current HIV/AIDS UK policy has a number of different focus spheres: vaccine research, prevention, local communities and/or support networks, needle exchange programmes, school programmes, mother-to-child virus transmission, disease scientific research, offender health services, testing, treatment, public health reforms, etc. Therefore, there are various focuses of the UK policies on HIV/AIDS, that cover HIV/AIDS prevention (awareness programmes, needle exchange etc), treatment, and research in the sphere.
Along with the healthcare policies, the Government of the United Kingdom supports various policies that support equal rights for citizens with AIDS/HIV. The most important document implemented in the UK is the Equality Act 2010, which operates in England, Scotland and Wales. The anti-discrimination legislation of the Northern Ireland is comprised of a number of various laws, with the most important one being Disability Discrimination Act 1995. The Equality Act 2010 protects the rights in the employment sphere, as well as education, purchase/rent of land or property, access to services and goods (NAM Publications 2013). Still, employment is the main sphere facilitated by the Act. The workplace issues covered in the document include but are not limited to application process, type of employment, treatment at a workplace, possibility to acquire references from the previous place of employment etc. All these regulations ensure that HIV-positive people receive the same treatment as the rest of employees (Croser 2010).
Policy Criticism
State authorities in the UK state that HIV/AIDS prevention and tackling policies are constantly developing in the UK, but still they are considered to be “woefully inadequate” and the numbers of people with the illnesses is still constantly growing (UK Parliament, 2011). The Lord Select Committee has published a report according to which there are four major drawbacks of the current state policy on HIV/AIDS: growth of the disease, lack of timely diagnosis, no proper prevention programmes, and public ignorance.
Over the past decade the number of people with HIV/AIDS has at least trebled. More than 100,000 are currently living with HIV in the United Kingdom (UK Parliament, 2011). At the same time, with the growth of the number of patients the treatment costs are increasing as well. Therefore, while the disease is spreading, the price of healthcare services is not decreasing, which creates an additional burden for the national budget.
It is a common thing among HIV-infected UK citizens to be unaware of their condition. The Lord Select Committee Report states that around ¼ of all people with the disease are not diagnosed (Health protection Agency 2012). This results in the spread of disease due to the lack of appropriate protection and awareness. Testing is only one of the possible ways to prevent the spreading of HIV (Health Protection Agency 2011; National AIDS Trust 2012a).
More money is being spent by the Government on the AIDS treatment, but the funding of HIV prevention programmes still remains inadequate. Although the disease can be 100% prevented, the programmes that rise awareness among the UK population of different ages are under-financed (NAT 2008). The Government expenditure of 762 million pounds on treatment is 300% higher than the money spent on prevention (UK Parliament, 2011). This results in the constant growth of HIV-positive people and thus – further growth of treatment expenditures.
Finally, the fourth criticism of the current UK HIV/AIDS policy is the lack of information on the issue. Scientists and politicians recognize the nation-wide ignorance that requires fast and efficient actions (NAT 2008). The only ways to improve the situation is to launch a nation-wide educational campaign that will increase the awareness of population. The lack of knowledge creates negative stereotypes that lead to discrimination and stigmatizing of HIV-positive people (Herek, Capitanio & Widaman 2002).
Policy Analysis
From the first glance it may seem that the current HIV/AIDS policy in the UK is a well-developed one because it covers various spheres: healthcare, social, disease prevention, informational etc. At the same time the criticism, provided above, shows that there are still spheres in which the UK HIV/AIDS policies have to be improved and developed. In order to propose possible improvements it is essential to have a short overview of the issue, based on different factors that shape each policy: Social, Technical, Economical, Environmental, Political, Legal, and Ethical.
Social context is one of the strongest modulators of the UK HIV/AIDS policy (Beckerman & Gelman 2000). This disease has caused a strong social response due to the ways in which it is transferred. Many still associate HIV/AIDS not only with unprotected sex with multiple partners, but also with drug addiction and homosexuality. As a result, HIV-positive people are commonly considered deviant. Although in some countries national HIV/AIDS policies are still stigmatized, the UK Government has tried to increase the awareness of population and protect those already infected.
HIV/AIDS still remains one of the untreatable diseases. Although the development in medicine have significantly increased not only the life expectancy of HIV-positive people, but also their quality of life, the disease still does not have a cure (AVERT 2013). Therefore, although the state still finances research on the disease and its’ pharmacology, so far there are no new significant technological improvement (Department of Health 2011).
The same as any other disease, HIV/AIDS creates a huge financial burden for the UK economy. With the constant growth of the HIV-positive population the treatment expenditures are growing as well. Even though people diagnosed with AIDS can perform almost equally as other employees and thus contribute to the national economy, the money spent on treatment is much more significant. While analyzing UK HIV/AIDS policies it is also essential to note that the country contributes to the disease prevention worldwide by supporting international organizations. Therefore, there are no financial benefits from the current policies.
Environment in case of HIV/AIDS state policies can be overviewed as the overall political/social situation in the country, which is getting more liberal and open. Therefore, with the growing awareness about the disease it would be logical to expect the decrease in negative stereotypes towards HIV-positive population.
It can be seen from the comparison with the United States that political parties at power play significant role in the formation of the state HIV/AIDS policy due to the very sensitive nature of the disease (Navarro 2006). Therefore, state HIV/AIDS policy is based on the politicians’ attitudes towards homosexuality, rights of women, and sexual freedoms. In case of the UK the attitudes of parties at power towards women and sexual minorities were and still are quite liberal, which can be seen through the overall policy patterns: educational programmes, disease prevention, availability of HIV tests, possibility to remain anonymous etc.
In the United Kingdom there is already nation-wide legislation that is oriented towards the protection of rights and interests of HIV-positive population, as well as provision of adequate healthcare. The White Paper Healthy Lives, Healthy People defines the strategies of HIV/AIDS treatment and prevention, while the Equality Act 2010 protects the rights of HIV-positive population for equal treatment. Although the Equality Act 2010 covers the territory of only three nations, in the Northern Ireland the rights of this group of population are supported by a number of local documents.
Ethical issues play a truly significant role due to the sensitive nature of HIV/AIDS, which is transferred via unprotected sexual intercourse. Moreover, this disease is commonly associated with sexual minorities, which adds complexity to the issue. As a result, anonymity has become one of the key concepts in the development of the national HIV/AIDS policies.
Mechanisms
The research has shown that there are some programmes that have proved to be extremely successful. The main one is the needle exchange, which has significantly reduced the HIV transfer through contaminated needles among drug users (Department of Health 2011). This programme, implemented on the earlier stages of HIV/AIDS development has significantly reduced the level of HIV in the United Kingdom (if compared to other European states). This is only one example that shows the general tendency of prevention programmes being more effective than treatment itself.
Currently the biggest mistake of the UK HIV/AIDS policy-making is disproportional financing of prevention/treatment spheres. On one hand, there is still no cure for the disease and treatment of existing patients requires significant financial contributions, while on the other under-financed prevention programmes have proved to be efficient by 96%. Therefore, if HIV-prevention programmes receive adequate funding, they will be able to stop the growth of the numbers of HIV-positive population. This will consequently stop the constant growth of the treatment expenses.
Taking into consideration all the mentioned information, prevention of HIV/AIDS has to become the new focus of the UK state healthcare policy. Financing should be allocated for awareness campaigns, needle exchange programmes, antiretroviral treatments (WHO 2012a), and needle exchanges. Although the HIV/AIDS treatment remains an issue of a great significance, it should not be the primary focus of the state policies.
A separate sphere that requires special attention of the UK national authorities is testing which, if done timely, is able to stop the spread of HIV/AIDS (Health Protection Agency 2011). Therefore, promotion of HIV/AIDS tests as a way to protect own partners and other society members has to become another issue for the disease prevention policy (Sax & Baden 2009).
There is one factor that unites all the abovementioned programmes – anonymity. As it was mentioned, there is a complex social background of AIDS, which causes negative discriminative attitudes towards HIV-positive. Therefore the ability to remain anonymous not only during treatment but also while testing is essential for the success of any HIV/AIDS programme. Therefore, while the state secures the privacy of its’ citizens, its’ programmes will be successful.
Despite all the focus of the National Government on the HIV/AIDS policies, it is not able to implement them without bodies, focused on the issue. While one of the ways to cope with the problem would be the implementation of new structures on the national level, on the other it will be more efficient to use the help of numerous local, national, and international organizations that are already working in the sphere. One of them is the HIV/AIDS Alliance, but it is far from being the only one. In the cooperation with the third sector the Government will be able to achieve better results than just working alone. There are two ways in which the National Government can cooperate with NGOs: financing through grants and legal support. On the other hand, non-governmental organizations will share their experience, contacts, workforce etc.
Outcomes
It was already stated a number of times that so far HIV/AIDS does not have a cure. Therefore, despite the medical researches conducted and financed by the government it would be too idealistic to expect short-term significant results. The main focus of all current innovative pharmacological interventions is the extension of life expectancy and improvement of the living conditions of HIV-positive citizens (AVERT 2013). Therefore, significant resources are allocated not for the research but for treatment of patients.
Prevention programmes, which currently require additional financing, have one major aim – to decrease the spreading of HIV/AIDS. If implemented successfully, they will be able to decrease the disease growth rates and thus minimize the funding spent on treatment. Moreover, the larger number of the UK population will remain healthy, which is the ultimate goal of all healthcare programmes.
One of the goals of the United Kingdom HIV/AIDS policy that is being sometimes ignored is the social context of the disease. By increasing awareness and providing various information about the disease it will be possible to influence the perceptions of people and form new attitudes towards HIV-positive population. The ultimate goal of the awareness campaigns is to decrease the stigmatization and discrimination tendencies of the modern society (Pryor, Reeder & Landau 1999).
Conclusion
HIV/AIDS is a disease that became known only in the 20th century, but has already managed to turn into one of the major healthcare threats. It is not only easily transmitted through blood and dome other body fluids, but still does not have a cure. Therefore, despite the existing policies and regulations the number of HIV-positive UK citizens increases each year.
The United Kingdom currently has quite a solid policy on HIV/AIDS issues, which covers not only healthcare elements, but also provides social and workplace regulations. Healthcare policies can be separated into treatment (which currently gets the most financing) and prevention (which includes testing, awareness campaigns, safe sex promotion etc.). Despite the seemingly varied set of programmes within the national policy, it still seems inefficient because the number of HIV-positive people is growing each year.
This analysis focuses on the drawbacks of the current UK policy and emphasized the need for the additional attention to prevention programmes that can be efficient and prevent people from acquiring HIV. Therefore, only by shifting its’ priorities the UK National Government will be able to decrease the constantly growing rates of HIV-positive population.
