Your report on our survey into how health authorities use the funding they receive for HIV prevention has helped further the debate about the quality and level of HIV prevention services ('AIDS trust attacks HAs in spending row', 25 January).

Our survey 'Are health authorities failing gay men?' found a wide variation in the proportion of expenditure allocated to prevention services aimed specifically at gay men - with some authorities spending worryingly little.

This is despite the fact that gay men continue to account for the majority of new diagnoses in most areas.

Another major concern is that the current accounting system for HIV prevention budgets does not allow for scrutiny of how authorities - particularly those in London - are targeting African communities, the capital's second largest affected population.

We acknowledge that authorities who may have used HIV prevention funding for other health needs in the past may have difficulties in re-targeting it to those most affected.

For example, there is little new funding to go into non-HIV services which have historically been funded by HIV budgets.

However, we are concerned that inefficient targeting of resources may be leading to new HIV infections that could have been avoided, particularly among young gay men who have not been exposed to past prevention campaigns.

As well as the huge personal cost to the individuals concerned, this creates an extra burden for the NHS - not least the cost of funding new anti-HIV drug treatments.

The government's forthcoming national HIV strategy needs to set clear targets for how authorities use the resources they receive for HIV prevention, and it should improve the monitoring framework to ensure greater accountability.

In the mean time, we urgently need an announcement from the Department of Health on the HIV prevention allocations authorities are to receive for the 1999-2000 financial year. We cannot expect authorities to make effective long-term expenditure decisions if they are not given adequate planning time.

Derek Bodell


National AIDS Trust