愛滋病毒新感診斷率下降，但更需要達到零新感
2019年9月3日/本文係TrustTerrence Higgins Trust（註1）回應英國公共衛生部今天發布的新數據；財團法人台灣紅絲帶基金會編譯
英國公共衛生部今天發布的新數據顯示，2018年英國有4,484例新的愛滋病毒感染診斷，下降了6％。
相較之下，2017年下降了17％，自2015年以來更下降了28％。
統計數據還顯示：
•不可接受的晚期診斷率：43％的愛滋病毒感染者仍在晚期才被診斷，其中異性戀男性和50歲及以上的人最有可能經歷晚期診斷。
•男同性戀和雙性戀男性人數下降最多：同性戀和雙性戀男性新診斷愛滋感染病例減少10％，自2015年以來，該群體的診斷率下降了39％。
•倫敦進步最大：相較於全國下降6％，首都更下降了12％。
Terrence Higgins Trust首席執行長Ian Green說：
「我們當然歡迎新的愛滋病毒感染診斷下降，但其進展趨緩，則需要視為一個明確的警告，亦即需要做更多工作，才能兌現政府在2030年前終止愛滋病毒傳播的承諾」。
「為了繼續取得進步，必須將愛滋病視為一個公共衛生優先問題去考量，因為『更多相同的處置』並不會削減它」。我們還需要確保愛滋病預防藥物PrEP的取得並能意識到其需要、定期進行愛滋病毒檢測的正常化，以及在全國範圍內投資性健康服務，並確保它們獲得適當的資金，以滿足不斷增長的需求。
「我們擁有必要的工具來終止傳播，但在全英國範圍內針對所有受愛滋病影響的群體，我們需要最大化地擴展這些措施，以確保不會讓任何一個人掉隊」。今天的數據，僅在同性戀和雙性戀男性以及倫敦和東南部地區進展得最快，顯示情況並非如前所述，仍有努力空間。
「雖然新感的診斷正在下降，但被認為係延遲診斷的人之比例，仍然頑固且令人無法接受地高達43％。這部份是非常重要的，因為晚期診斷對個人的健康不利，也會顯著增加愛滋病毒在不知不覺中傳播的可能。
「異性戀男性和50歲或以上的人仍然是受到晚期診斷影響最大的兩個群體，這意味著需要做更多的工作，來讓這些群體參與愛滋病毒相關防治活動和定期接受檢測」。
「我們還需要掌握基本的正確，即必須要在學校就教育年輕人了解愛滋病毒。我們很清楚，英國所有學校自2020年起『關係和性教育』(Relationships and Sex Education)將成為必修課程，必須非常重視愛滋病和性健康訊息，包括有關PrEP以及愛滋病之治療如何有效地阻止病毒之傳播」。
關於為實現愛滋病毒零傳播還需要做些什麼呢？Green補充說：
「對抗愛滋的醫學進展令人難以置信地進步，但恥辱污名仍然是阻礙一勞永逸地終結愛滋傳播上的巨大障礙。這也就是為什麼更新大眾對愛滋病之認知的工作、保險套的獲得、在主要街道貨架上輕易取得自我檢測套組，以及PrEP取得權之爭取等等都是一樣重要」。
「在英國最遲於2030年前終結愛滋病毒傳播此一方面上，我們被認為能發揮關鍵作用。這就是為什麼我們與國家愛滋病信託基金合作，成立了一愛滋病委員會，針對政府已承諾要去評估之部份，負責為實現這一目標去提出明確的建議。我們之所以如此做，是因為如果我們打算不讓任何一個人掉隊，並確保不讓風險變高，否則我們就無法繼續做我們正在做的事情」。
關於下降的原因，Green說：
「PrEP在預防愛滋病毒方面非常有效，並且可能是當今愛滋病毒新感診斷下降的一個因素，特別是在男同性戀和雙性戀男性中。儘管PrEP在愛滋病毒預防上明確是一遊戲改變者，但在英國這種藥物的取得仍然受限，然而這是情況是不能被接受的」。
「現在只有一年多的時間，直到PrEP影響試驗結束，同性戀和雙性戀男性仍佔愛滋病毒新感診斷的一半以上，在英國爭取正確的取得PrEP之抗爭仍正在繼續。試驗的地方數量雖有所增加，但是仍再次地存在需求超出可用性的鉅大的風險」。
「根據英國公共衛生部今天的數據，我們正在敦促英國衛生服務部門和地方理事會立即開始計劃將PrEP給予家庭作為常規的性健康服務之一部分。對同性戀以外之群體提高其對PrEP的認識，這將走很長的路，但亦對我們在2030年之前實現零傳播上有很大的助益。
「向新診斷出愛滋病毒的人提供建議，立即開始治療，這是新診斷持續下降的一個重要因素。此乃因經有效愛滋病毒治療的人，無論有無使用保險套，也不會將愛滋病毒傳染給他們的伴侶」。
「談到愛滋病毒檢測方面，有一些很好的創新方法– 包括自我測試，你可以在家中並於15分鐘內獲得結果。我們試行了一個線上點擊並取得的選擇，以便傳遞提供這些測試，這在非裔黑人男性中特別受歡迎，因為他們經常擔心相關的機密性」。
註1：Terrence Higgins Trust是英國的愛滋病和性健康慈善機構。除了支持愛滋病毒感染者並擴大他們的聲音外，並幫助使用他們服務的人們實現良好的性健康。
New HIV diagnoses falling, but much more needed to get to zero
3 September 2019 / We respond to the new data published today from Public Health England.
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New figures published today by Public Health England show 4,484 new HIV diagnoses in the UK in 2018, which is a 6% decline.
This is compared to a 17% fall in 2017 and a fall of 28% since 2015.
The stats also show:
· Unacceptable rates of late diagnosis: 43% of people with HIV were still diagnosed late, with heterosexual men and those aged 50 and over most likely to experience late diagnosis.
· Biggest drop among gay and bisexual men: 10% decline in new HIV diagnoses among gay and bisexual men, with a 39% decline in diagnoses among this group since 2015.
· Biggest progress in London: 12% decline in the capital, compared to 6% nationally.
Ian Green, Chief Executive at Terrence Higgins Trust, said:
‘New HIV diagnoses are falling in the UK which we of course welcome, but the slowing of progress needs to serve as a clear warning that more needs to be done to make good on the Government’s commitment to end HIV transmissions by 2030.
‘In order to continue progress HIV must be prioritised as a public health issue because ‘more of the same’ won’t cut it. We also need to ensure access to and awareness of HIV prevention pill PrEP, the normalisation of regular HIV testing, and to invest in sexual health services across the country to make sure they are properly funded to meet rising demand.
‘We have the necessary tools to end transmissions but we need to maximise these across all groups affected by HIV right across the UK to ensure that no-one is left behind. Today’s data shows that this isn’t the case with progress fastest among gay and bisexual men and in London and the south east.
‘While new diagnoses are falling, the proportion of people still being diagnosed late remains stubbornly and unacceptably high at 43%. This is so important because a late diagnosis is bad for an individual’s health and also significantly increases the chances of HIV being unwittingly passed on.
‘Heterosexual men and those aged 50 or over remain two of the groups most affected by late diagnosis, which means more needs to be done to engage these groups around HIV and regular testing.
‘We also need to get the basics right and that starts with teaching young people about HIV in schools. We’re clear that there must be a strong emphasis on HIV and sexual health when Relationships and Sex Education becomes compulsory in all schools in England from 2020, including information on PrEP and how HIV treatments stops the virus from being passed on.’
On what more needs to be done to reach zero HIV transmissions, Green added:
‘The medical progress in the fight against HIV has been incredible but stigma remains a huge barrier standing in the way of ending transmissions once and for all. That’s why work to update the public’s knowledge of HIV is just as important as access to condoms, self tests on the high street shelves and fighting for PrEP access.
‘We’re determined to play a key role in ending HIV transmissions in the UK by 2030 at the latest. That’s why we’ve joined with National AIDS Trust to launch a HIV Commission tasked with making clear recommendations for achieving that, which the Government has committed to reviewing. We’ve done this because we can’t keep doing what we’re doing if we’re to leave no-one behind and to ensure we don’t risk moving backwards.’
On the reason for the decline, Green said:
‘PrEP is highly effective at preventing HIV and is a likely contributing factor in today’s decline in new HIV diagnoses, notably among gay and bisexual men. Despite PrEP being a clear HIV game-changer, access to this drug remains capped in England and that’s unacceptable.
‘There is now just over one year until the end of the PrEP Impact Trial and with gay and bisexual men still accounting for over half of new HIV diagnoses, the fight for proper PrEP access in England continues. There has been an increase in places on the trial but once again there’s the very real risk of demand outstripping availability.
‘In light of today’s data from Public Health England, we’re urging NHS England, the Department of Health and local councils to immediately begin planning for PrEP to be given a home as part of routine sexual health services. Raising awareness of PrEP outside of the gay community will also go a long way in helping us to reach zero transmissions by 2030.
‘Advising people newly diagnosed with HIV to immediately start treatment has been a significant factor in the continuing decline in new diagnoses. That’s because someone on effective HIV treatment cannot pass on HIV to their partners, with or without a condom.
‘In terms of HIV testing, there have been brilliant innovations – including self tests where you can get a result at home within 15 minutes. We piloted a click and collect option for delivering these tests which was particularly popular among black African men who were often worried about confidentiality.