Health: HIV

Earl Howe Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Collins of Highbury]

To ask Her Majesty’s Government whether they intend to endorse the standards of care for people living with HIV published by the British HIV Association on 29 November.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Department of Health commends the British HIV Association for these important standards, which we welcome. The NHS provides excellent care for people living with HIV. These standards are important in setting out best practice to support continuing high-quality HIV care services for all HIV patients. They will provide a valuable resource and inform the commissioning of comprehensive HIV care services.

[Lord Collins of Highbury]

I thank the Minister for that response. One recommendation made by BHIVA related to self-management. As with many other long-term conditions, this approach can help people with HIV to gain confidence, skills and knowledge to manage their own health, with resulting improvements in the quality of life and independence. In the light of changes in the commissioning process, who will now have responsibility for funding the excellent self-management services currently provided by organisations such as the Terrence Higgins Trust and Positive East?

[Earl Howe]

My Lords, the noble Lord is quite correct. Self-management is one of the BHIVA standards. I agree that self-management and supporting patients to manage their own care, both for HIV and, for that matter, any other long-term condition, are very important for promoting the best treatment outcomes for individuals. A variety of approaches will be needed to support individuals to self-manage their HIV. There are already some innovative programmes, such as the online resource, My HIV, for people living with HIV, delivered by the Terrence Higgins Trust. The key to this is for commissioners of services to work together in future to ensure that self-care is part of the HIV care pathway, and GPs will have a role to play in that.

[Lord Fowler]

My Lords, I declare an interest as patron of the British HIV Association. Is it not the case that we now have 100,000 people living with HIV in this country but that a quarter of them are undiagnosed, so obviously risk spreading the infection further? Does that not mean that we must persuade even more people to come forward for testing? In that respect, will the Government now commit themselves to bringing forward proposals to allow home testing?

--- Later in debate ---

[Earl Howe]

My noble friend is quite right. As he will know, this is National HIV Testing Week. We support the Terrence Higgins Trust and its partners in this important new initiative. The NHS medical director has written to all medical directors about the week and the importance of healthcare professionals being alert to the need to offer HIV testing. As regards self-testing, we agree that the current regulations are not sustainable, which is why we are reviewing our policy on banning the sale of home HIV testing kits. We support repeal but we are required to do a short consultation setting out our reasons. We plan to do that early next year.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that we have some of the best services in the world for HIV/AIDS? Can he give an assurance that, with the changes in the National Health Service now, there will not be a dilution of these services?

[Earl Howe]

My Lords, yes. We believe that the complex needs of people with HIV will be best served by the work being done by the HIV national clinical reference group of the NHS Commissioning Board. The board will commission these services in the future, and that will drive greater consistency and quality throughout the system.

[Lord Hughes of Woodside]

My Lords—

[Baroness Trumpington]

Our turn. I am not sure whether I am in order but I should like to congratulate, through this House, the Minister on his award yesterday as Minister of the Year in the Lords.

[Earl Howe]

I am exceedingly grateful to my noble friend for that and for not asking me a question that I was unable to answer.

[Lord Hughes of Woodside]

My Lords, I am grateful that I gave way. In view of the reports of an alarming increase in the incidence of HIV, is not the old adage that prevention is better than cure even more important? Is this significant rise in HIV incidence caused by less use of condoms, or what?

[Earl Howe]

In fact, the numbers are more or less stable if one compares this year to last. However, the noble Lord is right: we cannot drop our guard in this area. There is a pressing need to reduce undiagnosed HIV. It is estimated that about 23,000 people are undiagnosed and 47% of those newly diagnosed with HIV are diagnosed late—that was the figure for last year. That is why the prevention campaign through local authorities will be so critical in this area.

[Lord Maclennan of Rogart]

My Lords, in view of the extensiveness and particularity of this important report, will the Government contemplate producing a response which deals with the matters particularly focused on? Will they seek to ensure that, due to the increase in non-AIDS comorbidity and the complexity of HIV drug interactions, clear protocols are established between primary and secondary care as there is some patient disquiet, particularly about primary care?

--- Later in debate ---

[Earl Howe]

My Lords, my noble friend is absolutely right that this is a complex condition. As regards a response to the BHIVA report, we are planning to publish an integrated sexual health strategy which will embrace all aspects of sexual health, including HIV. The vast majority of HIV in the UK is sexually transmitted. HIV and sexual health services are closely linked, as he will know, and we believe that it is in that strategy that the appropriate guidelines should be set out.

[Baroness McIntosh of Hudnall]

My Lords, will the noble Earl bear in mind that the stigma around people with HIV is still an extraordinarily important issue? Will he encourage healthcare providers to ensure that as much as possible is done to reduce this disincentive to people to come forward for testing?

[Earl Howe]

The noble Baroness is of course right to say that stigma is an issue, and it is doubtless why many people do not come forward for testing. Through the National HIV Testing Week we are encouraging doctors in all parts of England to consider this matter and to see what role they can play in terms of having the right conversations with patients who are in the most at-risk groups.