HIV/AIDS

Lord Black of Brentwood Excerpts

Thursday 5th March 2015 Grand Committee

[Lord Black of Brentwood (Con)]

My Lords, like other noble Lords, I am indebted to my noble friend Lord Fowler for securing this debate today and for giving us, as he said, what is probably the last opportunity before Dissolution to discuss the issue of HIV and AIDS.

It is therefore a fitting moment to pay him the warmest of tributes, as other noble Lords have done, for everything that he has done throughout this Parliament to keep this subject right up at the top of the political agenda, focusing on not just the impact of HIV and AIDS in the United Kingdom but on the terrible scourge of the epidemic in so much of the developing world, which the noble Lord, Lord Crisp, spoke about so eloquently just now. I only hope that at the end of the next Parliament in five years’ time, we will have seen more progress at home but also some of the incredibly important changes that need to take place in the developing world as a prerequisite to tackling HIV and AIDS. I absolutely agree with the noble Lord that the most crucial is the rapid decriminalisation of homosexuality in many Commonwealth countries. Criminalisation is not just a moral outrage; it is a public health disaster, and we must do everything that we can to stop it. I do not want to dwell on that subject today, but it would be good to hear from the Minister that the Government are continuing to put pressure on Commonwealth institutions to live up to their obligations under the Commonwealth charter.

I do not know whether it is a coincidence or whether my noble friend has engineered it this way, but this very week is the 30th anniversary of the approval of the first commercial HIV blood test on 2 March 1985. That was a seminal moment in the battle against what was then an unstoppable horror. Testing meant that the blood supply could essentially be freed of HIV. It also helped scientists and other public health officials to determine the extent of the epidemic. For the first time, it empowered individuals by allowing them to know their status and to protect their partners if they had been infected. What a change 30 years have made. Today, HIV testing is at an all-time high. As I understand it, in the United States, 86% of people who are infected know their status, although that means that an eye-watering 186,000 people in the United States of America do not know that they are infected.

Despite that success, however, rates of infection are still disturbingly high, as we have heard, with 6,000 people in the UK diagnosed in 2013. That figure crosses every age group. I am grateful to the Minister for providing information on that point in a Written Answer to me in the past few weeks. While the majority of people diagnosed in 2013 were in the 35 to 50 age group, 462 new cases of HIV among gay men were in those aged under 24 and 308 were in those aged over 50. Among heterosexuals, 105 women and 47 men were aged between 15 and 24 and 439 were over 50. This is still a virus that respects no boundary of age or background.

Despite the fact that an HIV diagnosis is no longer, as it was 30 years ago, a death sentence—indeed, those infected and properly treated will probably have a normal, healthy lifespan—problems, as we heard during the debate, remain. One is prevention, as my noble friend pointed out, and the other is ensuring ever-higher levels of testing. On prevention, there is a great deal of hope and optimism with the development of pre-exposure prophylaxis presenting incredibly exciting opportunities. Although it has been available in the US for some time, it is not yet here, but should, I believe, be available to all those at risk in the UK as soon as possible. As Yusef Azad at the National AIDS Trust—and I pay tribute to its work—put it to me, the very recent PROUD trial looking at the impact of pre-exposure prophylaxis here,

“is a prevention game-changer which we cannot afford to ignore. As a much needed addition to—not substitute for—condom use, its costs are modest when compared with the lifelong costs of treating someone with HIV if we fail to prevent their infection”.

He is absolutely right, and I hope that NHS England will heed those wise words. Action sooner rather than later will save not just lives, but money too. I support everything that my noble friend said. It must be Mickey Mouse economics to spend so much on treatment and so little on prevention.

Similarly, there has been much progress on testing, as we have heard, but the figures for late diagnosis—still above 40%—are shockingly high. To tackle that, I hope that, among other things, the NICE public health guidance recommending that high-prevalence local authorities commission HIV testing to be offered to all those admitted to a hospital and all those registering with a GP is implemented soon. The Government and Public Health England can play a powerful leadership role, and I would be grateful if the Minister could take the lead today in calling for such important initiatives to be implemented.

Of course, key to both testing and prevention is the ongoing problem of stigma. The National AIDS Trust survey on public attitudes published in December last year still makes very depressing reading. If anything, public knowledge and attitudes seem to be deteriorating, and we need to take action to reverse that, otherwise, all the good work on testing and prevention could be in vain. This is, of course, a matter that goes well beyond central government, but local government, the NHS and schools all have a role to play. The Government can, again, take a lead, and I know that the Minister, who has done so much to help in this area in the past, will take up that challenge and this afternoon energise all those involved to redouble their efforts to tackle stigma.

I am conscious that there are no noble Baronesses speaking this afternoon, undoubtedly because of the clash with the debate on International Women’s Day, but I want to say a word or two about the special issues still faced by women with HIV and to cast a quick glance beyond our own shores to where the situation for people with HIV is still incredibly difficult and in some cases horrific. I commend an excellent report published in the past few months by the Salamander Trust, which last summer conducted a global survey on the sexual and reproductive health and human rights of women living with HIV. Of those who responded in a survey that took place in 94 countries, a shocking 89% reported that they had experienced violence or fear of violence since or because of their diagnosis— in their homes, in their communities and even, most appallingly of all, in healthcare settings. Only 50% of respondents found their healthcare service providers to be well trained and knowledgeable about their condition. A significant number emphasised the challenges of poverty and the resulting strain that it places on mental as well as physical and sexual health. It is little wonder that 80% of respondents reported experiences of depression, shame, loneliness and feelings of rejection.

The report contains a wealth of recommendations about how to improve the specific condition of many women across the globe living with HIV. I hope that the Government will be prepared to support such recommendations. It is an initiative that the Commonwealth in particular could pursue. Progress may be slow—I think that we all understand that—but this is a tangible way in which we could help improve the lot of thousands of lonely, frightened and vulnerable people across the globe.

As so often in debates on this subject, there is much significant progress to applaud and great hope and optimism, but there are problems, too: in tackling stigma in particular. There are serious challenges beyond our shores in tackling the criminalisation of homosexuality, which is turbo-charging the HIV epidemic in much of the world, in dealing with the special problems faced by women with HIV and in ensuring access to healthcare for all who need it. As I said earlier, some of those issues will take time to tackle, but I hope that this debate will again spur us to redouble our efforts both here in the UK and in the wider world one day to bring to an end a horrific epidemic which has already claimed too many lives and will yet claim many more.