by Tristan Barber

There are opportunities GUM has given me that I couldn’t possibly have expected when I started my training or, indeed, medical school. Undoubtedly a career highlight has been a successful campaign to change UK law to allow people with HIV to donate gametes. This follows the science of U=U, where legislation has lagged behind the evidence, and allows people with HIV wider options should they want to have children. We started this campaign back in 2018 and arranged a meeting with the HFEA. Brexit was taking up a lot of government time, and COVID intervened, but eventually we took up the fight again, alongside BHIVA and the National AIDS Trust. We’d had a number of people come forward with cases that some were prepared to go public with, and were also considering legal action against the UK government, framing things not only alongside U=U but, also in some cases, LGBT equality laws. In 2022 I was invited to take part in a Gamete Advisory Group to The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO). Working alongside colleagues from the HFEA, BHIVA, SaBTO, and the Dept of Health and Social Care, as well as a virologist to advise on hepatitis B and C, we were able to rewrite the guidance in light of modern evidence on blood borne virus transmission. We were also supported by the All Party Parliamentary Group on HIV/AIDS (APPG). This guidance was subsequently accepted by SaBTO, and the UK Government, and led to an announcement in parliament that this change would be approved.

There are many reasons this was a highlight. First and foremost, it removes a barrier for people with HIV who want to have children, based in evidence, removing unfair discrimination and also challenging HIV related stigma. Second, it is the essence of all that is GUM to work collaboratively with others, including politicians and those that know how to influence them best, to effect change for the good, focussing on the rights of people so often marginalised. In many ways it felt like a point that all my training had led to, being able to follow the science, but also influence government policy and, ultimately, change legislation. It also makes the UK a global leader in fertility rights for people with HIV.

GUM has also given me the opportunity to travel for teaching, and to conferences, all over the world, finding a network of people providing sexual health and HIV care, but also fighting sigma, prejudice, inequity and injustice. Many experiences and battles are shared, and in addition to UK work, it is amazing to feel part of an international network in this way.

GUM physicians are crucial for the health of the UK. It is a unique specialty to our country and one that, when properly funded, ensures sexual wellbeing, avoids pathology and infertility, reduces HIV transmission rates, promotes vaccination and planned pregnancies, supports mental health, and pushes us forward in holistic, inclusive, person-centred healthcare for a huge range of diverse populations. We should be rightly proud of our specialty, and our work, and continue to fight the cuts and underfunding, and workforce crisis, that have affected GUM so heavily in recent years. Often our patients don’t have the loudest or most represented voices, and it falls to us to fight for their rights to sexual health and HIV testing and provision of care including, increasingly, services for those with diverse gender identity also.

I most enjoy working in GUM for the colleagues across the whole team, students, and of course patients – that we work with and serve. I knew I had found my spiritual home in my first GUM job back in 2002, and I am so glad to be working in GUM still, and (hopefully) enthusing others to consider the speciality. It’s a fantastic career, with still much to do, and I feel so privileged to know and work with such amazing people.