HPA advise that the risk for heterosexual sex derived HIV is higher than ever. The two reasons being;

1. Complacency by this group combined with the recent high prevalence of anal issues requiring surgical intervention on younger women.

2. From April 2014, the statistics for all screening, tests and interventions will combine at source for the first time. So primary care testing will be added to the HES (secondary care) data and registration requirement of private healthcare to provide statistical data of screening activity. (Positive tests are already collected.)

Then, we can talk about figures for The UK. The system is not so harmonised in The USA and CDC are in about the same position as HPA were prior to The Health Act 2006 tightening up.

It may well be that MSM prevalence follows historical trajectory. If so, we shall have a better understanding of that concern and the scope. It may well be though that the non London figures, (as with many health statistics I may add) shape the general approach.

Pressure groups and high clusters of many issues, sexual health and mental health chiefly amongst them, lead to extrapolation of small clusters and inappropriate actions. The best example I can give as an ex miner is that in the old coalfields, COPD is a huge issue, but as it is less prevalent in London, it does not have a national service framework, yet diabetes does. Some of us are a bit fed up with London solutions to national problems, the consultant contract being chief amongst them.

So... Sorry, but I don't buy into media and popular views. I am briefed on reality and advise NHS England in my particular sphere of influence accordingly. I teach at a university accordingly. I lead on service redesign and improvement within a large teaching trust accordingly. I used to regulate services (including sexual health) accordingly. NHS care still has a long way to go, and so does private healthcare for that matter, but the setting up of NHS England and associated buy in for Scotland, Wales and NI means that at long last, we can start tackling issues based on the epidemiology rather than the political pressure.

Just that someone needs to tell the Secretary of State that his predecessor set this up for that purpose......