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Pamela Nash (Airdrie and Shotts) (Lab)
I am grateful to have secured this debate during the week in which world AIDS day is marked. The HIV virus was discovered 30 years ago, since when it has claimed the lives of more than 30 million people throughout the world, including 20,000 in the UK. Over the past 20 years, we have seen remarkable progress in the medication available to people living with HIV, including today’s welcome approval of a drug that will provide triple antiretroviral therapy in a single tablet taken once a day. That does not, however, diminish the fact that there is still no vaccine or cure for HIV, and more efforts must be made to prevent the transmission of the virus.
Let me take this opportunity to pay tribute to my predecessor as chair of the all-party group on HIV and AIDS, the late David Cairns. One year ago in this Chamber, he spoke on this topic with eloquence and passion, and he consistently spoke out against the stigma and discrimination faced by people living with HIV both in the UK and overseas. I am glad that his work continues in the all-party group and through the David Cairns Foundation set up in his name, which was launched last week.
The House of Lords Committee on HIV and AIDS, led by the vice-chair of the all-party group and former Health Minister, Lord Fowler, recently published a report on HIV in the UK. Lord Fowler has done much to champion the cause over his long and distinguished career, and I believe that many owe their lives to the work he carried out as HIV began to take hold in the United Kingdom. The needle exchange programme that he introduced is a good example of that work, and it changed the course of the epidemic, particularly in Edinburgh and the rest of Scotland. In September this year, the Committee concluded that the Government’s current policies on tackling HIV in the UK are “woefully inadequate.” I will focus on some of the report’s recommendations, and I look forward to the Minister setting out the Government’s response to that report.
I will start with some startling headline figures. Some 30 years after the virus was discovered, almost 100,000 people in the UK live with HIV. Newly diagnosed cases of HIV among young people have risen by 48% over the past decade, and it is estimated that about a quarter of those living with HIV in the UK do not know that they have the virus. Half of all cases of HIV in the UK are diagnosed late, meaning a greater cost to public health and the public purse. HIV is spreading for many reasons, but principally because of high levels of undiagnosed HIV, too few people with HIV receiving stable treatment, persistent risk-taking behaviour, and a lack of HIV awareness. That is set against a dangerous backdrop of inconsistent sex and relationships education in our schools and beyond.
Early diagnosis of HIV for one person can obviously translate into prevention of the disease for their future sexual partners. People diagnosed with HIV are far less likely to pass the virus to others, as they can take steps to prevent transmission such as using a condom. Once diagnosed, people can receive HIV treatment that dramatically reduces levels of the virus in the body, so that the risk of transmission can be reduced to almost zero. This year I was surprised by the results of a remarkable clinical trial in South Africa that proved that putting people on medication for HIV can reduce the risk of transmission by an enormous 96%. That has extraordinary ramifications for efforts to tackle the HIV epidemic around the world and makes the need for the early diagnosis of HIV all the more pressing.
It is estimated that 51% of all people with HIV in the UK have undetectable levels of the virus. That is great news, although the UK should aim to increase that percentage to at least 65% over the next four years.
Mike Weatherley (Hove) (Con)
I congratulate the hon. Lady on securing this important debate. Does she agree with the recent remarks made by the US Secretary of State, Hillary Clinton, who said that an “AIDS-free generation” should be a policy priority for all Governments, including that of the UK?
Pamela Nash
I completely agree with the Secretary of State’s remarks. I raised the issue during Deputy Prime Minister’s questions last week. I hope that the coalition will take that aim on board and that it will be raised by the Prime Minister. The all-party group on HIV and AIDS is a member of the “Halve It” coalition that campaigns for levels of late-diagnosed and undiagnosed HIV to be halved in five years through more testing. That will help to stop the spread of HIV, improve health outcomes for those living with the virus, and in the long term save the Government money.
Patients and doctors have a large role to play. A study of people of sub-Saharan African origin in the UK who were diagnosed late with HIV found that three quarters had visited a doctor in the year preceding their diagnosis. Doctors and patients must be more aware of the primary infection symptoms of HIV. Incentivising HIV testing, particularly in areas with a high prevalence of HIV, is vital to ensure that people are diagnosed in time. One powerful incentive would be to ensure the inclusion of the late HIV diagnosis indicator in the Government’s revised public health outcomes framework. We have heard several times that a decision on that will be made later in the year. Will the Minister assure hon. Members that that indicator will be included, or at least say when the Department will reach a final decision?
As I understand it, the Department is investigating the possibility of legalising home-testing kits. I look forward to the outcome of that investigation. It is clear from the House of Lords report that home-testing kits ordered from overseas, usually over the internet, are already in use in the UK. If legalised, that practice could be regulated and allow people to test themselves securely and safely in their own home, again producing savings for public health and the public purse.
How else can we prevent the transmission of the HIV virus? The House of Lords report stated:
“More resources must be provided at national and local levels… The current levels of investment in national HIV prevention programmes are insufficient to provide the level of intervention required.”
Hon. Members may be surprised to learn that the Department of Health currently spends just £2.9 million a year on two national HIV prevention programmes for gay men and black Africans. That compares with an enormous £762 million spent on treatment. Preventing one infection avoids lifetime treatment costs for HIV of between £280,000 and £360,000, but as local service cuts kick in throughout the country, HIV prevention programmes are being reduced.
Under the new NHS structure, local HIV prevention work, campaigns and testing will be commissioned by local authorities, leading—we hope—to additional national campaigns, but I am concerned about the possible fragmentation and subsequent prioritisation of prevention work between HIV treatment that is commissioned nationally by the commissioning board, prevention and testing work commissioned by local authorities, and national campaigns overseen by Public Health England. Within local authorities, HIV prevention work is likely to face strong competition for funding within constrained budgets. A fragmented health care system will not deliver the results that we desperately need, or enable us to make headway against the rising tide of new HIV infections. We do not want a postcode lottery, or for sexual health services to be sidelined because of local sensitivities.
Guto Bebb (Aberconwy) (Con)
I congratulate the hon. Lady on securing the debate. In my north Wales constituency there is an HIV respite centre, which is extremely well supported by the local community. The problem that the centre has is that many of the people who take advantage of the respite care are coming in from north-west England and are therefore not funded by the local health authority in Wales—health is devolved. A centre that is able to serve people from north-west England therefore finds it very difficult to secure funding, because it is based in Wales, but its patients are from England. Is that the type of postcode lottery problem that the all-party group could deal with?
Pamela Nash
We can certainly campaign on the matter. I will be happy to discuss that with the hon. Gentleman outside the Chamber. He makes a very important point: this issue is not just about the NHS and the Health and Social Care Bill in England, but about achieving agreements with the other Assemblies and Parliaments in the United Kingdom to ensure nationwide consistency in the treatment and support for people living with HIV.
I shall now discuss public awareness in the UK. Twenty-five years ago, Lord Fowler led huge public health campaigns about the virus. Leaflets were sent to every household in the country and there were very visible television campaigns. However, public awareness of HIV has undoubtedly fallen during the past 10 years. For my generation, it is just not a priority any more. Despite the very high increase in the number of young women contracting HIV, when I speak to my friends about this issue I find they rarely regard themselves as at risk.
Unbelievably, earlier this year, an Ipsos MORI poll found that one in five people do not realise that HIV is transmitted through sex without a condom between a man and a woman, and the same proportion do not know that HIV is passed on through sex without a condom between two men.
Stuart Andrew (Pudsey) (Con)
I congratulate the hon. Lady on securing the debate. It is a shame that it is only a half-hour debate, because the last time that we debated the issue, we had an hour and a half, I think, and even that was too brief. The figures that she is giving now are shocking, certainly for my generation, who are getting older now. I remember the HIV debate and campaign that she refers to and how phenomenally successful it was and how aware we all were of the dangers. Something needs to be done so that the younger generation realise the very severe dangers of having sex without protection.
Pamela Nash
The all-party group has consistently campaigned for the Government to put more funding into another national 1980s-style campaign. I hope that today’s debate and the events taking place throughout the week will get the message across to the Government that it is necessary to have that style of campaign again.
An increasing proportion of adults—about 10% at the moment—incorrectly believe that HIV can be transmitted through impossible routes, such as kissing and spitting. That is not helped by scaremongering media reporting. There was recently a report in Edinburgh about a couple who, when being arrested by the police, had bitten a police officer. Both members of the couple were HIV-positive, and that was the primary headline in the Scottish media, much to my disappointment. Misinformation fuels stigma and discrimination, which are still a daily reality for many people living with HIV.
Naomi Long (Belfast East) (Alliance)
The hon. Lady has rightly referred to the importance of people being tested, but she has also referred to stigma. Does she agree that unless we overcome the stigma surrounding simply having been tested for HIV and for AIDS and not having the disease—the stigma that still exists in society about going for those tests—that will decrease the number of people who come forward to submit themselves for testing and take care of their health as they should?
Pamela Nash
Yes, that is a crucial point. I hope that any future public campaign would incorporate looking at the stigma about the virus. Unfortunately, in the meantime, it persists. That is why I would also push for the home testing kits to become available, but that is not the ultimate solution.
In a recent study in east London, one in three people living with HIV said that they had been victims of discrimination, but most alarmingly the study showed that half of all that discrimination was in the health care system. The Department of Health must take a lead on tackling stigma and develop training resources for its staff that are aimed at stopping such discrimination. Those resources must be used by all current and new NHS and professional bodies.
Mrs Anne Main (in the Chair)
I remind hon. Members that there are 16 minutes of this interesting debate left. Members who make interventions should do so briefly.
Pamela Nash
Since I took on the role of chair of the all-party group, I have been extremely surprised by the high levels of inaccurate and sensationalist reporting in the UK’s press on HIV. That reflects a wider lack of public awareness.
The lack of basic information fuels prejudice and leads to the exploitation of people, as was tragically illustrated in recent weeks by the frightening cases of HIV-positive patients being told by evangelical pastors that they could be cured of HIV through the power of prayer alone and that they should stop taking their antiretroviral drugs. The BBC has reported at least three deaths resulting in London, which I am sure the Minister will agree is a grave tragedy on her own doorstep. I am aware that the Department already funds work through its partners to raise awareness among religious communities, but in light of the shocking revelations and the relatively small budget that is allocated to HIV prevention in the UK, does the Minister think that that is enough? Is the Department planning to do more to tackle that issue?
The Government must take a lead in acting to improve the understanding of HIV. It is vital that all young people learn about HIV in school, and HIV must be included in local and national sexual health promotion campaigns and information. Such measures will help not only to tackle HIV stigma, but to enable people to protect themselves and others to improve public health.
HIV treatment services in the UK are generally of a high calibre, but access to other elements of care, such as primary care services, social care and psychological support, can vary widely. Unfortunately, time and time again, individuals living with HIV have contacted the all-party group to tell us that the social impacts of HIV on their lives are much greater than the health impacts. Generic services are often ill-prepared to meet the specific needs of people living with HIV. Individuals can be apprehensive about accessing services because of concerns about confidentiality or lack of expertise. Numerous clinical guidelines relate to care and support for people with HIV, but there is no coherent and authoritative guidance that integrates clinical, social and psychological care and covers the different stages and eventualities of the condition. Integrated guidelines from the National Institute for Health and Clinical Excellence or a national care pathway would help to make the responsibilities of different bodies and professionals clearer and make service provision more consistent and cost-effective.
The House of Lords’ report recommended that NICE develop treatment and care standards for HIV patients, and the Government’s response acknowledged that they should consider the value that NICE could add in developing standards for HIV. The Government also cited the British HIV Association’s clinical guidelines, but the guidelines do not address the need to co-ordinate specialist HIV services with other services. We in the all-party group urge the Government to act on the Lords’ Committee’s recommendations.
People with HIV live with a fluctuating, long-term condition. However, like many other people with long-term conditions, with the right support, people with HIV can play a full and productive part in society. Social care services are being cut across many local authorities and are often limited to the most severely disabled people. It is not acceptable to limit social care only to the most acute cases. Social care has a vital preventive function, particularly in treating fluctuating conditions such as HIV. Social care can also play a crucial role in dealing with the new phenomenon of the increasing number of older people who are living with HIV.
It is clear that the Government understand the value of HIV social care. That is shown by the inclusion of a specific funding line for HIV/AIDS support in the formula grant. However, local authorities are no longer required to report on the spending of that grant to the Department of Health and we have heard of several cases—for example, in Hertfordshire and Leicestershire—where money for HIV/AIDS support has been siphoned off into other areas of spending. Once that expertise in HIV/AIDS support has been lost, it will be difficult to recover. The Government must ensure that the performance of HIV social care is effectively and consistently measured, and that the needs of people living with HIV are reflected in the social care outcomes framework. It is also clear that NICE must prioritise a social care quality standard for HIV.
To conclude, I am proud that the UK has nobly led the international community during the last 30 years in the response to AIDS, advocating universal access to HIV treatment throughout the world for all those who need it. It is my great hope that that leadership role will continue to be performed by the current Government, particularly at a time when we have such an incredible opportunity to improve the quality of life for those living with HIV, to make a dramatic impact on the number of new infections and to stamp out this epidemic for good.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
Thank you very much, Mrs Main, for calling me to respond to the debate. It is a pleasure to serve under your chairmanship for the first time.
I want to begin by congratulating the hon. Member for Airdrie and Shotts (Pamela Nash) on securing today’s debate. She rightly started her remarks by referring to the issue of stigma, and it has been raised by other speakers. I also want to pay tribute to the significant contribution that has been made to fighting HIV/AIDS by my noble Friend Lord Fowler. Political leadership is not often spoken of these days, but it was precisely that leadership from Lord Fowler that made the progress in the UK against HIV/AIDS so remarkable. However, the issue of HIV has been dogged over the years by stigma, and it is disappointing for people as old as me to realise that stigma is still alive and well in our communities and even in some aspects of the delivery of services.
HIV remains a serious global issue that must always be at the top of our priorities, particularly now, of course, as we approach world AIDS day in a couple of days’ time. I also congratulate the hon. Lady on her appointment this year as chair of the all-party group on HIV and AIDS. I know the work of the group well. It deservedly has an excellent reputation within Parliament and it tirelessly works to raise awareness of HIV, both globally and within the UK. As is the case with many of the things that she mentioned, that work needs to continue.
World AIDS day provides an excellent opportunity to reflect on the progress that has been made and on the continuing challenges that we face. There is much to celebrate. Globally, new HIV infections have fallen by 21% since 1997 and new infections have stabilised in many regions, including sub-Saharan Africa, the Caribbean and south and south-east Asia. Nearly 7 million people are on anti-retroviral treatments, which is an increase of more than tenfold in the past five years. However, nearly 8 million people still need treatment and are not receiving it. I have responsibility in the UK for global health matters, and I have taken the opportunity to speak to the South African Health Minister.
Thanks to effective treatment, in developed countries such as the UK people who are diagnosed early with HIV can expect to live to a near normal life expectancy. As the Health Protection Agency says in its annual report, which was published today, in 2010 87% of people who were diagnosed with HIV were accessing treatment services within a month of being diagnosed and 85% were reporting an undetectable viral load within 12 months of starting treatment. That is excellent; it is not the end of the story, but it is a good start. However, the challenges remain at home and overseas. There are 34 million people living with HIV globally. The title of the recent report by the House of Lords Select Committee on HIV and AIDS in the UK says it all, really—there is still “no vaccine, no cure”. That report comes many years after Lord Fowler led the national response to HIV and AIDS in the UK, and I remember that time well.
In October, we published the Government’s response to the report from the House of Lords Select Committee, and we made it clear that we agree with many of the Committee’s recommendations. The Committee’s report will be critical in helping to inform the Department of Health’s sexual health policy framework, which we will publish next year. It will be a vital source of information and current evidence.
Hon. Members and hon. Friends have rightly mentioned the challenges presented by late and undiagnosed HIV. In the UK, there are an estimated 91,500 people living with HIV, of whom around 25% are undiagnosed, which means that those people cannot benefit from treatment and, of course, they risk transmitting the virus to others. Late diagnosis is the most significant cause of HIV-related death in the UK and we cannot say that often enough. The 25% of people with HIV who are undiagnosed are more likely to die than the other 75% of people with HIV who have been diagnosed, and we all need to do absolutely everything we can to promote the benefits and the uptake of HIV testing. I will come on to some of the specific issues that the hon. Lady raised in that regard.
The Department of Health is considering the findings of the final report by the HPA, “Time to test for HIV”, in developing the new sexual health policy framework. That HPA report presented the findings of eight pilot projects that were funded by the Department, which assessed the feasibility and acceptability of routinely offering HIV testing in general practices and some hospital settings. It showed that testing was acceptable to most patients, and I am really pleased to see that some of the pilots have led to changes in local practice in high-prevalence areas, which is quite a significant step.
We are also funding the Medical Foundation for AIDS and Sexual Health to help it to develop ways of getting GPs and primary care staff to offer HIV tests more routinely. Both the Terrence Higgins Trust and the African Health Policy Network actively promote HIV testing as part of the national HIV prevention programmes. Also, we have asked the UK National Screening Committee to provide evidence-based views on increasing routine HIV testing. As the hon. Lady rightly commented, we are reviewing our policy on the ban on HIV home-testing kits and we will ensure that we consult on any proposals to remove the current ban.
We are considering the consultation responses to the public health outcomes framework, which include a proposal for an indicator on late HIV diagnosis, and we will publish that framework very soon. We want to get it right, as it will be an important driver of what happens locally.
I am aware that some primary care trusts are already funding new HIV testing initiatives in both primary and secondary care, in line with guidelines from NICE and the British HIV Association. However, more work is needed to capture data through the HPA’s current HIV monitoring and surveillance programme.
Twenty-five years have passed since the first Government AIDS awareness campaigns in the UK, and who can forget those iconic TV adverts? At that time, we did not really know much about the virus and how it would evolve, and we certainly did not know very much about people’s sexual habits. As I say, I remember that period well and I want to pay particular tribute to the gay community and the terribly responsible attitude that it took to this issue at that time.
As our understanding of the virus has increased, our approach to it has changed. Our national prevention programmes focus on men who have had sex with men and people from sub-Saharan Africa, because they are the groups in the UK who are most at risk of developing HIV; the risks they face are significantly greater than those faced by other groups in the UK. We have invested £2.9 million in programmes of HIV prevention for those communities, delivered by the Terrence Higgins Trust and the African Health Policy Network, but of course that is only a fraction of the sum that is spent. A great deal more money goes in locally.
The programmes by the Terrence Higgins Trust and the African Health Policy Network both use evidence and a range of approaches to support responsible sexual behaviour and to reduce risk-taking behaviour. For example, to promote HIV testing they use social media and the internet, and for African communities they work with faith leaders. It is quite an uphill struggle in some areas to promote awareness, to reduce stigma and to encourage people to come forward.
Finally, it is vital that the public health system is versatile and sufficiently proactive to deal with HIV. Our modernisation of the NHS and the priority that we attach to public health provide an opportunity to reinvigorate HIV prevention and improve outcomes for those with HIV.
The hon. Lady is absolutely right to say that we need to bring everything together. What we do not want, although we sometimes have it, is fragmentation of services, not only for services dealing with prevention and diagnosis of HIV but, as she mentioned, for services dealing with the social and psychological impacts of HIV. Health and well-being boards and the joint strategic needs assessment will be critical. For the first time, ring-fenced public health funding is central to the NHS and to public health, and it will allow us to plan spending on prevention. In today’s restrictive financial climate, the fact that we will have a ring-fenced public health budget will be critical.
There is still a great deal of work to do, and everyone, in this House and outside, must work together to keep HIV at the very top of our list of priorities, because only by doing that can we improve the lives of people living with HIV. The hon. Lady is right to mention that young people’s awareness has slipped. Their awareness of the dangers they face and of the part they can play in ensuring that they maintain their sexual health is not as great as it should be. They need the skills to make some very difficult choices.
I finish by congratulating the hon. Lady on securing the debate. I am very keen to work with the all-party group to ensure that we get this right, and that the sexual health strategy reflects all the work that needs to be done to ensure that we decrease the level of late diagnosis of HIV, raise awareness and reduce stigma.