HIV/AIDS

Lord Cashman Excerpts

Thursday 5th March 2015 Grand Committee

[Lord Cashman (Lab)]

My Lords, I begin with what is a normal courtesy but I really mean it. I thank the noble Lord, Lord Fowler, for securing this debate and for his dedication and overwhelming commitment to the issues of HIV/AIDS and non-discrimination. I also want to develop the theme which he outlined. There has been a massive expansion globally of HIV interventions, which has transformed the HIV epidemic and the broader public health landscape, demonstrating that the right to health can be realised even in the most trying circumstances. I remember well the 1980s when, as a gay man, I saw AIDS and HIV portrayed in the media as the gay plague. We have moved further, and onwards, since then. I welcome that move and I welcome this Government’s commitment and their increased funding, particularly for the Global Fund.

There has been much progress in the developing world but I must express my concern at our view, now taken, that we should pull back in those so-called middle-income countries such as South Africa, where there is a high and increasing prevalence of HIV infection. To pull back in those middle-income countries, with this Government leading on asking the Global Fund to pull back in them, will reverse all the good that has been done.

I turn now specifically to the United Kingdom. People with HIV who receive appropriate treatment, as we know, have a near-normal life expectancy and are very unlikely to transmit the virus. Yet the proportion of people receiving a late diagnosis, according to Library statistics, was 47% in 2012. An estimated 22% of people living with HIV in the United Kingdom are unaware of their infection or status. Increasing HIV testing is therefore important so that treatment can be given and onward transmission prevented. Successful prevention depends on a combination of testing, treating and behavioural change. Giving antiretroviral drugs to those at risk could reduce infections. We know that that work is being rolled out in the United States. Work is also being done here on that. I have to express concerns at some parts of the media comparing the cost of this treatment to that of cancer care. When it comes to the health of an individual, comparisons are odious. There are concerns that the separation of commissioning HIV treatment and prevention has negatively impacted patients.

I have specific questions for the Minister but I will come to those shortly. First, let me refer to the National AIDS Trust and its press release of 20 February 2015. In its report, HIV Prevention—Underfunded and Deprioritised, the charity states:

“Not enough money is being spent on HIV prevention to have any impact on the … new HIV infections”—

as was outlined by the noble Lord, Lord Fowler. The trust estimates that,

“in 2014/15 £15 million was spent nationally on HIV prevention compared with £55 million allocated in 2001/02 … In this time the number of people living with HIV has trebled whilst the amount spent on prevention has decreased to less than a third of the original budget”.

This makes no sense whatever. The report continues:

“This estimate is based on information provided to NAT from local authorities in England with a high prevalence of HIV. £10 million was spent in 2014/15 on HIV prevention in these areas—this works out at only 70p per person. The report found that in local authorities with high prevalence of HIV less than 1% of local authority public health allocation is spent on HIV prevention. In 2013 the NHS spent 55 times more on HIV treatment and care in these areas than local authorities spent on HIV prevention”.

According to the chief executive of the NAT:

“Our research found, shockingly, in the 58 areas of highest prevalence of HIV in England, seven local authorities weren’t spending anything on primary HIV prevention or on additional testing services. Worryingly we also found no correlation between level of HIV prevalence in an area and how much was being spent on prevention”.

The report continues:

“The HIV charity is also concerned that more problems are on the horizon when the ring-fencing for the public health budget is removed. Currently, local authorities are given money to provide basic services such as sexual health clinics. In April 2016 they will be able to spend this money on anything”.

To quote the chief executive:

“In the current climate of cuts and pressure on budgets we are extremely worried this money will be used to shore up other areas of council spend. This would be a disaster for public health in this country”.

I now come to my questions. Will the Government address this funding gap, maintain public health ring-fencing and prioritise HIV prevention and testing services? It is three weeks to purdah and the new financial year. The people who are supposed to be managing the national HIV prevention programme, which has been cut in half, have still had no instruction on how the money should be reallocated, let alone spent. They are dependent on getting approval for this from the Department of Health, which means that the charities involved will not even get the four weeks’ notice they need to give notice, in turn, to staff who may lose their jobs. How do the Government intend to ensure continuity of service?

We also need a nationally co-ordinated approach to ensure that we use ever-decreasing resources effectively to reduce undiagnosed HIV and forward transmission. How will the Government ensure a co-ordinated approach when they are not planning and consulting on it? We have a situation where reducing duplication and using money wisely is paramount, yet I am reliably informed that there is a total abdication of any national responsibility for this. Both the Department of Health and Public Health England say they can only advise. It is deeply worrying and I look to the Minister for his replies.