World Aids Day is a moment to remember the millions lost to an epidemic that has spanned more than four decades.
While the US government ignored the day for the first time since 1988, our government chose a different path. It launched a bold new HIV Action Plan, aiming to make England the first country in the world to end new HIV cases. Crucially, the plan shows that this government understands the lessons of the HIV epidemic. More than that, it could transform the future of healthcare.
When HIV emerged in the 1980s, it was a crisis that exposed deep inequalities in our health system. It disproportionately affected marginalised communities. At the time in the UK, gay men and intravenous drug users were the most impacted and globally, those in poverty felt the greatest burden. But from that devastation came a revolution in healthcare: patient-centred care.
People living with HIV fought for the right to be heard, to be partners in their treatment and to have their knowledge of their own bodies respected. They hacked the system and proved that patients could know as much - or more - than their doctors about their health. That principle now underpins how we approach long-term conditions.
HIV remains a virus that preys on inequality. Poverty, racism, homophobia, transphobia and stigma still shape who most needs HIV prevention and who struggles to access care. But despite all that, England is on the verge of becoming the first country in the world to end new HIV cases. That's not just a public health triumph - it's a blueprint for tackling health inequalities across our health system.
It's important to understand why this milestone is in reach for a condition that, within my lifetime, seemed unstoppable. Firstly, the NHS's model of free care at the point of use gives us a huge advantage over countries where testing and treatment are only accessible to those who can pay. Secondly, people living with HIV, HIV charities and clinicians have for decades been putting health inequalities at the heart of everything we do. The new HIV Action Plan, launched this week, is a masterclass in how to continue that legacy.
At its core is a £9 million national programme to find and support the up to 12,000 people living with HIV who have fallen out of care. These are people who face the toughest barriers - mental health challenges, addiction, poverty, unstable housing situations, all exacerbated by stigma. Bringing them back into treatment is essential. When people are on effective HIV treatment, they are able to live long, healthy lives and cannot pass the virus on to others.
It will also break down barriers to testing. Through this plan, we have won funding for the continuation of opt-out HIV testing in A&Es in high-prevalence areas. Compared to those found through other services, those diagnosed through opt-out testing are more likely to be older, women or from an ethnic minority background. The men who have sex with men diagnosed in this setting are much less likely to describe themselves as gay or bisexual. These are all groups who are otherwise more likely to be diagnosed late, when HIV has already had a chance to damage a person's immune system.
A ground-breaking pilot will allow people to order HIV tests through the NHS App, backed by £5 million. It's discreet, convenient and will help address the stigma that still stops people from getting an HIV test.
We learned in HIV care decades ago that people who understand their diagnosis and are partners in their treatment have better outcomes. That principle is now shaping healthcare.
The theory of change behind the NHS 10 Year Plan is simple but profound: long-term conditions are driving up NHS costs, but when people are empowered to take control of their health, they stay healthier and use the NHS less. NHS Connect, the fledgling programme announced in July by the prime minister and health secretary to help link those diagnosed with a long-term condition to support that helps them understand and come to terms with that diagnosis, will be key in this. Surely, HIV is a candidate condition for early adoption of this innovative approach. It lowers costs and saves lives.
Ending new HIV cases will be an enormous achievement. But the real legacy will be what this teaches us about tackling inequality in healthcare. Of all medical conditions, HIV is perhaps the one where both the stigma and the impact of inequalities have been most acute. If we can tackle these for HIV, we can do it for other conditions too.
We can build a health system where no one is left behind, where stigma is dismantled and where patient power is not the exception but the rule. While the US seeks to ignore the issue, the UK is facing it head-on.