Health: HIV

Baroness Walmsley Excerpts

Monday 5th September 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I too congratulate the noble Lord, Lord Black of Brentwood, on introducing this important debate, and at a particularly serendipitous moment—the very first day of the noble Lord, Lord Fowler, as Lord Speaker. I join with noble Lords who have expressed their admiration for his vision and energy. Not many of us in this House can say that we have saved hundreds, if not thousands of lives; the Lord Speaker did.

One of the subsidiary UN sustainable development goals is to end the epidemic of AIDS—by which is meant HIV—by 2030. UNAIDS has set interim targets for 2020 which have been agreed by UN members, including the UK. Individual nations are expected to develop a national strategy for HIV. However, England has not had one since 2010, which is what we have been exploring in this evening’s debate. Therefore, my first question for the Minister is: why not? We have the tools now. How sad it is to think, as we heard from the noble Lord, Lord Maude, who lost his dear brother many years ago in the early days of HIV infection, that if the tools we have today had been available then, many of us would not have lost close family members and close friends. I too lost a dear friend years ago, in the early days, and I still mourn and remember what a lovely person he was and feel so sad that it happened at a time when research was in its early stages. As we have heard, part of the problem is that although we do quite well on treatment, we are falling behind on diagnosis. Thousands of people have undiagnosed HIV, which means they will pass it on without knowing it. They will also develop associated conditions for which proper treatment will be difficult because of the undiagnosed HIV.

Since April 2013, prevention of ill health generally has been funded from the ring-fenced public health budgets of local authorities. But while NHS funding has been protected, public health has been subject, as we have heard, to repeated government cuts—£200 million in one year—which I and others have lamented in the House many times. We are also told that there will be further cuts of 3.9% a year over the next five years. Government proposals to abandon the ring fence or even fund public health through business rates could further lessen the funds available for this work.

HIV prevention funding is already inadequate to meet changing needs and behaviours and is a fraction of what it was 15 years ago. It is also 55 times less than the amount spent on HIV treatment. In this situation a more effective and widely available prevention strategy is needed. If we can have a strategy on hepatitis C, why can we not have one on HIV? HIV prevention needs a strategy because it requires a combination approach, including traditional forms of outreach, sexual health counselling, condom schemes, harm reduction and of course—I say this particularly because the noble Baroness, Lady Gould of Potternewton, is not able to be with us this evening, and she and I share an interest in this—good sex education in schools, with frank discussion of the risks and of how young people can protect themselves. That is what is needed. Information is power when it comes to health, as the noble Lord, Lord Fowler, proved in his campaign many years ago.

Most HIV sufferers are very responsible about their condition. However, the majority of onward transmissions occur when the transmitter is not aware that he or she has AIDS. The majority of those already diagnosed are in treatment and, since treatment reduces viral load to the point where transmission is almost impossible, new cases are not coming from there; they are coming from people who do not know that they have the disease. Therefore, better diagnosis is essential in defeating the epidemic.

Why, then, when the number of diagnoses is rising, does the NHS refuse to make use of or fund PrEP—the most effective preventive treatment yet devised, as we have heard very clearly—and then appeal the decision of the High Court? I find it very difficult to understand why the NHS wants to spend its money on lawyers instead of treatments. We have to balance the cost of treating a patient pre-infection against the cost of treating the disease if it happens, as well as against the loss to the public purse of the talents of that person and the taxes that would be paid if he or she was fit and healthy and not suffering from HIV.

Prevention has long been at the heart of our NHS. Vaccination was one of the most beneficial discoveries of medical science and has been used over the years to save lives and to save the NHS many billions of pounds. Those of us who were war babies will remember that we had orange juice to increase our vitamin C level when we could not get citrus fruits, as well as cod liver oil to give us vitamins A and D to ensure that we did not get rickets. Programmes such as those prevented a lot of ill health and saved the NHS billions of pounds. Surely, pre-infection prophylaxis of such a dangerous disease corresponds to many of the vaccination and supplement programmes that have saved the lives of babies and children over the years.

For diagnosis to be improved, we need an effective programme of testing, as we have heard, but in 2014-15, contrary to national guidelines, 60% of high-prevalence local authorities did not commission any HIV testing outside the sexual health clinic setting. That is probably because they are so cash-strapped. Putting the financial burden of PrEP on them will not help the diagnosis rate; nor will it help them provide the support that many patients need to take their medication. On the whole, HIV medication requires a high level of adherence and some patients need support and help with that.

So we need a proper strategy, including PrEP being made available on the NHS for people in risk groups, not just for the sake of those at risk but for the sake of the many people to whom those patients might transmit the disease in the future. We must be realistic: risky behaviours happen and we have to live with that fact. Unless we protect from infection those who take part in those behaviours, we fail to protect the whole population. If the international community can help very poor African countries to eliminate a highly infectious disease such as Ebola, why cannot a wealthy country like ours eliminate HIV? We should get on and do it. We know how to do it but, as others have said, it needs leadership.