Barking and Dagenham is facing a significant challenge with a high rate of late HIV diagnoses, with nearly half of individuals diagnosed at a late stage of the infection. This was highlighted during a Health Scrutiny Committee meeting where Mark Santos, Executive Director of Positive East, presented an overview of the organisation's work and the ongoing issues surrounding HIV in the borough.
Positive East, which has been supporting residents for over 30 years, reported that Barking and Dagenham has a HIV prevalence rate of 4.82 per thousand, exceeding guidelines for high prevalence areas. A critical concern is the late diagnosis rate of 44.4%, which drastically increases the risk of mortality. While specific factors contributing to this high rate of late diagnosis were not detailed, Mr. Santos identified stigma and disengagement from care as significant issues. He also noted that addressing stigma, improving people's understanding of their proximity to risk, and ensuring services are accessible are key to tackling late diagnoses.
Furthermore, there is a low uptake of PrEP (pre-exposure prophylaxis), a medication that prevents HIV acquisition, particularly among heterosexual individuals from Black heritage communities and women. Mr. Santos explained that a key challenge is a lack of awareness about PrEP, especially in Black and global majority communities, who may also experience mistrust around medication and engaging with the health service. Positive East is focusing on PrEP equity for these communities, adapting their approach to meet specific needs and concerns, and emphasising the importance of making PrEP as accessible as possible through community clinics and online provision.
Positive East is addressing these issues through various community-based initiatives. These include HIV testing at locations such as Barking College and Dagenham Library, a testing bus at Barking Market, and projects focused on PrEP equity, such as 'Women for Women'. The organisation also provides comprehensive support services, including an advice service that secured £184,000 in benefits and hardship funds last year, peer support, and a specialist psychology service for women experiencing trauma.
Councillor Donna Lumsden, Deputy Chair of the Health Scrutiny Committee, questioned the training provided to GP surgeries for routine HIV tests and initiatives to tackle stigma. Mr. Santos explained that while training is offered, access can be difficult
and it is sometimes very hard to get time in front of GPs.
He suggested opt-out testing in emergency departments as a model for GP registration, noting that the public health team has been supportive in facilitating this. He also highlighted the importance of workshops on self-stigma and promoting the message of U equals U
(Undetectable equals Untransmittable) to combat stigma.
Councillor Glen Spoor sought evidence of improved outcomes. Mr. Santos responded by stating that Positive East engaged with 1,285 people in Barking and Dagenham in the last financial year, working with 113 people living with HIV and testing 122 for HIV and STIs. He noted that a third of people tested by Positive East have never tested before, and significant numbers have not engaged with any services, including primary care.
Regarding trends, Mr. Santos stated that overall numbers are on a downward trajectory, but those communities that I've referred to that are largely underserved, so it's often black and global majority communities, both heterosexual and gay and bisexual men, that are not doing as well, and that's where our focus is going now.
The organisation tracks outcomes through new diagnoses, epidemiological data, surveys, and impact reports.
While the success of opt-out testing in emergency departments was highlighted, the specific barriers to its widespread adoption in these settings were not detailed. However, the challenges in GP registration appear to be linked to difficulties in accessing GPs' time for training.
For more information on the Health Scrutiny Committee meeting, refer to the Public reports pack.
