Money allocated for HIV prevention work among the groups most at risk is being diverted to other uses, according to two surveys from the National Aids Trust.

NAT is demanding action from the Department of Health to ensure that the money is spent in line with DoH guidance, which says resources should be targeted at the groups most affected by HIV - gay men, those with links to Africa and people injecting drugs.

The surveys show that in many areas, significantly more HIV prevention money is spent on substance misuse services and health promotion work than on work with gay men - who continue to account for the majority of cumulative and new infections diagnosed in most areas.

NAT development officer James Fitzpatrick said: 'We are not saying that money is being squandered, but there is strong guidance from the centre saying that it should be spent on the high-risk groups.

'In many areas, there appears to be disparity between how it is spent and the epidemiology.'

The first survey analysed 90 per cent of the AIDS (Control) Act reports returned to the DoH by English health authorities last year.

It found that in a major city in the north-west, where gay men account for 44 per cent of cumulative infections, 3 per cent of HIV prevention money was spent on gay men.

Forty-two per cent went on drug users, who make up less than 4 per cent of cumulative infections.

In a south coast town where gay men account for 77 per cent of cumulative infections, only 5 per cent was spent on gay men, compared with 34 per cent on young people as a whole.

Similar findings emerge from an in-depth survey of a representative sample of 17 HAs and boards in the UK. Funding pressures were acute in all areas, and many had set up reviews to find savings to release funds for combination therapies.

Primary HIV prevention work with gay and bisexual men was the issue that was 'most commonly identified as requiring additional investment, particularly where investment patterns had not kept pace with changing epidemiology'.

Mr Fitzpatrick ruled out sanctions on HAs not following the guidance but said the DoH should be having discussions with them.

'If HAs are reluctant for whatever reason to spend money on those most at risk, ie gay men, and the DoH doesn't act, then events like the recent discovery of HIV infection among straights in Doncaster could legitimise a knee-jerk response to concentrate on that area instead,' he said.

A DoH spokesperson said HIV prevention money is ringfenced, so HAs could only spend it on prevention unless they asked the department for permission.

Only two such requests had been made, both linked to combination therapies, she added.

See Noises Off, page 17.