CHAPTER 4: Prevention: Getting the Message
56. The previous sections established that prevention
should be a focus whilst there is no realistic prospect of either
a vaccine or a cure for HIV. This is especially important given
that the cumulative effect of year-on-year increases in the number
of people living with HIV is that treatment costs will continue
to rise, presenting an increasing burden for the NHS.
57. This chapter examines existing prevention
activity, reflecting upon the effectiveness and resource base
of such work, before setting out how prevention initiatives should
be developed and improved.
NATIONAL HIV PROGRAMMES
58. Currently, nationally funded HIV prevention
work is 'targeted' at the two groups most at risk of infection.
Since 1996, the Department of Health has funded the Terrence Higgins
Trust for a national prevention programme focused upon MSM; and
since 2000, the Department has funded the African Health Policy
for work with African communities living in England. For 2011/12,
the Terrence Higgins Trust will receive £1.9 million, whilst
the AHPN will receive £1 million.
59. Terrence Higgins Trust and the AHPN work
through partnerships which bring together a wide range of community
and third sector groups to deliver locally specific HIV prevention
activity. For MSM, this work is delivered through the Community
HIV and AIDS Prevention Strategy (CHAPS), whilst for black African
communities, activities and funding are delivered through the
National African HIV Prevention Programme (NAHIP).
60. In both cases, prevention activities undertaken
typically comprise HIV awareness-raising through media campaigns
(often using community-specific media), leafleting, advertisements
and posters. This work is complemented by direct contact work
including workshops, counselling and group activities, in addition
to the use of the internet and social marketing tools. In some
areas, open-access testing facilities are also available.
61. NAHIP stated that: "The amount currently
spent by the Department of Health on HIV prevention is not sufficient."
Its funding of £1 million per annum equates to between £1
and £2 for each African living in England.
It noted that the £1 million currently spent on prevention
for Africans is 0.25% of the £400 million annual cost of
treatment and care for the African population. NAHIP concluded
by stating that: "Greater spend on prevention is an investment
to lower the HIV treatment and care costs to the NHS in the future.
Reducing this future burden is one reason why UNAIDS recommends
that spending on prevention should be close to 45% of the total
spend on treatment and care."
62. We have highlighted the costs of treating
HIV, and the long-term savings which could be made through investment
in HIV prevention. The current levels of investment in national
HIV prevention programmes are insufficient to provide the level
of intervention required.
LOCAL HIV PROGRAMMES
63. In addition to the national campaigns funded
by the Department of Health, a range of local provision also exists.
Prevention campaigns at the local level are usually funded by
Primary Care Trusts, local authorities and charitable donations;
typically, providers will draw funding from all of these sources.
Some providers, such as Yorkshire MESMAC,
match local funding with money received from the national CHAPS
64. Voluntary bodies play a strong role in these
local programmes, building on campaigns delivered nationally through
more direct work with at-risk groups. 'Outreach'a diverse
term which can include visits to churches, publicising HIV testing
in gay nightclubs and promoting condom use in gay saunasis
a particularly important facet of the work of many of these providers.
65. Of these local campaigns, the largest is
the Pan-London HIV Prevention Programme (PLHIPP), with a budget
of around £3m in 2009/10.
For the current financial year, the PLHIPP has experienced a reduction
of 20% in the funding received from London PCTs.
This is illustrative of a trend towards disinvestment in local
HIV prevention. Sir Nick Partridge, Chief Executive of the
Terrence Higgins Trust, suggested that: "Over the past 10
years we have seen a consistent reduction in the investment and
funding in local HIV prevention services ... That leaves a gap.
It has meant that the responsibility and the expectation on the
national programmes are far greater than they can deliver and
are currently funded to deliver."
66. The Minister for Public Health acknowledged
the important role of local campaigns and the voluntary sector,
stating that: "voluntary sector organisations can be extraordinarily
good value for money."
She acknowledged that it was a difficult period for voluntary
organisations, but said that "the challenge for funding bodies
such as councils, PCTs and others is to look at the provision
of services imaginatively",
going on to state that "cuts can be counterproductive because
of the costs further down the line. Invest to save."
67. At this point, we pay tribute to the voluntary
organisations, without whose efforts the effectiveness of the
early response to HIV and AIDS would have been vastly reduced.
The Minister praised the "very, very responsible attitude"
and "leadership" of the gay community in the early years
of the epidemic.
Throughout the inquiry, we have been impressed by the continuing
strength of the voluntary sector. At a national level, the AHPN,
the National AIDS Trust (NAT)
and the Terrence Higgins Trust have coordinated policy and prevention
work, whilst groups such as Positively UK,
Body and Soul
and National AIDS Manual (NAM)
have been firm advocates for patients. Locally, groups such as
Yorkshire MESMAC, Leeds Skyline,
Summit House and
the Sussex Beacon
have been integral to local prevention, testing and support strategies.
This work must continue to be supported.
68. Local prevention programmes, and the voluntary
sector bodies that deliver them, have played an important role
in tackling HIV. Local authorities, health services and other
funders should avoid undermining local HIV prevention work when
taking budget decisions. The ongoing trend of pressure on local
prevention services also underlines the importance of enhanced
Government funding for national HIV prevention programmes.
WIDER SEXUAL HEALTH CAMPAIGNS
69. Whilst the Department of Health spends £2.9
million on national HIV prevention work, this is only part of
the £10.6 million that the Department spends on sexual health
promotion more generally. A range of other campaigns have been
supported including, for example, the Sex: Worth Talking About
campaign, which ran from November 2009 to March 2010. This £6.7
million campaign, which sought to raise awareness of sexual health
and promote dialogue around safe sex, ran across various media,
including television, radio and newspapers. It did not mention
HIV or AIDS.
70. The omission of HIV from general sexual health
campaigns is a cause for concern. NAT noted that HIV did not feature
in the 2006 Condom: Essential Wear campaign either. It
suggested that HIV awareness should be incorporated into wider
sexual health campaigns.
This view was shared by AHPN, which stressed that: "the NHS'
general sexual health campaigns, which are aimed more widely,
still need to include information about HIV and increase support
to targeted HIV campaigns."
Positively UK suggested that the lack of general national campaigning
on HIV contributed to the stigmatisation of 'at-risk' communities.
71. Dr Rowena Merritt, Research Manager
at the National Social Marketing Centre,
said that campaign financing within the Department of Health took
place within "silos", with HIV sitting separately from
wider sexual health, even though different teams of staff were
often working to target the same audiences. This, she felt, was
72. HIV awareness should be incorporated into
wider national sexual health campaigns, both to promote public
health and to prevent stigmatisation of groups at highest risk
of infection. We recommend that there should be a presumption
in favour of including HIV prevention in all sexual health campaigns
commissioned by the Department of Health.
Do current campaigns work?
73. In the course of visits to HIV clinics in
London and Brighton, we received anecdotal evidence which suggested
that levels of risky sexual behaviour are on the increase. To
an extent, this is borne out by the findings of the 2009 University
College London Gay Men's Sexual Health Survey. This community-based
study found that, of those respondents who were HIV-negative,
46.4% had had unprotected anal sex in the past year; for those
who were HIV-positive, this figure rose to 57.7%. In addition,
40.4% of those who were HIV-positive had had unprotected anal
sex with a casual (once-only) partner in the preceding year.
74. These figures have increased since the mid-1990s
as, indeed, has the level of HIV prevalence identified by the
studyfrom 11% of respondents in 1996 to 15.2% in 2008.
These numbers are alarming, particularly given the high prevalence
of HIV amongst the London MSM community.
75. The Department of Health, however, suggested
that HIV prevention programmes have been effective according to
a number of outcomes for MSM, amongst them:
- Awareness of the availability
of post-exposure prophylaxis (PEP) following potential sexual
exposure to HIV increased from 22% before the CHAPS campaign to
56% after the campaign;
- Preliminary analysis of data suggested that between
2001 and 2008 there was a fall in numbers of sexual partners among
76. Likewise, the Terrence Higgins Trust argued
that national programmes have demonstrated their effectiveness,
suggesting that without them levels of new HIV infection would
be much higher. It cited typical target audience recognition rates
of 30 to 40% for CHAPS campaigns, as well as a reduction in the
number of infections diagnosed amongst MSM between 2007 and 2009.
77. Others have suggested that current programmes
are failing to either effect behaviour change or stem the tide
of new HIV diagnoses. NAM felt that initiatives have been delivered
with insufficient energy and pace, with expenditure declining
over the past decade.
The London Specialised Commissioning Group suggested that national
programmes have tended to be output, rather than outcome focused,
whilst Status argued that a culture of complacency and 'provider
knows best' meant that initiatives were failing gay men.
The Tuke Institute suggested that campaigns are not sufficiently
informed by behavioural science, with data on the dynamics of
transmission not informing the size or delivery of programmes.
78. We accept that levels of new HIV infection
would have been higher without the national prevention programmes,
and we support those delivering this work. We feel, however, that
more needs to be done to reduce dangerous and risky behaviour
that is leading to HIV infection. In part, more funding is needed
but, in addition, a broader range of evidence-based approaches
are required. We give further detail on this approach in paras
116 to 118.
DELIVERING THE RIGHT PREVENTION
79. We have described above the existing practice
of 'targeting' national campaigns at those groups at greatest
risk of HIV infection. The balance between targeting and more
general campaigns is important. NAM,
the African Health Forum
and AHPN argued
that targeting is an efficient use of limited resources, given
that the epidemic within the UK is largely focused in two particular
and the Faculty of Public Health
argued that targeting is sensible, but suggested that high prevalence
areas, as well as high prevalence groups, should be targeted.
They suggested that broader, more general campaigns should be
run alongside community specific activities in areas of high HIV
HIV Scotland and
the Medical Foundation for AIDS and Sexual Health (MedFASH)
believed that funding should be given to both universal prevention
campaigns and targeted interventions for those most at risk. Awareness
of responsibility and risk must extend to the population as a
whole; general campaigns may be necessary to educate the wider
population. Shield South Yorkshire noted that targeted campaigns
at the national level produced materials featuring particular
sections of the population, and that these groups were not always
present amongst the local population.
This made materials difficult to use and prevention messages more
difficult to convey.
82. A general HIV prevention campaign, it is
felt, would address this. NHS commissioners noted that some people
at risk do not identify with campaigns targeted at particular
groups. MSM who
portrayed themselves as heterosexual to friends and family were
one example; young MSM who might not identify as gay were another.
These sub-sections of the target groups are therefore missed by
83. The 1986 Don't Die of Ignorance prevention
campaign had a general, national focus. Post-campaign polling
showed that 98% of the public understood the transmission routes
for HIV. This
illustrates what can potentially be achieved through public health
campaigns in this area. In contrast, a 2010 survey undertaken
by NAT found that 20% of people did not know that HIV was transmitted
by sex without a condom between a man and a woman.
A recent survey of young people, undertaken by the Sex Education
Forum, found that
27% of respondents had not learnt about transmission routes for
84. Both targeted and national HIV prevention
campaigns have an important role to play. Given the concentration
of HIV infection in two specific groups, we recommend continued
targeted HIV prevention campaigning focused on these communities.
This should be coordinated at the national level.
85. We also recommend that the Department
of Health undertake a new national HIV prevention campaign aimed
at the general public. This will ensure that HIV prevention messages
are accessible to all of the population.
86. Contributors also considered the technologies
used to deliver prevention information. Professor Jonathan
Elford, of the Department of Public Health at City University,
and Peter Weatherburn both highlighted the increasing role that
internet and mobile phone-based applications could play in delivering
This is of particular relevance given the increasing role of the
internet in generating and forming sexual relationships.
87. Shield South Yorkshire highlighted the reliance
upon written and printed materials in current prevention activity.
It argued that over-reliance on these forms of delivery failed
to take account of the limited literacy and English language skills
of some members of the target audience. Television and radio campaigns
would lend greater effectivenessespecially when complemented
with the group and individual work that we have advocated above.
88. For some audiences, however, printed media
remain important. Felton Communications
highlighted that the gay press was still the most adept form of
targeted media in reaching that audience, but that different messages
and different audiences would require different approaches.
It was therefore important that campaigns combined all media options.
89. We recommend that those delivering HIV
prevention campaigns, whether nationally or locally, should utilise
the full range of available media, including internet, social
networking and mobile phone applications. We note that national
sexual health campaigns, such as Sex: Worth Talking About,
have been sufficiently resourced to purchase advertising time
with national broadcasters. We recommend that messages around
HIV are included in these campaigns in future, ensuring the greatest
possible exposure for HIV prevention messages.
EVALUATING THE EFFECTIVENESS OF
90. At present, the national HIV prevention programmes
commission their own evaluation from within their programme budgets.
This is undertaken by Sigma Research, based within the London
School of Hygiene and Tropical Medicine. Some contributors, such
as Status, questioned the rigour and transparency of these evaluation
arrangements, believing that evaluation should be commissioned
independently by the Department of Health.
In their own submission, Sigma Research also suggested that the
evaluation of campaigns would be stronger if commissioned directly
by the Department of Health.
91. On this point, the Minister for Public Health
stated that: "... I am always worried if there is a perception
that evaluation is in any way biased, because what really matters
is that evaluation is robust and people trust it. Otherwise, 50%
of the job of evaluation has failed. So there is obviously, irrespective
of the facts, a perception issue that we have to address ..."
Whilst we do not question the independence of current evaluation
programmes, we agree with the Minister that the perception of
independence is of equal importance.
92. At the same time, a large number of witnesses
suggested that more resources should be dedicated towards researching
the effectiveness of different HIV prevention interventions. These
included submissions from the British HIV Association (BHIVA),
HIV Scotland and
Professor Sir Andrew McMichael.
Professor Graham Hart, Director of the Division of Population
Health at University College London, proposed the establishment
of a HIV research strategy committee, to be led by the Department
of Health. He
suggested that: "The major health funders in the UK could
work together to look at the available evidence of success with
regard to prevention, identify the gaps, look at the relationship
between biomedical interventions and social and behavioural interventions
... and really determine the direction of travel ... to provide
us with a clear strategy for HIV prevention."
93. Whilst we do not doubt the integrity of
current evaluation processes, we recommend that the practice of
HIV prevention providers commissioning their own evaluation of
campaigns be ended. The Department of Health should commission
evaluation, ensuring separation from delivery of prevention activity.
We also recommend that, once instituted, such independent evaluation
activities are used to inform, refine and reinforce subsequent
prevention campaigns, providing an evidence-led approach to influencing
94. Given the significant cost savings that
can be accrued from successful HIV prevention work, the Department
of Health should prioritise HIV prevention research. We recommend
that the Department establish an advisory committee, to give leadership
and coordination to biomedical, social and behavioural prevention
95. A large majority of our witnesses stressed
that there were one set of interventions which had repeatedly
proven to be effective. These were intensive group, workshop and
one-to-one sessions that supported MSM in modifying sexual risk
behaviours. Professor Graham Hart said that: "We have
some very good evidence, mainly from the US, that behavioural
interventions at the community, group and individual level are
highly successful in impacting risk behaviour."
Professor Jonathan Elford went on to say: "Systematic
reviews of different behavioural interventions have demonstrated
that behavioural interventions can be effective at an individual
and community level, but the most successful interventions were
intensive. If they were provided at a one-to-one level they would
involve, say, 10 one-to-one sessions."
96. Peter Weatherburn highlighted the financial
difficulties of delivering this particular type of intervention,
reflecting upon the work of the Terrence Higgins Trust: "Unfortunately,
it invests in group work that 600 men can attend. Given that there
are probably 500,000 to 600,000 homosexually active men in England,
that is one in 1,000."
He went on to advocate " ... continuing to do the kinds of
campaigns that we have done for gay men, for Africans and maybe
even for the general populationsuch as Condom: Essential
Wearand following through with a far more robust programme
of interventions for those at highest risk."
97. A range of intensive interventionsincluding
group and individual counselling workshould be delivered
for those who are most at risk of either contracting or passing
on HIV. This should be set against a backdrop of national campaigns
and awareness raising which is properly evaluated and refined
Stigmaan obstacle to prevention
WHAT IS STIGMA?
98. During the course of our work, we have heard
numerous examples of stigma and discrimination. These include:
- People not wishing to share cups
or cutlery with people living with HIV;
- People living with HIV finding themselves homeless
and ostracised by their communities;
- Graffiti being sprayed on the homes of people
living with HIV;
- Bullying of the children of people living with
- People losing their jobs following disclosure
of their HIV status;
- Most worryingly, we have heard evidence of stigma
being encountered from healthcare professionals, including patients
being refused treatment by doctors and dentists.
99. HIV stigma is complex, and can take many
forms. People living with HIV may experience discrimination, prejudice
and stigma from others; they may also begin to internalise these
messages and stigmatise themselves. Persistent stigma has effects
upon both people living with HIV and upon public health more generally.
100. Discrimination against those affected
by HIV is based, at best, on ignorance and, at worst, on prejudice,
and we unreservedly condemn it. This underlines the need for a
general public awareness campaign on HIV.
THE CAUSES OF STIGMA
101. There are many deep-seated causes of HIV
stigma. Witnesses have suggested that there is a historic association
of stigma with diseases or conditions where the person suffering
is perceived to be responsible, in some way, for contracting it.
There is also, of course, a historic stigma around STIs, reflected
in the long-established confidentiality arrangements for GUM services.
Progressive and incurable conditions have also historically attracted
stigma, as have conditions which are not well understood by the
102. Positively UK suggested that people living
with HIV may not wish to disclose their status due to a fear that
they will be associated with particular behaviour. They fear that
they will be judged to have had many sexual encounters, or to
have been injecting drug users at some point in the past.
Witnesses from religious groups felt that stigma around HIV could
be traced back to the 1980s, when it was perceived as a 'homosexual'
disease and that "for many faiths it was seen as a judgement".
EFFECTS UPON PUBLIC HEALTH AND PREVENTION
103. Stigma and lack of understanding can undermine
HIV prevention efforts. Misinformation circulated about HIV, suggesting
that it is a 'judgment' or that it can be cured through non-medical
methods, poses a threat to public health messaging. This is especially
the case when such statements are made in faith-based settings,
given the significant influence of faith leaders in some communities.
104. The potential negative effects of a positive
diagnosis (as outlined in para 98) can also have an impact upon
prevention. Those at risk from HIV may be deterred from testing
and, as a consequence, remain infectious and go on to infect other
partners. Difficulties around disclosure of a HIV-positive status
can also impact upon adherence to treatment, with negative impacts
for the individual and a heightened risk of onward transmission
through increased viral load. Stigma, therefore, impacts upon
the prevention of HIV.
105. The Equality Act 2010, and the Disability
Discrimination Act 2005 before it, have provided a measure of
legal protection to people living with HIV. In particular, the
Equality Act, in prohibiting the use of pre-employment healthcare
questionnaires, removed a significant barrier faced by people
living with HIV when accessing employment.
It also introduced protection from discrimination for those perceived
to be HIV-positive, as well as for people associated with someone
who is perceived to have HIV.
WHAT MORE CAN BE DONE?
106. In addition to action initiated nationally
by Government, we acknowledge the work of others, principally
in the voluntary sector, in combating stigma. Commitment to this
work needs to be reaffirmed, and such work needs to be supported
in a constrained funding environment.
WORKING WITH FAITH LEADERS
107. Faith and religion play a strong role in
the lives of many people. It is essential that faith leaders engage
with HIV as an issue and provide effective and truthful support
and communication around the subject. We are not convinced that
this is happening universally at the moment, although evidence
received from faith leaders suggested that opinions and approaches
have progressedto varying extentsover the past 30
108. Much can be learnt from recent work undertaken
in the black African community. NAHIP runs a series of initiatives
which seek to build and develop the knowledge of faith leaders
on HIV. The partnership has produced a toolkit, Life and Knowledge,
which seeks to support targeted work with faith leaders in this
area. The importance of this work has been highlighted by the
Department of Health,
the African Health Forum
and Dr Sheena McCormack, Clinical Epidemiologist at the MRC
Clinical Trials Unit.
109. Reverend Ijeoma Ajibade, of St Philips Earls
Court, when reflecting on work with the AHPN, suggested that:
"There are myths and taboos around HIV, and what our faith
leaders can do in the churches is speak the truth about HIV,"
going on to state: "Stigma is very real and one of the things
we do in the African Health Policy Network, which is a secular
organisation, is give people the tools to speak about HIV, and
we then have people who are HIV-positive speaking in churches
about HIV, which I personally find very powerful."
In Leeds, we heard about the complexity of working to raise HIV
awareness in a religious community that is often disparate, with
many different churches, denominations, languages and cultures.
110. Work within African communities has been
important in developing approaches to religion and HIV. It is
not, however, only African churches who need to take on this focus
and workload. HIV prevention messages are necessary across all
communities and all faiths.
111. Given the significant influence of faith
leaders in some communities, we recommend that the Government,
local authorities and health commissioners build upon work already
taking place with all faith groups to enlist their support for
the effective and truthful communication of HIV prevention messages.
112. We recommend that the Department of Health
ensures continued funding and support for work, building upon
that currently delivered by the African Health Policy Network,
which aims to develop the knowledge of faith leaders about HIV.
Such work is vital in supporting a wider range of interventions
which aim to address, prevent and treat HIV within all communities.
PEER SUPPORT GROUPS AND THE ROLE
OF PEOPLE LIVING WITH HIV
113. HIV-positive people, as advocates and confident
service users, can play an important role in addressing stigma
through publicising the condition and encouraging dialogue. Francis
Kaikumba, Chief Executive of the African Health Policy Network,
highlighted the work of its Ffena programme, which has
trained over 100 people living with HIV to become advocates for
understanding of the condition.
Silvia Petretti, Community Development Manager at Positively UK,
highlighted her work in training 40 women from across Britain
to become HIV advocates, undertaking radio interviews and responding
to policy issues.
114. MedFASH believed that overcoming stigma
will require openness, visibility and leadership on the part of
people living with HIV.
The British Association for Sexual Health and HIV (BASHH)
and the Royal College of Physicians suggested that HIV-positive
people should be empowered to build their self-confidence in medical
Petretti stated that peer support networks, such as that provided
by Positively UK, were vital in equipping people living with HIV
to undertake this work.
115. People living with HIV need to be empowered
to become advocates for understanding of the condition, in order
to help to address stigma. We understand the importance of peer
support networks and voluntary organisations in supporting this
work, and recommend that local authorities and other public sector
funders acknowledge the importance of this work in their future
116. Over the last 25 years, our knowledge of
HIV has increased considerably. Whilst in the 1980s public education
was one of the few tools available to prevent transmission, there
are now a range of options, encompassing behavioural, social and
biomedical interventions, which can limit the spread of the virus.
The potential role of treatment as a preventive measure is becoming
increasingly prominent. The prevention of mother-to-child vertical
transmission, through HIV screening and treatment, has been an
117. These advances mean that public education
measures, such as those described above, can now be combined with
a range of interventions that either decrease HIV infectivity
or limit susceptibility to infection. These measures, integrated
with public awareness and engagement of those at high risk, can
be brought together to provide 'combination prevention'. We discuss
some of the measures that can be incorporated into this combined
approach in the following chapters.
118. Progress achieved over recent decades
mean that there are now many facets to HIV prevention. We recommend
that the full range of available interventions be used to prevent
new HIV infections. We call this approach combination prevention.
116 See Appendix 8 Back
HAUK 19 (Department of Health). Back
HAUK 102. Back
A sexual health organisation, based in Yorkshire, that focuses
on HIV prevention amongst MSM. Back
Q 740 (Simon Williams), HAUK 17 (Sima Chaudhury) and personal
correspondence with Mark Creelman, Inner North West London PCTs. Back
BBC Online, London HIV services cut as infections rise,
15th June 2011. Back
Q 106. Back
Q 1125. Back
Q 1125. Back
Q 1129. Back
Q 1089. Back
See Appendix 8 Back
A policy and advocacy organisation for people living with HIV. Back
A charity supporting children, young people and families who are
living with or affected by HIV. Back
See Appendix 8. Back
A group providing HIV support services in Leeds. Back
A support service working with people affected by HIV in Dudley
and Sandwell. Back
A clinical care centre for men and women living with HIV and AIDS. Back
HAUK 47. Back
HAUK 57. Back
HAUK 37. Back
A strategic partnership between the Department of Health and Consumer
Focus, focusing on social marketing and behaviour change. Back
Q 960. Back
University College London, Gay Men's Sexual Health Survey 2009,
London 2011. Back
HAUK 19 (Department of Health). Back
HAUK 64. Back
HAUK 24. Back
HAUK 51. The London Specialised Commissioning Group is a coordinated
commissioning body for specialised services in London. Back
HAUK 33. Status is a HIV prevention campaign group. Back
HAUK 45. The Tuke Institute is a health think tank and policy
HAUK 24. Back
HAUK 81. Back
HAUK 57. Back
HAUK 47. Back
HAUK 38. Back
HAUK 5 and 83. FPA is a sexual health charity. Back
HAUK 61. HIV Scotland is the national HIV policy charity for Scotland Back
HAUK 63 and 66. See also Appendix 8 Back
HAUK 26. Shield is a South Yorkshire-based charity offering support
to people living with HIV and/or hepatitis C. Back
HAUK 9 (LSL Alliance). Back
COI/Gallup poll, March 1987. Back
HAUK 47. Back
A sex education policy and advocacy group. Back
Sex Education Forum, Young people's experiences of HIV and
AIDS education, May 2011. Back
Q 910. Back
HAUK 26. Back
An advertising agency used by the Terrence Higgins Trust for its
media campaigns. Back
HAUK 84. Back
HAUK 33. Back
HAUK 27. Back
Q 1103. Back
HAUK 53.See Appendix 8. Back
HAUK 61. Back
HAUK 14. Back
HAUK 8. Back
Q 897. Back
Q 882. Back
Q 884. Back
Q 883. Back
Q 903. Back
Q 541 (Annemarie Byrne, Body and Soul). Back
HAUK 59 (NAHIP). Back
Q 549 (Annemarie Byrne, Body and Soul). Back
Q 130 (Deborah Jack , NAT). Back
Q 550 (Jim Jewers). Back
HAUK 37. Back
Q 647 (Revd Ijeoma Ajibade and Revd Dr Brendan McCarthy). Back
Including HAUK 37 (Positively UK) and HAUK 64 (Terrence Higgins
HAUK 19. Back
HAUK 81. The African Health Forum is an information platform for
health promotion and social care initiatives relevant to African
communities in London. Back
HAUK 56. Back
Q 651. Back
See Appendix 6: Visit to Leeds, 9 May 2011. Back
Q 113. Back
Q 551. Back
HAUK 63 and 66. Back
See Appendix 8. Back
HAUK 55 and 73. Back
Q 586. Back