HIV Action Plan Annual Update 2022-23

Tuesday 18th July 2023 Westminster Hall

16:30

[Nicola Richards (West Bromwich East) (Con)]

I beg to move,

That this House has considered the HIV Action Plan annual update 2022-23.

It is a pleasure to serve under your chairmanship, Dr Huq. I was pleased to be successful in my application for this debate, and I thank colleagues from across the House for attending. I start by thanking the Government for fulfilling their commitment to update Parliament on the progress they have made on the HIV action plan—which I fully support—as it is crucial that Members are given the opportunity to scrutinise the progress that we are making on tackling HIV.

We are the generation that has the golden chance to end new cases of HIV by 2030. It is vital that we do all we can to ensure that that becomes a reality. Positive progress has been made to that end, as highlighted in the report. However, there remain further opportunities to stop new HIV transmissions in this country. That would certainly be a lasting legacy the Government could be proud of.

Two measures, in particular, will help to ensure that the Government fulfil their mission to turn the tide on HIV once and for all. First, opt-out testing is the hidden tool in our armoury that is waiting to be unleashed. Last December, I spoke in the House during the World AIDS Day debate about how effective opt-out testing was in those places that had already introduced it.

[Scott Benton (Blackpool South) (Ind)]

My hon. Friend will be aware of how health practitioners in Blackpool have led the way on opt-out testing to achieve great results. The focus on that in high-prevalence areas is of course particularly important, but does she agree that, although the NHS is making solid progress in this regard, it needs to up its game if it is to achieve its own targets by 2025?

[Nicola Richards]

I thank my hon. Friend for his intervention. I know that opt-out testing is already making improvements and that that will benefit his constituents in Blackpool. We have the blueprint for how to do this; we just need to roll it out further.

The numbers do not lie. The annual update revealed that more than 2,000 people have been diagnosed with HIV, hepatitis B and hepatitis C in 12 months alone. It is very likely that without opt-out testing many of these people would not have been diagnosed until a much later stage. That includes diagnoses in parts of London classed as having a “high” rather than a “very high” prevalence of HIV. Let us imagine what can be achieved if we now extend the roll-out to areas of high HIV prevalence, such as in my constituency of West Bromwich East.

The west midlands have several high-prevalence areas outside Sandwell, including Wolverhampton, Coventry and Birmingham. That is why, for World AIDS Day last year, West Midlands Mayor Andy Street joined the calls to fund this scheme in the west midlands. The way to end this virus is to find exactly these people—those who are unaware that they are carrying the disease but who are in fact passing it on to others—so that they can get the care they need and do not increase transmission further.

Opt-out testing in London, Blackpool, Brighton and Manchester has also revealed a quiet but growing crisis by identifying people who have previously been diagnosed with HIV but are not receiving the treatment they need. The UK Health Security Agency estimates the number of people who have fallen out of the HIV care system since 2015 to be an alarming 22,670. The Terrence Higgins Trust, which I take this opportunity to thank for all its excellent work, estimates the number of those who are alive and remain living in the UK as somewhere between 10,650 and 13,006. They are all at risk of becoming seriously ill and further transmitting the virus. In fact, hospitals in London are reporting that this has overtaken undiagnosed HIV as the primary cause of HIV-related hospital admissions.

This is totally preventable. Once someone living with HIV is on effective treatment, they can live a long, healthy life and do not pass on the virus. The annual update shows that more than a third of those found with HIV by opt-out testing were previously lost to care. That is another 473 people who can access treatment, prevent further serious illness and help to stop the spread of HIV. This is an important step forward, but we should not only be finding people when they need emergency care; we should be supporting them to stay in care in the first place. Without finding and providing treatment to those people, we cannot realise our ambition of ending new cases by 2030.

Opt-out testing is helping not only to save lives, but to save money in our health system. The initial investment to set up opt-out testing is dwarfed by the amount saved by providing treatment earlier and preventing serious illness. There is a huge saving to be made, and it is truly making a difference to health outcomes in the places in the country that already have opt-out testing.

[Dame Caroline Dinenage in the Chair]

Furthermore, the Elton John AIDS Foundation has done fantastic work with hospitals in south London on a pilot scheme that can inform a national programme to re-engage people who have been diagnosed with HIV but who are lost to care. Clearly, finding and restarting treatment for those lost to care is an urgent consideration and, at a cost of £3,000 per person, it would be significantly cheaper than providing emergency care if their condition worsened.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

The hon. Lady highlights an important study from the Elton John AIDS Foundation, which found that, with a low amount of money, people can be returned to care. The problem is that sexual health and HIV services are under strain. That money needs to be ringfenced and provided by the Government so that we can spend now to save later.

[Nicola Richards]

The hon. Gentleman does a lot of work in this area and is a voice to be listened to.

I have shown that the key benefits of extending opt-out testing and further lost-to-care work are threefold: saving lives, saving money and reducing the pressure on the NHS at a time when every effort must be made to reduce waiting lists.

At the time of the World AIDS Day debate last December, I was assured that the Minister would look closely at the outcomes of the trial once 12 months of data was available. I hope that he agrees that the trial has been a success, as the annual report states, and that we should extend the roll-out without delay.

We already have an excellent programme in place, ready to support the expansion of combined blood-borne virus testing. After the Government initially invested £20 million in opt-out A&E testing through the HIV action plan, funding from the hepatitis C programme made it possible to add hep B and hep C to the programme. The success of that has been remarkable, and the hepatitis C elimination programme is already funding opt-out hep C testing in further areas. However, without specific funding for HIV we are missing an opportunity to save even more lives by testing for HIV at the same time.

For example, a pilot programme that took place in the Leeds Teaching Hospitals NHS Trust, where opt-out HIV testing was rolled out alongside hepatitis testing, found 25 people with HIV in just 17 months, along with a combined 297 people with hep B and C. After the end of that pilot, the hospital has been able to secure funding from NHS England to reinstate hepatitis C testing in the emergency department whenever blood is taken. However, it is disappointing that no funding has been provided for HIV testing to go alongside that, especially when the area is one in which there is a high prevalence of HIV. These opportunities to test are currently being wasted.

If we are to expand HIV testing further, it has to be combined with blood-borne virus testing—there is no hierarchy when it comes to the elimination of viruses, and it is important that we make progress against both. We are showing that combining testing is not just better; it is cheaper, more effective and de-stigmatising. I would therefore appreciate it if the Minister could confirm that a national expansion of opt-out hepatitis C testing would include HIV and hep B, as should be the case.

Another way in which we can stop the spread of the virus is by better utilising PrEP, which has been proven to be very effective at preventing the transmission of HIV. As part of the HIV action plan, we committed to an innovation in PrEP delivery to improve access for key groups, including provision in settings outside sexual and reproductive health services. However, we continue to await a date for when that will start, and I strongly urge the Department to outline when that will be as soon as possible.

The Prime Minister recently committed to making other prescription medications, including contraception, available directly from pharmacies. Please can the Government consider doing the same for PrEP, which would make a massive difference to so many? By making it easier to access, we can prevent those most at risk from ever being infected with HIV. PrEP needs to be available to people in GP surgeries, pharmacies and online to truly harness its potential to stop HIV spreading and to end the inequalities in access to the drug. I hope that that is something the Minister can provide an update on when responding to this debate.

[Lloyd Russell-Moyle]

The hon. Lady is dreadfully kind for giving way. I hope she will acknowledge to the Minister that many people end up buying PrEP online, anyway, so there is already a market for it where people access it outside of clinics. The Government are taking a cautious approach, and the people have already marched two miles ahead. The Government should take a more reactive approach, follow where the people are and allow them to buy it over the counter, with advisory blood tests rather than compulsory ones.

[Nicola Richards]

I thank the hon. Member again for his intervention, and I totally agree.

I would also like to raise the plight of those who are living with HIV but who feel unable to access healthcare for a variety of reasons—mainly as a result of the stigma surrounding the virus and concerns over their mental health. Engagement with this group is an important part of the action plan. Can the Minister please use this opportunity today to reassure colleagues that people living with HIV have the opportunity to seek support, and that tailored measures will be introduced to combat the issues I have raised?

Finally, all parts of the health system are responsible for delivering on the action plan. Shortly this will change, with adult HIV services moving from NHS England to integrated care systems in April 2024. As may be evident, the lines of responsibility are somewhat blurred. For that reason, it is key that we clarify as soon as possible the exact lines of authority, so that work can be accelerated to deal with the disparity in HIV support across different areas of the country. Again, I strongly encourage the Minister to provide the House with information on what the Government are doing to deal with this issue.

It is vital that we deliver on the HIV action plan, which gives us a genuine opportunity to be the first nation in the world to end this epidemic, which has both taken and harmed so many lives. By working together and implementing the reforms the action plan sets out, some of which I have mentioned today, we can stop the spread of the virus and, instead of allowing transmission to go undetected, we can stop the virus in its tracks. Many of these measures are non-burdensome but highly effective, so it is vital that we act before it is too late. We have a social responsibility to do all we can now and not to delay the implementation of the plan. I look forward to hearing the Government’s response.

[Several hon. Members rose—]

[Dame Caroline Dinenage (in the Chair)]

I plan to call the Front Benchers at 5.13 pm, to be precise. I do not think there is any need to impose a time limit at the moment, but we are looking at roughly six and a half minutes per Member, if everybody could self-edit.

16:41

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

It is a pleasure to serve under your chairship this afternoon, Dame Caroline, in this really important and timely debate. I thank the hon. Member for West Bromwich East (Nicola Richards) for opening it so well and for outlining the importance of the action plan and what more the Government should do.

This issue is really important for me, because my constituency has one of the highest rates of HIV prevalence not just in London but in the whole UK. Forty years ago, the situation seemed hopeless, but we have seen life-changing improvements in treatment since then. With today’s medical advancements, someone on effective medical treatment cannot pass the virus on. That is vital, and we need to reiterate it loudly and clearly. What we have achieved is incredible and testament to the hard work of so many people in our life sciences industry and the NHS, and of the many charity and community groups that work behind and across the sector.

The HIV action plan, which was launched by the Government in 2021, is a comprehensive strategy aimed at tackling the HIV epidemic across the country. It focuses on four key areas: prevention; testing and diagnosis; treatment and care; and reducing stigma. However, the progress made in the last year is not equal across all areas—we have to be honest about that.

As part of the action plan, hospital emergency departments in London, Brighton, Blackpool and Manchester are testing people for HIV. I had the opportunity to visit Lewisham hospital a year and a half ago to see that work, to listen to the doctors and to see the results. The doctors told me that the oldest person tested for HIV in the A&E was an 85-year-old woman.

This programme has identified people living with HIV from groups who are less likely to test routinely, including women, heterosexuals and those of black ethnicities. That is crucial, as many people in those groups are currently experiencing poorer health outcomes due to late diagnoses.

The opt-out testing figures show that hundreds of people are being identified with HIV but are not currently engaged in treatment. Minister, that is simply not good enough. The longer that people are living with HIV, but without medication and support, the sicker they become, and they are still able to transmit the virus to others.

People are not able to engage in medical care for their HIV for a whole variety of reasons, but in each case more must be done to empower and support vulnerable people to access life-saving treatment that—most importantly—meets their individual needs. People should not be dying of HIV in the UK in 2023; that is the reality.

I want to echo the points made by the hon. Member for West Bromwich East on opt-out testing: it works, and the results are there. It is time to expand that programme to more hospital emergency departments across the country. Any further delay from the Government on expanding opt-out testing will mean missing the chance to diagnose hundreds of people across England. Everyone should have an equal chance to be diagnosed and to access treatment.

Finally, I want to pay tribute to my colleagues on the all-party parliamentary group on HIV and AIDS. I am proud to be one of the co-chairs. The APPG has been at the forefront of work on this issue for 36 years, as one of the longest-standing APPGs, ensuring that this important subject is high on the parliamentary agenda for all of us, regardless of our political background. I am proud of the work done by the APPG in looking at how the UK will be one of the first countries to end the transmission of HIV, and on helping those 106,000 people currently living with HIV in the UK. The APPG’s hope is that positive news from the HIV action plan galvanises the Government to go further with their HIV interventions. Our 2030 goals are achievable but by no means guaranteed.

16:46

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I, too, would like to congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on securing the debate and on her comments. She has already said much of what I wanted to say, so that will spare us some time.

I apologise if anyone thinks I am about to drift out of order—I am not—but I want to focus on the women’s health strategy. We know that the HIV action plan has been incredibly effective in increasing the number of men diagnosed with HIV. We have seen a fantastic and sustained fall in HIV incidence for gay, bisexual and other men who have sex with men, but not for women. That is because there seems to be a lack of joined-up thinking when it comes to breaking down some of the stigmas and taboos that still exist for women, and we need to do more to ensure that they are tested.

This is where I drift off into the women’s health strategy, which is a comprehensive and excellent document, and I pay tribute to you, Dame Caroline, for ensuring we saw it get over the line. It clearly states:

“independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.”

The document contains some important and crucial points around tackling taboos and stigma and addressing disparities in outcome that might be affected by age, ethnicity or where the woman is from. It says clearly that those factors should not impact a woman’s ability to access services, but they do.

We know that women are less likely to have access to PrEP and that they are the least likely group to have their need for it identified—only 33% in 2021 had had their need identified. They are also the least likely to continue taking PrEP. The HIV action plan told us about making PrEP available from GPs, and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) commented on making medication more readily available from pharmacies. We have already done that for a range of conditions. Some contraception is readily available from pharmacies. For women, some forms of hormone replacement therapy are available from pharmacies. The morning-after pill is available from pharmacies. What we need to do, to break down the stigma and taboo, is to ensure that PrEP is more accessible from pharmacies. It seems to be a complete no-brainer.

[Lloyd Russell-Moyle]

The right hon. Lady makes some very good points about PrEP. But is this not also about a problem with sexual health and reproductive testing in clinics? In Britain, only one in 10 clinics offers online testing. That means that many people who cannot take time off work, or who cannot get away at the right time, are never able to get tested.

[Caroline Nokes]

The hon. Gentleman makes an important point, and one that I had completely forgotten about but that I wanted to highlight. Online testing and receiving test packets through the post is incredibly discreet, quick, easy and efficient. I know that because even I have availed myself of those services—that will send the Twittersphere into an absolute frenzy. It is a really important point: to be in control of their own health, a person needs to know. Annually, I have an HIV test provided to me—I believe it is Terrence Higgins Trust that does that, because it is a brilliant charity that does fantastic work, not least in providing us with up-to-date information. It also promotes relentlessly the need to make sure that testing kits are readily and easily available through the post and online. It is absolutely critical that we have that. We learned during the pandemic, did we not, the importance of test, test, test?

That moves me on to tests, tests, tests of the opt-out variety. My constituency in Southampton does not benefit from opt-out testing at present. It is classified as having a high prevalence of HIV, with 2.4 adults per every 1,000 living with HIV in the area. We know that opt-out testing finds people living with HIV and brings about an earlier diagnosis in many cases. We all know that earlier treatment is the most effective and that once somebody on treatment has got to the point where their viral load is undetectable, it is untransmissible. Of course, we have to do the maths backwards; we know that if people are not diagnosed and not receiving treatment, they are more likely to be transmitting HIV.

We know that opt-out testing works. We know that it works in Blackpool and London, but we know that in Southampton, more than a third of HIV diagnoses are late, which puts people at much greater risk of ill health and death and increases the problem of onward transmission. We also know that women, black Africans and older people are more likely to be diagnosed late. My plea to the Minister is to ensure that we have an expansion of opt-out testing so that we can identify those people from groups who are less likely to be identified. We know that opt-out testing means that a higher proportion of women and older women are also likely to be identified.

That takes me very neatly back to the women’s health strategy, which puts people into three stages of life. There is the early stage, from puberty up to about 24; the mid-stage of life; and older people, such as me, who have passed their 51st birthday. The important thing about the women’s health strategy is that it is absolutely explicit in saying that sexual health and wellbeing is relevant across all three of those age groups. I make a big plea that we do not forget older people; the hon. Member for Vauxhall (Florence Eshalomi) mentioned a woman of 85 going through opt-out testing. It is absolutely, crucially important. Representing Romsey and Southampton North, it would be remiss of me not to make a quick plea for those living in rural areas, who wait an average of 19 days to get an appointment with a sexual health service. That is far too long to wait.

Much of this comes down to education and information. We know from the women’s health strategy that there is a big emphasis on relationships, sex and health education and that the Department for Education is conducting a review into that at the moment. We must teach boys as well as girls about sexual and reproductive health. The best place to do that is via RSHE, yet a written answer from the Department of Health and Social Care tells me that there has not yet been any contribution to the RSHE review from the Department. That is remiss of the DHSC; it should feed into the review in the same way that every other Government Department that has even a passing interest in the wellbeing of our young people and their ability to respect themselves and each other should. Notwithstanding the fact that I had a very negative answer from the Department, dated earlier this week—it might have been the latter end of last week—will the Minister take back to the Department how crucial that is if we are to hit the target of living HIV-free? Government Departments must work together to ensure that that happens.

16:54

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

It really is a great pleasure to serve under your chairmanship, Dame Caroline. I am grateful to my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing this timely debate and for her thoughtful contribution, which laid out the principal issues. I am also grateful to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for making sure that the full gamut of issues was covered, because sometimes it is possible for the perception to be that this is just an issue about gay men, and it is not. The hon. Member for Vauxhall (Florence Eshalomi), who, along with me and others, is a co-chair of the all-party parliamentary group on HIV and AIDS, made it absolutely clear that this is a wider issue than for just that one group.

As the HIV action plan has put in print, we have already reached the UN’s 95-95-95 target and are hopefully within touching distance of ending new transmissions by 2030. If that can be achieved, we should be clear that it is a milestone, equivalent to the eradication of polio in past years. I believe it is also a tangible example of British leadership in health and a testament to consistent and concerted efforts, which have produced incremental gains, giant leaps and, ultimately, a pathway that others have followed. As we have heard, however, we are not there yet.

The HIV action plan makes it clear that the goal will not be reached without PrEP. We know that PrEP works, with new transmissions of HIV dropping by over a third from 2019, but a recent survey by Prepster, the National AIDS Trust, the Terrence Higgins Trust, Sophia Forum and One Voice Network found that many people end up being diagnosed with HIV while waiting for PrEP. We need to close the gap between awareness of risk, accessing services and receiving PrEP, and I absolutely agree with the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) about the availability of PrEP. I could sit down after this speech, go on my phone and order PrEP to be delivered to me from India in the next few days, but I could not go to a pharmacy in the centre of London or, indeed, in my own constituency to receive that. Not only is that discriminatory, in the sense that people who can afford to buy it or access online services have an advantage; as the hon. Member suggested, it is putting the risk ahead of the reality that people are already accessing it. It is far better to get it from a pharmacy than from an Indian or other overseas supplier.

Our targets on new transmissions will not be reached if we have not identified those who are living with HIV, and we have heard Members speak about that. Many of these issues are devolved in relation to Scotland, but one thing that I would like to see there is a properly funded national testing week. To maximise its impact, it should work in tandem with that which already takes place in England, because having a UK-wide event—with a focus on national television, in the national media and on social media—is a much better way to draw attention to the issue. We have heard from my right hon. Friend the Member for Romsey and Southampton North; like her, I can confirm that even someone like me can use a test kit. I am grateful—this will interest the hon. Member for Vauxhall—that the funding is at least better now in Vauxhall, because people used to have to phone up at 3 am to get the kit. If someone tried to phone at about 9 am, all the kits for that day had been distributed, but now people seem to be able to get them 24 hours a day. Virtually anyone can use such a kit effectively.

As the action plan identifies, reaching those who do not know that they are living with HIV will mean targeting hard-to-reach parts of our society, and those who either do not see themselves at risk or ignore the risk because of stigma. Opt-out testing has proven to be a success in that regard, and it is also cost-effective. When I was in South Africa, I had the opportunity to hear directly from medical professionals that opt-out testing, where it applies, has had a remarkable effect on the identification of cases in women. There are issues with support and treatment, but in terms of identification of cases, South Africa demonstrates that opt-out testing has a proven record. We should not prevaricate before rolling out opt-out testing beyond the areas already identified. Agencies and charities are champing at the bit to partner the Government to do just that.

The position of no new transmissions is almost tangible, but, as with the progress we have already made, it will not come without consistent and concerted action. Like the hon. Member for Vauxhall, I commend the all-party parliamentary group on HIV and AIDS, and the Members across both Houses who are part of it, for the continued commitment to action. As the hon. Lady did, I vouch that the group will continue to work with any charity, trust, health board or Government to get our country to the position of no new transitions and to highlight the issue globally.

17:01

[Peter Gibson (Darlington) (Con)]

It is a privilege to serve under your chairmanship, Dame Caroline. I congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on leading this important and timely debate. As I remarked in Prime Minister’s questions in February, that month marked the 22nd anniversary of the death of a good friend of mine from AIDS-related complications. I am absolutely certain that had he been tested earlier and more regularly, he would have been given the right treatment and would still be alive today. It is because of people like him that this issue is so important to me.

I am entirely supportive of the Government’s commitment made in 2019 to end all new HIV transmissions in England by 2030. Although we have made some progress, we cannot be complacent. We should rightly celebrate the successes in improving HIV treatment, prevention, management and care. However, without testing we cannot treat, and without PrEP we cannot prevent further infection. It is great that HIV-positive people now experience a similar life expectancy to people without HIV, but we still have a lot of work to do. Although new HIV diagnoses have continued to fall, late diagnoses remain stubbornly high in England, and progress across the UK is not equitable.

There are three key areas where we need to seek more action: access to PrEP, more HIV testing and care for people living with HIV. As we have heard, access to PrEP remains limited. The HIV action plan included a commitment to develop a plan for PrEP access beyond sexual health services. However, more than a year on from that commitment, it is still not possible to access PrEP at a pharmacy or a GP surgery. May I ask the Minister why that is, and whether he will look urgently at this point? This is an easy win in our fight against HIV.

The HIV action plan included a £20 million investment in opt-out testing in emergency departments in areas classed as very high prevalence. As a result of additional hepatitis C funding, the whole of London was included and the programme became a combined one to tackle bloodborne viruses. The annual report includes the first year of data, and the results have been quite remarkable across London, Manchester, Blackpool and Brighton, as other speakers have highlighted. The figures demonstrate the huge success that opt-out testing has had in rooting out cases of bloodborne viruses—not just HIV, but hepatitis C and B.

In February, as a result of campaigning from many colleagues here and stakeholders across the country, the Public Health Minister committed to consider the case for expanding opt-out testing to all areas with a high HIV prevalence. Will he tell us the outcome of that review? When will opt-out testing be rolled out to high prevalence areas? People do not live their whole lives in fixed locations. Simply because someone now lives in an area that is not high prevalence does not mean that they did not once do so or have not visited such areas in the past.

Opt-out is a win-win: it is good for public health and the public purse. It is essential that we meet our target of ending all new HIV transmissions in England by 2030. We have made progress, but I fear that without renewed impetus, greater access to PrEP and an expansion of opt-out testing, we will miss the mark. Our internationally significant position on HIV is in no small part due to the zeal of giants in the field, such as Lord Fowler, and the efforts of the Terrence Higgins Trust. I ask the Minister to rekindle that zeal and energy, and ensure we take up this mantle and race towards a day when we have no new infections. It can be done.

17:06

[Nickie Aiken (Cities of London and Westminster) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I am glad to have the opportunity to contribute to this debate on the Government’s annual update on their HIV action plan. I thank my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing it.

The annual update makes it clear that progress has been made. The plan has set the stage for a transformative approach to prevention, testing, treatment and support but, as ever, there is still room for improvement, and the annual report highlights several key opportunities. First, there is scope for improving access to the HIV prevention drug PrEP, HIV testing and care for people living with HIV. As the Member of Parliament for Cities of London and Westminster, I know how important that is. Reports show that Westminster has among the highest HIV prevalence in the country: eight 15 to 59-year-olds per 1,000 are living with HIV. The action plan will change those statistics, and the Government’s investment in opt-out HIV testing and emergency departments in areas classed by the UK Health Security Agency as having a very high HIV prevalence should be highly commended.

As a result of additional funding, in St Mary’s Hospital in my constituency, three people were newly diagnosed with HIV, seven with hepatitis B and 14 with hepatitis C in the first 10 months of the Government’s programme. Those figures from the first year of the programme have been broken down by the Terrence Higgins Trust. There have been more than 2,000 positive diagnoses across London, Blackpool, Brighton and Manchester.

Now that we are in the second year of the programme, it is only right that we consider expanding opt-out testing. I understand that NHS England has costed and prepared a plan for expanding HIV testing to 41 additional A&E units in areas with a high prevalence of HIV, and I hope that will go ahead. Modelling by the Terrence Higgins Trust shows that such an expansion has serious merit in supporting the Government’s aims and ambitions.

Also important in supporting the aims of the action plan is increasing equal access to PrEP. That revolutionary drug has changed so many lives—including for many of my friends. I am proud that my constituency is home to the outstanding 56 Dean Street—the sexual health clinic that pioneered PrEP in England—which is recognised internationally for its innovation, particularly in regard to its engagement with London’s higher-risk communities. More than that, it has been a haven for so many of the LGBT+ community over the decades. I pay tribute to the outstanding staff who work there today and have worked there in the past. They have always operated without prejudice, even in the face of systemic discrimination.

Nearly 60% of people wait more than 12 weeks for their PrEP. I am glad that the annual report acknowledges the publication of the first national PrEP monitoring and evaluation framework, but there is more to do. The framework is clear in showing that there are inequalities in who is able to access PrEP; we really need to push against that. The HIV action plan includes a commitment to develop a plan to expand access to PrEP through sexual health services, but there is a case to be made to have access through GP surgeries in particular, as well as pharmacies. We need to ensure equal access to PrEP if we are to meet our 2030 commitments.

In the remaining time I have left, I would like to pay tribute to the work of the Terrence Higgins Trust. From its policy to its fundraising efforts, it is second to none in its field. In fact, I have been to visit its brilliant team in Boutique, the only Terrence Higgins Trust charity shop in the UK, which happens to be based in Pimlico in my constituency. The shop recently reached £1 million raised for charity, which is utterly amazing. I pay tribute to all the volunteers who work there. For nearly 15 years, the shop has helped the Terrence Higgins Trust to fund its hardship grant, services for people living with HIV and its campaign to end new cases by 2030. I pay huge tribute to both the shop and the Terrence Higgins Trust.

The Government’s HIV action plan is the first step in reinforcing the progress the UK has already achieved. Now Government, civil society organisations, healthcare providers, researchers and communities must continue to work together to address the global challenge. By combining our knowledge, resources and expertise, we can develop innovative solutions, advocate for policy change and create a sustainable impact that will shape the future of HIV prevention and treatment.

[Dame Caroline Dinenage (in the Chair)]

I thank all Members for keeping to time so beautifully. I call Andrew Gwynne.

17:11

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is always a pleasure to see you in the Chair, Dame Caroline. I congratulate the hon. Member for West Bromwich East (Nicola Richards) on securing this important debate. It has been a good debate, and we have had consensual contributions from Members across the House. I pay tribute to my hon. Friend the Member for Vauxhall (Florence Eshalomi), the right hon. Members for Romsey and Southampton North (Caroline Nokes) and for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), and the hon. Members for Cities of London and Westminster (Nickie Aiken) and for Darlington (Peter Gibson), for their thoughtful contributions. I thank them individually for the work they are doing here in the House of Commons on this important topic.

The publication of the first HIV action plan update in Parliament last month showed real positive progress in ending new HIV cases and HIV-related deaths in England by 2030. However, as the number of new HIV cases falls, it will become harder to find people living with undiagnosed HIV—something we have recognised in the debate. I therefore welcome the opportunity to press the Minister on some key points, particularly regarding the HIV action plan update. The first relates to opt-out HIV and hepatitis testing. The inclusion of opt-out testing in areas of high HIV prevalence—something for which Labour has called for some time—has been hugely successful. Across London, Manchester, Blackpool and Brighton, we have seen 343 people newly diagnosed with HIV, over 1,500 people newly diagnosed with hepatitis B and C, and 473 people previously lost to care found. Those are incredibly encouraging statistics, and they point to the effectiveness of opt-out testing. I would be grateful if the Minister set out what assessment the Government have made of opt-out testing being implemented in areas of high prevalence—and if not, does he have any plans to do so?

The second thing I want to focus on were those people lost to care. By “lost to care”, we mean those previously diagnosed with HIV who have not attended an HIV clinic in the past year. In general, those people are disproportionately likely to be black women, and most likely to be from the most deprived parts of the country, to have caring responsibilities, or to be subject to the misuse of drugs and alcohol.

I also commend the Terrence Higgins Trust, which does brilliant work and I thank those there for their support for me in my role. The trust estimates that the number of people lost to care, but alive and still in the UK, could be as high as 13,000. That is extremely concerning and means not only that individuals are at risk of developing serious HIV-associated illness, but that they risk passing the virus on to others. What action is the Department taking to re-engage those individuals? What further work is the Minister planning nationally to support people back into care?

The third and final point I want to ask the Minister about is access to PrEP and sexual health services more generally. As we have heard in the debate, there are serious inequalities in PrEP identification and initiation. Even when people access care, they face extraordinarily long waiting times, with 57% of people waiting more than 12 weeks to receive PrEP. The Terrence Higgins Trust is aware of people who have, tragically, acquired HIV while waiting to access PrEP. That is clearly unacceptable. Such cases were entirely preventable and should seriously alarm Ministers.

The HIV action plan included a commitment to develop a plan for PrEP access beyond sexual health services. However, more than a year on from that commitment, there is no pharmacy or GP surgery in the country where PrEP is accessible. I know from responses to written parliamentary questions that the Minister is still committed to that aspect of the HIV action plan, so when can we expect it to be set out in detail? The Government initially promised their PrEP plan in the autumn of 2022. We are now three days away from summer recess in 2023. Where is the plan?

In closing, I want to raise the issue of sexual health services and ask the Minister about Government proposals to change schedule 1 to the Health Protection Notification Regulations 2010, which lists notifiable diseases. What guarantees will the Minister give that that will not impact the important anonymity of those accessing sexual health services or increase stigma?

Labour stands ready and waiting to support the Government in driving down HIV prevalence. I am sure that the Minister will agree that, across the House, we have a responsibility to redouble our efforts so that we can eliminate all new transmissions of HIV by 2030. I hope that, with cross-party action, we can make that a reality.

17:17

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

I pay tribute to my hon. Friend the Member for West Bromwich East (Nicola Richards) and to all other hon. Members present. A number of them have played leading roles in campaigning on this issue.

This afternoon, we have had an excellent debate, hearing important contributions about particular aspects of the challenge: my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on the dimension for women; the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) on the opportunities for home testing; and the hon. Member for Vauxhall (Florence Eshalomi) on the importance to her constituency. We heard about the inspirational work of centres such as 56 Dean Street from my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) and about the searing personal experience of friends and families of people suffering and dying of this terrible disease from my hon. Friend the Member for Darlington (Peter Gibson).

[Andy Slaughter (Hammersmith) (Lab)]

I apologise, as I have not been present for the whole debate. May I mention one other clinic, 10 Hammersmith Broadway? I visited it recently and was hugely impressed by the staff and their partners in the community, such as the Terrence Higgins Trust. It is clear, however, that they are under increasing stress. The problem is that it only takes an emergency like the outbreak of mpox, or STIs going up, and routine services such as providing PrEP go on to the back foot. Will the Minister look at that, particularly in high-prevalence areas, because the limited cost is not worth the great risk involved?

[Neil O'Brien]

I am happy to look into that. We provided extra funding

in respect of mpox, but I will look into the issues the hon. Gentleman raised.

This debate is an opportunity to restate our joint commitment to tackling HIV and to reflect on the progress we have made since 2019, when the Government first announced our ambition to end new HIV transmissions, new AIDS diagnoses and new HIV-related deaths in England by 2030. As all Members know, 30 years ago AIDS was a fatal illness; today, when they are diagnosed early and have access to antiretrovirals, the majority of people with HIV in England can expect a near-normal life expectancy. People who are diagnosed with HIV can expect to receive HIV care that is world class, free and

open access.

We have come a long way. Despite the unprecedented and challenging backdrop of the covid pandemic, England has seen a 33% fall in new HIV diagnoses since 2019, and fewer than 4,500 people live with undiagnosed HIV. The vast majority of those diagnosed are on high-quality treatment and are now unable to pass on the virus—still not enough people know that. Our successes have been possible only through clear national leadership and strengthened partnership working.

I am incredibly grateful to Professor Kevin Fenton, the Government’s chief adviser on HIV, who chairs the HIV action plan implementation steering group, which has representation from the key partners involved in the delivery of the HIV action plan, including local government, the UK Health Security Agency, the NHS, professional bodies and our voluntary and community sector. The group has met quarterly throughout the year to monitor progress on our commitments and ensure that appropriate action is taken to help us to move forward on our objectives.

Within the steering group’s remit, we have established a community advisory group, comprising representatives from a wide range of community and voluntary groups, from which we have a lot to learn, and four task and finish groups to support PrEP access and equity, workforce, HIV control strategies in low-prevalence areas, and retention and engagement in HIV care. The groups provide vital, comprehensive and timely advice and help us to remain on track to meet our 2030 goal.

Many areas of the country have replicated the national action regionally by providing leadership and oversight of the work that is under way within local systems. For example, we have seen the development of regional HIV action plans in areas such as the south-west, multi-agency working groups in the midlands, and stocktakes of testing activity and action via sexual health networks in the south-east, the north-east and Yorkshire.

[Peter Gibson]

I am interested to hear the stories the Minister is telling about regional action plans; do they include opt-out testing?

[Neil O’Brien]

I will come on to opt-out testing in a moment.

We are incredibly grateful for the work of the UK Health Security Agency, which is a world-class organisation that runs high-quality data-collection and surveillance systems to help us to better understand the scale of the challenge. In December 2022, the UKHSA published the first monitoring and evaluation report on the HIV action plan, which indicated that the achievement of our ambitious commitments, including the interim commitment to an 80% reduction in transmissions by 2025, is within our grasp, and we should be encouraged by the progress that has been made.

As various Members pointed out, progress in the UK is increasingly recognised internationally at different HIV global forums, such as the UNAIDS and WHO international boards. The proof of that is that the UK met the UNAIDS 95-95-95 targets for the second time in 2021: 95% of HIV-positive individuals were diagnosed; 99% of those diagnosed were receiving treatment; and 98% of those receiving treatment were being virally suppressed and unable to pass on the disease.

Transparency and accountability are a key cornerstone of our plan, which is why we also committed to update Parliament each year on the progress made towards our ambition to end new HIV transmissions. In particular, we are committed to ensure that underserved populations benefit equally from the improvements made in HIV outcomes, including by scaling up our prevention efforts and increasing access to PrEP. We have already invested £33 million to roll out PrEP across sexual health services over the past two years, and PrEP is now being commissioned as a routine service through the public health grant. However, we know that there is more to do to improve PrEP access and equity for key groups, and we are in the process of developing a road map based on the input of the PrEP task and finish group that I mentioned, to improve PrEP provision and help us to reach those who are under-represented in PrEP access.

The hon. Member for Brighton, Kemptown raised the issue of the blood test, which I will absolutely take away and look at. On the specific point about timing made by my hon. Friend the Member for Darlington (Peter Gibson) and by my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), the HIV plan implementation steering group is working to develop a road map based on the task and finish group’s recommendations, to help to guide our movement forward. Our work will be informed by the findings of research on the use of HIV PrEP commissioned by the English HIV and sexual health commissioners group. In particular, we want to understand the barriers for underserved groups that access PrEP and how they can be mitigated.

It is expected that the research will be published this month—of which there is, of course, not much left. Members will see that very shortly, because we know the urgency of this issue, and I have been struck by Members’ testimony today about what is happening in respect of private access and the need for people to access PrEP in a timely and smooth way.

A number of hon. and right hon. Members raised the issue of the opt-out testing programme. I have met some of the people who have already benefited from that incredible programme, which powerfully underlines its huge benefits. Preliminary results from the pilot are promising, and we are still considering the full evidence from the first year of the programme, alongside the data on progress towards our ambition of ending new transmissions. Through the HIV action plan, DHSE is investing £3.5 million in our national HIV prevention programme from 2021 to 2024, to raise awareness of ways to prevent the spread of HIV and other sexually transmitted infections among the most affected communities.

As part of that programme, we deliver National HIV Testing Week in partnership with the Terrence Higgins Trust. In 2023, it distributed almost 22,000 free HIV testing kits ordered by the public. The self-testing kits provide instant at-home results and are available for the very first time. A targeted summer campaign is currently being delivered through the brilliant work of our partners at the Terrence Higgins Trust. The campaign has been carefully developed and tailored through strong audience insight evaluation to help us reach those most at risk, and it aims to increase testing among key groups, particularly young people and people of African heritage. It also aims to promote awareness of good sexual health practices to prevent transmission of other sexually transmitted infections. To reassure my right hon. Friend the Member for Romsey and Southampton North, we are working with the Department for Education on its RHSE review, and have been doing so since March, so I absolutely recognise the importance of the point that she made.

Achieving our 2030 goal will require sustained commitment from many partners across the health system and beyond—in education, for example—and the HIV action plan describes the role that each partner will play in this vital endeavour. The success of recent years, and the scale of the task that remains, should give us the belief and the drive to go further in the years ahead. Let us continue working together to ensure that we are the generation that ends HIV once and for all.

17:27

[Nicola Richards]

I thank all hon. and right hon. Members for taking part in today’s debate. We all said very similar things, and I hear from the Minister that the first year’s data from the opt-out testing trial is still being analysed. I think he will agree with us that it looks very promising so far, and I want to reiterate that we have all the knowledge we need to end new transmissions of HIV in the UK by 2030. We have the tools and the knowledge to do it. We just need to get on and do it, so I urge the Minister to speed up the work on this issue, because it will be an incredible achievement if this Government can end new transmission by 2030 through the programmes we have set up. It is possible, we can do it and we have to get on with it.

Question put and agreed to.

Resolved,

That his House has considered the HIV Action Plan annual update 2022-23.

17:27

Sitting adjourned.