Marseille 2007
Marseille 2007
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Abstract #376  -  The growing challenge: a strategic review of HIV social care, support and information services across the UK
Session:
  6.58: Posters A (Poster) on Monday   in  Chaired by
Authors:
  Presenting Author:   Mr Ford Hickson - University of Portsmouth, United Kingdom
 
  Additional Authors:   
Aim:
As the UK HIV epidemic has grown its demographic profile has changed. Overlaying the long-standing epidemic among gay men is the more recent epidemic among African migrants to the UK. These populations differ in terms of social care, support and information needs. In order to assess the extent to which services are responding to these changing needs, we conducted a review of both service commissioning and service provision across the UK.
 
Method / Issue:
1111 unique email addresses (456 NGOs, 492 NHS commissioners/ sexual health leads and 163 Local Authority HIV leads) were targeted with an invitation to complete an online survey (available in May 2006). About 10% of emails were undeliverable, suggesting about 1,000 people were invited to participate. After exclusions, the sample consisted of 371 responses including 164 workers or volunteers from 111 different charities serving people with HIV; 78 commissioners of HIV services; and 76 staff from NHS providers of HIV services and from 63 Local Authorities.197 survey participants volunteered for follow-up telephone interview of whom 18 (eight commissioners and ten charitable providers) were interviewed. Respondents were selected to maximise variation between urban and non-urban, high and low prevalence areas.
 
Results / Comments:
Factors inhibiting needs-led service development fell into three categories: (1) HIV is not a political or policy priority, either nationally or locally; (2) The NHS is in crisis; (3) Local Authorities are mainstreaming services. There are no government targets against which performance with respect to HIV prevention or care is measured. There are no core competencies, skills or formal training for NHS HIV commissioners. Constant NHS restructuring and shrinking budgets means that NHS deficits figure more prominently than need in commissioning decisions. HIV social care, support and information services are seen as secondary to treatment and care budgets. Retraction and mainstreaming of Local Authority services threatens to disrupt provision of HIV social care. Social services are increasingly unable to serve the acute needs of asylum seekers with HIV. This is putting undue pressure on charitable providers. The majority of respondents did not think all people with HIV were equally well served by the current configuration of services. Migrants, asylum seekers and ethnic minorities were seen as substantially under-served. The majority of respondents thought commissioners should prioritise specific needs when considering future funding of services (including needs around social care and support, financial security, education, training and employment, housing need, health care needs, legal and welfare benefits).
 
Discussion:
Current HIV service configuration in the UK is unlikely to meet the changing needs of the population of people with HIV because it is neither sufficiently flexible nor needs-led. Moreover, while the number of people in the UK with diagnosed HIV increases by 10-15% per year, investment in HIV social care, support and information provision is static or reducing. Services are funded mainly because of historical precedent and funding tends to roll forward year-on-year, unless under-performance or budgetary pressure allows it to be withdrawn. Changes in population size or need are not central to decisions to change service configuration. More important are NHS funding shortfalls, Local Authority mainstreaming of social care services and wider political pressures.
 
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