England is on the cusp of eliminating new HIV transmissions by 2030, thanks to a comprehensive new government action plan that includes routine testing at accident and emergency departments.

Set to be announced on World AIDS Day, this HIV action plan aims to re-engage thousands who have drifted from HIV care, ensuring they return to essential treatment. With a £170 million investment, the plan introduces opt-out HIV testing during routine blood tests in high-incidence regions such as London and Manchester.

Prime Minister Keir Starmer emphasized the government’s commitment, stating, “I pledged to eradicate HIV transmissions in England and Wales by 2030, and our action plan is turning this vision into reality. This includes a groundbreaking prevention program, at-home testing via the NHS app, and opt-out testing in emergency departments.”

Since 2005, England has seen a steady decline in HIV diagnoses. However, the pandemic disrupted this progress, leading to a rise in new cases as testing was impeded. Despite this setback, HIV remains a manageable condition due to advancements in treatment.

According to a National AIDS Trust report from September, approximately 10% of individuals living with diagnosed HIV are not currently receiving medical care. The new action plan seeks to reconnect these individuals with treatment and enhance testing measures to further reduce transmission rates.

Health Secretary Wes Streeting remarked, “Today, individuals with HIV can lead full, healthy lives and cannot transmit the virus. This is a tremendous achievement. We are committed to the ambitious goal of ending new HIV transmissions by 2030 and are resolute in making it a reality.”

The Department for Health and Social Care said it would target its support towards the approximately 5,000 people living with HIV who had fallen out of medical care, for reasons including mental health issues, addiction, poverty and fear of judgment. Hospital staff in trusts where the opt-out scheme is in place will receive anti-stigma training, so patients can access care without fear of being judged for their HIV status.

A £5m trial has also been announced that will allow people to order home HIV tests through the NHS app. The new digital service is aiming to offer a discreet route for those anxious about their sexual health to get a test without visiting a clinic.

The plan will also fund formula milk for all babies born to mothers living with HIV, who need it as part of HIV prevention measures.

Prof Susan Hopkins, the chief executive of the UK Health Security Agency, said the latest figures showed progress towards the 2030 target, with about 95% of those living with HIV now knowing they have the virus. “But about 4,700 people remain undiagnosed, including one in three in Black African communities and higher rates of late diagnosis in older age groups,” she said. “People need testing that meets them where they are, in ways that feel safe and accessible.”

Hopkins said the government needed to also improve access to pre-exposure prophylaxis (PrEP), a medication that can reduce the risk of acquiring HIV from sex by about 99%. PrEP is free on the NHS through sexual health clinics, but research has shown that in practice it can be difficult to access.

“We need to make starting PrEP straightforward for anyone who wants it, with particular focus on heterosexual and Black communities who are being failed by current disparities,” Hopkins added.

Richard Angell, the chief executive of the Terrence Higgins Trust, said the funding for opt-out HIV testing would be transformational. “The government has an ambition that is both momentous and historic: that England becomes the first country in the world to end new HIV cases,” he said. “This new plan recognises the scale of the challenge, with the biggest new investment in HIV testing and care in decades.”