HIV: Barriers to Treatment

Lord Cashman Excerpts

Thursday 1st December 2016 Lords Chamber

Asked by

[Lord Cashman]

To ask Her Majesty’s Government what assessment they have made of barriers to accessing treatment to prevent the spread of HIV; and what steps they are taking to address those.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, HIV treatment in itself is preventive. HIV positive people are now being given early access to HIV drugs, resulting in an undetectable viral load, which makes it very unlikely that the virus will be passed on to others. To ensure that we continue to make progress in preventing HIV, NHS England and Public Health England will say more about their further plans for a new programme in the next couple of days.

[Lord Cashman (Lab)]

I thank the Minister for his response and indeed for his commitment on this issue. However, there has been much prevarication and procrastination over who is responsible for providing access to PrEP, a drug that is known to prevent transmission of HIV. More people are at risk than ever before, so will the Government explain how they are working with NHS England and Gilead, the supplier of PrEP, to take the lead on this issue? If the price of PrEP does not decrease, how and when will the Government ensure that those at significant risk from HIV will have access to it?

[Lord Prior of Brampton]

My Lords, negotiations have been going on between NHS England, Gilead and others, and we expect a positive outcome in the very near future—in the next few days. I cannot comment on the details at this time, but as soon as we have that information, I will ensure that it is placed in the Library of the House of Lords immediately.

Health: HIV

Lord Cashman Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

I am not an expert in this area, but having thought and read about this issue a lot over the past few days, it seems to me that the number of people who have not been diagnosed with HIV is a critical issue. As those people are not aware that they have HIV, their behaviour is not adjusted and because they are not taking treatment, they have a greater amount of the HIV virus. It is estimated that 18,000 people have not been diagnosed so, if one had to make a choice, increasing our rate of diagnosis must be crucial. However, I do not disagree with the noble Baroness that the evidence around PrEP as a prophylaxis is strong.

[Lord Cashman (Lab)]

My Lords, I have a simple question. Does the Minister agree that we cannot afford not to provide PrEP on the NHS, given that it saves lives and prevents HIV infection?

[Lord Prior of Brampton]

The critical issue is: to whom do we provide it? The whole purpose of the trials that NHS England is now funding is to ensure that when we provide PrEP, we do so for those who can most benefit from it.

NHS: Food Banks

Lord Cashman Excerpts

Thursday 26th November 2015 Lords Chamber

[Lord Prior of Brampton]

I thank my noble friend for that remark. It is entirely up to local organisations and local institutions, and those doing the work in Birmingham and Tameside are to be congratulated.

[Lord Cashman (Lab)]

My Lords, I do not doubt the Minister’s sincerity in his answers, but I point out that food banks result because people are going hungry. People are starving in this country and should not have to rely on such charity. Does he agree that obesity often occurs when people on very meagre budgets have to have the worst kind of food in order to feel satisfied?

[Lord Prior of Brampton]

The factors behind obesity and malnutrition are extremely complex. The all-party inquiry referred to complex and frequently overlapping factors. The work done by the University of Warwick found that there was no systematic evidence on drivers of food aid in the UK—and the evidence was drawn not just from the UK but from the US, Canada and Germany.

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.

Health: Lesbian, Bisexual and Trans Women

Lord Cashman Excerpts

Wednesday 3rd December 2014 Lords Chamber

[Lord Cashman (Lab)]

My Lords, I congratulate the noble Baroness, Lady Barker, on introducing this extremely important topic. She rightly referred to the three lesbians who abseiled into your Lordships’ House. Why did they do that? They did it on the absolute principle of equality. From that brave fight against Section 28, which all parties were to recognise was wrong and should be repealed, came a determination that we would treat all our citizens equally.

The good news is that I prepared a very long speech. The even better news is that my computer refused to print it. I have yet to discover whether it was bi-phobic, transphobic or homophobic, or merely that the operator was technologically incompetent. I think that it was the latter. As a gay man, I will try not to rain on the parade of the important issues that we are discussing. Therefore I will not give a prepared speech, but, as Edgar says at the end of Shakespeare’s King Lear, I will:

“Speak what we feel, not what we ought to say”.

In the excellent work that is placed before us by the House of Lords Library it is clear that there is an inequality in access to health services for lesbians, and bisexual and trans women. It is clear in the sexual minorities report, which I have here and which conclusively looks at more than 2.1 million respondents, that the healthcare access and treatment experienced by people within GP services was poor and inadequate.

I must declare an interest as the co-founder of Stonewall. I want to refer to the Stonewall Healthcare Equality Index 2013. But before I do, I say also that I await eagerly the contribution of the noble Baroness, Lady Gould of Potternewton, who has a long and distinguished record within your Lordships’ House and beyond on the issues that we are discussing.

The really interesting part of the Stonewall Healthcare Equality Index 2013 is that,

“32 healthcare organisations entered, including mental health trusts, acute trusts, ambulance trusts, social enterprise organisations, community services, clinical commissioning groups and independent sector providers. The organisations provide services to over 15 million patients and are from across all regions of England”.

When you first read the report, you think it is good news, but the reality is that:

“A third of respondents said they felt the healthcare organisation they used was gay-friendly”—

in other words, two-thirds found that it was not. The report continues:

“Half of respondents felt they were treated with dignity and respect all the time”—

but what of the other 50%? The report also says:

“Two in five respondents felt comfortable telling healthcare professionals their sexual orientation all of the time”.

That was in 2013. I await the 2014 report because, despite the Government’s good intentions—I recognise that there are good intentions; there are enough reports and action plans on the way forward—I fear that the gap is widening rather than narrowing.

It is equally worrying that older gay, bisexual and trans women, as well as gay men, are increasingly fearful about what will happen to them when they approach social care in their later years. We must consider this with the utmost seriousness because I believe that access to health and healthcare systems defines the kind of civilised country in which we would like to live, and if we cannot serve the minorities of our society, we have failed.

There is a very interesting document in the Library, Advancing Transgender Equality: A Plan for Action—another one. The responses to the Government’s surveys indicate that,

“transgender people face persistent challenges in accessing public services … More than half of respondents said they suffered discrimination in accessing public services because of their transgender status … More than half of respondents said health was their most significant area of concern … Two thirds of respondents said they had experienced threats to their privacy (e.g. having one’s gender identity revealed at work without consent)”.

There is enough evidence for us collectively, on all sides of the House, to move forward with determination.

I believe that I have outlined quite clearly that there is inequality in healthcare services. I make a special plea on behalf of the trans community. Trans women and men are so often forgotten in the language of non-discrimination. Their needs are overlooked and it is shocking, indeed shameful, that the World Health Organization still classifies trans as a pathological disorder. I hope that the UK Government will lead discussions within the WHO to end that swiftly.

I also had the great good fortune to attend a Home Office LGBT internal networking group. It was a wonderful morning of sharing of experiences—good and some doubtful—of what it was like to work in the Home Office, and the Home Office is like any other big employer. There was a trans woman who stood up and gave her experience. At the end of her presentation there were questions and someone asked her, “What is it like at work? How are you described?”, and she said—I am paraphrasing—“Well, at work it is like it is for most people who are different. It is difficult. How am I described? I am described as ‘that thing’”. Can your Lordships imagine what that does to you and your mental well-being, let alone your physical well-being?

Now is the time to move forward. I look forward to hearing from the Minister about what action plans have been undertaken and what is actually being done within the NHS in England.

I have enjoyed speaking in this debate, although “enjoyed” is perhaps not the right word when we are talking about inadequate services and the expression of difference and human rights. I believe that access to decent healthcare is a human right. This country has a good and proud record on this, stretching back generations. However, I honestly believe that we need one more push so that we narrow the gap in accessing goods and healthcare services for good, decent, honourable women and men of this country, who deserve such. I thank your Lordships.