HIV and AIDS in Greater Manchester: service delivery in times of devolution, neoliberalism and austerity

Carey, Craig David (2024) HIV and AIDS in Greater Manchester: service delivery in times of devolution, neoliberalism and austerity. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

This research examines the impact of devolution, neoliberalism and austerity on the governance and delivery of specialist HIV and AIDS physical and mental health services for service users across the Manchester City Region. This research further documents the decline of specialist HIV and AIDS healthcare, including mental health services, over the last decade and details the extent of these changes on people living with HIV and AIDS across the Manchester City Region. Focusing on the interplay of neoliberal policy interventions with the structural changes implied in devolution, the research locates the participants' accounts within the broader analysis of cultural, political and economic developments in health policy and (urban) governance. This thesis draws on a queer-feminist methodology and a series of semi-structured interviews with service users of HIV and AIDS healthcare provisions; organisations specialising in HIV and AIDS support, advice and advocacy services to improve health outcomes; healthcare staff specialising in HIV and AIDS healthcare and those who advocate for improved treatments; academics who work in the field of HIV studies; and activists who are campaigning for improved HIV and AIDS services. The interview data was analysed to show how funding changes have affected the delivery of HIV and AIDS healthcare services. Secondary data sources, such as public health data, were also utilised to address gaps within the interview data. The interview data shows that the shift to cheaper generalist services results in poorer service provision because healthcare staff may not understand the full range of needs of service users with HIV and AIDS. Moreover, the study participants pointed to the persistence of discrimination in healthcare settings, leading to poorer mental health. As a result, service users may stop taking their antiretroviral treatments. Historically, HIV has been heavily stigmatised, and this is a theme which arose in the data. This study focuses on specific campaigns, such as “U=U” and “You Can’t Pass It On,” which attempt to combat HIV-associated stigma and discrimination by creating awareness. Still, the efforts of these campaigns have only tended to reach those who know about HIV. In response, there has been some work in Manchester to educate healthcare professionals, but this is limited and still in its infancy. This study further argues that there is an urgent need for increased investment in specialist HIV and AIDS healthcare services. There needs to be a refocus on providing services across the Manchester City Region. Furthermore, the research data analysis suggests that even more funding may be required to achieve the goal of advanced specialist training among health professionals to secure adequate healthcare provisions for people living with HIV and AIDS within the Greater Manchester City Region.