Cabinet paper: HIV Action Plan for Wales

The Cabinet is asked to agree the HIV Action Plan, and for approval to publish the final plan in early March.

1. The Programme for Government (PfG) made commitments to “develop an HIV Action Plan for Wales” and “to tackle HIV related stigma”.

• A draft HIV Action Plan for Wales has been developed by an HIV Action Plan Working Group and supported by three task-and-finish groups.
• Membership of these groups came from a broad range of organisations, including people living with HIV.
• The draft plan was launched on 14^th June and was the subject of a 12-week consultation period.
• The plan was well received and has been amended to take account of the consultation responses.
• The Working Group will reconvene on 09 February to sign off the post-consultation amendments.
• A soft launch of the revised and final HIV Action Plan is proposed for early March.

2. In response to the PfG commitments, Health Protection Division set up an HIV Action Plan Working Group, supported by three task-and-finish groups who focused on: stigma; peer support and living well with HIV; and PrEP and prevention.

3. Membership of these groups came from a broad range of organisations including health boards, voluntary and community groups, academia and people living with HIV. All worked collaboratively and brought considerable expertise. Officials also worked closely with colleagues across Welsh Government, in particular LGBTQ+ policy leads who are developing an LGBTQ+ Action Plan for Wales.

4. Members considered current evidence and good practice and its relevance to Wales and initially put forward 26 actions (attached at Annex B, with post-consultation revisions highlighted) to help meet the Government’s 2030 HIV elimination commitment and to tackle HIV-related stigma. The group recognised that stigma was largely driven through fear and ignorance and many people remain unaware that those living with HIV on effective treatment are no risk to others, therefore all efforts should focus on informing and educating. Fast Track Cymru and the Education sector will have a key role in supporting this, and in addition all those delivering support and care will be enabled to provide compassionate, holistic, and non-discriminatory care.

5. The plan contains five priority areas for action:

• Prevention
• Testing
• Clinical care
• Living well with HIV
• Tackling HIV-related stigma.

6. The actions were underpinned by the following three core principles aimed at eliminating all HIV in Wales and achieving zero tolerance of HIV-related stigma by 2030:

• That there should be zero tolerance of HIV-related stigma
• That plans for implementation of new initiatives and services will be informed by, or developed with, people living with HIV. Alongside this there will be a recognition of contextual differences by sexuality, ethnicity, age, gender, and location, to ensure that no one is left behind
• That all new initiatives and services will be subject to ongoing monitoring and evaluation to make sure they meet the actions and principles laid out in the plan.

7. As well as the many stakeholders who had been part of the development of the initial draft plan, officials wanted to ensure all stakeholders, as well as the public, had the opportunity to contribute and influence this plan for Wales. The plan was subject to a 12-week consultation period. Three stakeholder events (two virtual and one face-to-face) were also held during the consultation period to seek further views.

8. 55 responses were received during the consultation exercise. Given that many of the key stakeholders had had the opportunity to shape and influence the draft plan, this number was broadly in line with officials’ expectations.  Responses were overwhelmingly supportive of the plan and the proposed actions, but several responses did highlight certain gaps in the original plan and/or potential areas for improvement.

9. Officials have amended the plan to take account of some of the suggestions and comments made in the consultation exercise. A number of the original actions have been tweaked and four new actions have been developed (see Annex B). These actions will not require additional funding but rather an expectation that services currently providing care will work together for a better patient experience going forward.

10. The amended plan was agreed by the Minister for Health and Social Services on 07 February 2023. It will be presented to a meeting of the reconvened HIV Action Plan Group on 09 February. If the Cabinet agrees, the final plan will now be published via a “soft” launch in early March.

11. The proposed main changes post-consultation are:

• Timescales for completion of many of the key actions have been added to the plan.
• A commitment has been added that the Minister for Health and Social Services make an annual statement to the Senedd on progress in implementing the plan.
• Increased emphasis on the role primary care will have to play in the life course of HIV, this will include support for prevention initiatives, normalising testing for HIV, supporting provision for PrEP and being part of the multi-disciplinary response for those who are ageing and have other illnesses.
• A new action requiring all health boards to evidence that all children living with HIV are supported by multi-disciplinary teams and that their transition to adult services is seamless.
• Two new actions on people ageing with HIV, highlighting the fact that as people with HIV now live longer, they will, as with all ageing populations, develop comorbidities and it is imperative that their care is joined up with regular multi-disciplinary team meetings.
• A new action stating that the evidence base and current research undertaken in sexual health and HIV will be optimised and overseen by PHW and the Research Network from Welsh universities.
• Actions on stigma have been strengthened, particularly in relation to care home and school settings.

13. The draft HIV Action Plan is predicated on the principle that all people should receive the full range of HIV services they need.  Tackling HIV-related stigma across a range of sectors, notably, but not exclusively, the health and social care  and education sectors, will be a major step towards removing the discrimination and the barriers faced by people of all ages living with HIV when accessing  services. The plan also reinforces the benefit of those evidence-based interventions that have the greatest impact across the continuum of HIV services, including comprehensive, combination prevention to innovative and targeted HIV testing and the delivery of people-centred treatment and care. These interventions should ensure that those with, and those at risk of acquiring, HIV have positive health outcomes and a good quality of life. A positive difference will also be made to the lives of people in Wales living with HIV and in protecting current and future generations from the virus.

14. Contained within the HIV Action Plan are actions across the five priority areas for action aimed at achieving significant improvements to both the quality and accessibility of HIV services and HIV-related stigma. In so doing, it is anticipated that once implemented the plan will make an important contribution to ensuring there is parity (in terms of HIV testing and access to care) and to delivering the goals of the Well-being of Future Generations (Wales) Act 2015 (FGA), particularly its focus on building a healthier Wales. Also, action 22, which aims to ensure those living with HIV receive holistic, compassionate and non-discriminatory care, supports the FGA’s goal of being a compassionate nation.

15. Progress on the implementation of the actions and outcomes will be monitored, reviewed and overseen by an Implementation Group which will be established in early 2023.

15. The draft action plan and consultation was the subject of an oral statement in June, followed by a Senedd launch at an event arranged by the Terrence Higgins Trust to commemorate the 40^th anniversary of Terrence Higgins’s death. The launch attracted considerable media attention and was largely well received on social media. Given that the changes to the original plan are relatively minor, officials propose a soft launch in early March, with a written statement from the Minister for Health and Social Services focussing on the proposed additional actions, particularly those actions on ageing well with HIV, and children living with HIV.    

Cabinet is asked to agree the HIV Action Plan and for the final plan to be published in early March.

Statutory Requirements 

Integrated Impact Assessments have been completed for the Plan, with particular focus on the equality, data protection and health assessments which are all positive.

Finance Requirements and Governance Implications

Funding for a key action within the HIV Action Plan was agreed in MA/EM/1932/22 – Continuation of the Online STI Testing.  The cost for the online STI testing is £3.885m, and will be accommodated within BEL 20, as part of the Draft Budget 2022. An announcement about this funding was made at the launch of draft HIV Action Plan in June 2022. MA/EM/1931/22 also highlighted that further costs were anticipated to take forward the actions in the final Plan.

The remaining actions with cost implications as referred to in the paragraphs above are set out in the table below:

The H&SS Minister recently agreed the revenue allocations for 23-24 and 24-25 in MA/EM/3613/22. This will be funded from BEL 20 in the HSS MEG and the relevant budget transfer will allocate this funding to a new budget line in BEL 232 Targeted Health Protection. The capital funding of £0.5m for the All-Wales Case Management System has not yet been confirmed (NH2023/8642).

Due to the overprogramming of capital budgets as part of our new budgetary policy and reserves position (first implemented through the multiyear Budget 2022-23 process) we will not be able to accommodate any requests from reserves. The Minister with budgetary responsibility for this activity will be required to ensure there is adequate cover for all financial asks associated with this request.  On this basis, Budget and Government Business Division have cleared this paper (BGB/0795/6).

Colleagues in Digital Policy and Delivery Division are aware of the proposals for a case management system and are supportive. Similarly, Digital Health and Care Wales are supportive and will work with Public Health Wales in the development/discovery phase.

Legal Services

The Welsh Ministers have broad powers under the NHS (Wales) Act 2006 (“the 2006 Act”) to introduce the initiatives and services suggested in the Action Plan. Under section 1 of the 2006 Act the Welsh Minister have a general duty to provide or secure the provision of services for the purpose of the promotion in Wales of a comprehensive health service, which includes securing improvement in the prevention, diagnosis and treatment of illness. The Welsh Ministers may, under section 2 of the Act, do anything which is calculated to facilitate, or is conducive or incidental to the discharge of such a duty. Additionally, section 3(1)(e) places a duty on the Welsh Ministers to provide throughout Wales, to such an extent as they consider necessary to meet all reasonable requirements, services and facilities for the prevention illness as they consider are appropriate as part of the health service.

Research and/or Statistics 

There is no research or statistics contained in this paper, and clearance by Knowledge and Analytical Services is therefore not required/ All data contained with the HIV Action Plan itself has been provided by Public Health Wales.

Joined up Working

The development of an HIV Action Plan and tackling HIV-related stigma are two of the actions in the recently launched LGBTQ+ Action Plan. Officials in Health Protection Directorate have worked very closely with LGBTQ+ policy leads on the development of this plan and the LGBTQ+ policy official was a member of the HIV Action Plan Group.

The vast majority of the actions contained within the plan relate to public health or healthcare. There is one education-centred action in the plan relating to the curriculum. This has been developed in conjunction with the relevant policy lead in the Education Directorate who sat on the HIV Action Plan Group.

Actions added post-consultation are highlighted in bold.