Plan Zero – The groundbreaking new initiative from 56 Dean Street

Between 2015 and 2016, 56 Dean Street saw a dramatic reduction in the number of new HIV infections recorded, which as Europe’s largest sexual health clinic and where one out of every nine new HIV diagnoses are made in the UK, makes it especially significant news.


The team at the clinic is now hoping to build on these welcome results with a new initiative called Plan ZERO, with the hope that numbers of new HIV diagnoses in London will be reduced to zero. We spoke with Lead Clinician, Dr Alan McOwan, about the new project.


So 56 Dean Street’s hoping to reduce new HIV infections down to zero. What prompted this ambitious target?

Last year was the first time Dean Street saw the number of new HIV cases fall. In 2017, it has continued to drop. Where we used to diagnose 60-70 new cases a month, we now see around 15-20. That’s clearly something to celebrate. However in the last few months, it’s leveled out again. We know what works. Loads of gay men are already doing it. However to get the numbers falling again we need to get the message out to everyone else.

Do you think it’s achievable?

Absolutely. There’ll always be the odd case. London’s a big place, people are moving in and out all the time. However, if you’re asking me can we make new HIV a rare event? Yes we can. But it will only happen if we all take action. That’s why we’ve translated Plan ZERO into three more languages: Spanish, Italian and Portuguese.

Tell us a bit about the new plan ZERO tool.

There are loads of different ways to stop the spread of HIV. It can get confusing what to do. Plan ZERO makes it really simple. You’re asked a maximum of 4 questions. It takes less than 30 seconds. There’s a plan designed for everyone. Even if you bareback with no precautions, you can still help London get down to ZERO.

The clinic saw a massive 42% reduction in HIV diagnoses between 2015 and 2016. What would you attribute that to?

What we’ve learnt from around the world is that to beat HIV you have to attack it from all angles. No single strategy works for everyone. We know that effective treatment makes people with HIV non-infectious. This means that increased testing and earlier diagnosis of HIV together with the shift to immediate treatment has played a part. Then there’s HIV Pre exposure prophylaxis meds (PrEP), which taken before sex gives excellent protection. Several thousand men are now buying it online. That’s making a big difference. Plus let’s not forget that the majority of gay men still use condoms for anal sex.

People with HIV are most infectious in the first few months. About half of all HIV is caught from someone in this early stage. That means preventing one person catching HIV has a knock on effect. Think of it like dominos. If you can stop the first one toppling, none of the others will fall either.

Were similar drops seen elsewhere, both in and outside the UK?

The largest drops in HIV diagnoses were seen at four central London clinics. What they all had in common was a focus on regularly testing the men at highest risk. They also all provided practical support and monitoring for people buying PrEP online. However, gay men don’t just have sex with people who use the same clinic as they do. So it makes sense that Public Health England has recently spotted a small nationwide drop too.

The picture is really varied elsewhere in the world. HIV is still increasing in places where gay men are stigmatised, testing services are poor and if there is little access to PrEP.

Plan ZERO was inspired by San Francisco’s ‘Getting to zero’ project.  Rates have plummeted there. If San Francisco can do it, why not London?

What effect do you hope to see from the upcoming PrEP IMPACT trial?

This is the most exciting development we’ve had in years. Being able to offer NHS funded HIV prevention meds to those at highest risk is a powerful new weapon. Buying daily PrEP online costs around £50 per month. Lots of people simply can’t afford that. Similarly, if you’re not open about your sexuality, how would you explain the delivery of drugs to your Mum or flatmates? IMPACT makes PrEP an option for thousands of high risk men who have never had that choice before. Bring it on.

If you want people reading this to take away just one thing, what would it be?

Take 30 seconds to visit www.dean.st/zero . Share it with your friends. We will beat HIV if we all act together.

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