HIV

(Limited Text - Ministerial Extracts only)

Tuesday 29th November 2011 Westminster Hall

[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.