Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Lexden Excerpts

Tuesday 4th June 2013 Lords Chamber

[Lord Lexden]

My Lords, we are fortunate that my noble friend Lord Fowler has brought these immensely important international health issues before the House today. My noble friend has been a tireless champion of the global fund, whose crucial role he has underlined once again. The fund embodies a remarkable international partnership, bringing together Governments and private-sector organisations and uniting them in an unrelenting campaign to overcome the world’s pandemics.

We are united this evening in believing that the fund can be even more successful in the future than in the past. There remains so much for it to do, as we have heard from speakers in this debate. It is a matter of considerable pride that our country, under both the previous Government and this one, has been the third largest contributor to the global fund. Like all those who have taken part in this debate, I look forward to hearing what my noble friend the Minister has to say about our future contribution.

I hope that she will be able to allay widespread concerns that government support for research into new treatments and advances in prevention is about to be cut significantly. Continued funding is essential if recent scientific progress is to be carried forward steadily by those involved in highly regarded, not-for-profit public/private partnerships, such as the International AIDS Vaccine Initiative. This works with more than 50 academic, industrial and governmental organisations around the world to research and develop AIDS vaccines. There could be no more important work.

At the same time, it is accepted by the global fund and by all those who back it that at a time of severe pressure on the public purse everywhere, contributions from individuals, corporations and private foundations must be encouraged. That point was made forcefully in a recent report from the influential Center for Strategic and International Studies in Washington. It needs strong emphasis in this debate.

If the global fund is well equipped and resourced, as we hope strongly, as a result of a combination of public and private support, it will still labour under a formidable handicap. However successful the fund and the efforts of the vast numbers of people working to end the pandemics may be, they will not be able to reach and relieve all the suffering with which they contend. That is because homosexuality is a criminal offence in some 78 countries. Where homosexuals are criminals, HIV cannot be fully relieved or curtailed. The statistics are stark. In Caribbean countries where homosexuality is not against the law, of every 15 men who have sex with other men, one is infected with HIV. In Caribbean countries where homosexuality is criminalised, the rate of infection is one in four. So we come back to the deep-seated problem of criminalisation, which is and always should be a prominent feature of our debates on these issues.

We naturally direct our concern principally to the countries of the Commonwealth. In 42 of the Commonwealth’s 54 member states, homosexuality is a criminal offence. The Commonwealth’s collective institutions produced clear evidence in 2011 that where homosexuality had been decriminalised, HIV infection had fallen. To the infinite sadness of us all, that has not led to a widespread acceptance of the case for decriminalisation. In some countries the situation has got worse. Last week the Nigerian Parliament passed a harsh anti-LGBT Bill that is bound to fuel prejudice and hatred in other countries.

On moral as well as on health grounds, the Christian churches in Commonwealth countries ought to be at the forefront of efforts to stem the tide of oppression and extend basic human rights to all LGBT people. In fact, as we know well, all too often the churches are to be found in the forefront of militant antigay activity. The Church of England, which is my church, has great influence in many Commonwealth countries. I end with a fervent plea that it should consider issuing a strong public statement utterly condemning the criminalisation of homosexuality. If it did that, it would confer an inestimable boon on those working, through the Global Fund and other remarkable, selfless organisations, to end the pandemics that so disfigure the world today.

HIV/AIDS: Commonwealth Countries

Lord Lexden Excerpts

Wednesday 13th March 2013 Lords Chamber

[Lord Lexden]

My Lords, like my noble friend Lady Brinton, I must apologise for not being in the Chamber at the very start of this debate, having lingered outside for too long after the debate on the Succession to the Crown Bill, in which I was involved. After a friendship of some 27 years, I think my noble friend Lord Black will probably forgive me.

As my noble friend reminded us in his powerful speech, this House has debated HIV/AIDS from time to time, most recently on the initiative of our noble friend Lord Fowler, whose continuing interest and commitment took him recently to Uganda. It is a matter of great regret that he cannot be with us this evening. Last October I opened a debate, to which kind reference has already been made, on the criminalisation of homosexuality, which, shockingly, remains widespread in the developing world in general and the Commonwealth in particular, breaching fundamental human rights.

This debate brings those two grave issues together. They are by common consent among the most important challenges confronting the world today. My noble friend Lord Black has shown conclusively that the spread of HIV/AIDS and the retention of harsh criminal punishments for homosexual conduct are inextricably linked. As my noble friend reminded us, after a detailed inquiry the UN Development Programme’s Global Commission on HIV and the Law found that criminalisation of homosexuality “both causes and boosts” HIV among men who engage in sexual activity with other men.

As we have heard, the records of most Commonwealth countries—which in so many respects are our closest associates and most valuable friends—testify with particular bleakness to the malign link between criminalisation and HIV/AIDS. Sadly, the majority of Commonwealth countries defy international human rights obligations by treating homosexuals as criminals; as a result, those countries suffer disproportionately from the incidence of HIV. The Commonwealth contains some 30% of the world’s population; it also contains twice that figure—60%—of all people living with HIV across the globe.

John Wesley once said:

“No circumstances can make it necessary for a man to burst in sunder all the ties of humanity”.

The same goes, perhaps even more strongly, for societies, communities and countries. The heart bleeds at this spectacle of suffering and injustice in countries of the Commonwealth, of which my noble friend Lady Brinton has given such a harrowing example. How thankful we should be, therefore, for the sensitive yet determined work of the organisations that have come into existence to combat it: the Terrence Higgins Trust, Kaleidoscope, Stonewall, the Human Dignity Trust and the International HIV/AIDS Alliance prominent among them, all of them working in the name of our common humanity without regard to politics, religion or ideology. They are becoming increasingly well known for their work and that, too, is a cause for thankfulness. They deserve the fullest possible support from all those within the Commonwealth who want to overcome the sundering of the ties of humanity. This great cause must be among the highest priorities of the Commonwealth as a whole—I repeat, as a whole—so that ill intentioned people blind to the ties of humanity cannot decry and belittle it as some neo-colonial plan by Britain and a few others.

In this connection, it was extremely heartening to finds words of the highest wisdom in the report of the Commonwealth Eminent Persons Group two years ago, which recommended:

“Heads of Government should take steps to encourage the repeal of discriminatory laws that impede the effective response of Commonwealth countries to the HIV/AIDS epidemic, and commit to programmes of education that would help a process of repeal of such laws”.

How good it would have been if these fine sentiments had been fully reflected in the new Commonwealth charter, which was described last week by my noble friend Lord Wallace of Saltaire as,

“one of the most important outcomes from the Commonwealth modernisation process. The charter conveys clearly the values that the Commonwealth stands for”.—[Official Report, 7/3/13; col. 1674.]

As we have already heard in the extremely moving speech of the right reverend Prelate the Bishop of Newcastle, the charter—of which so much is being made —does not include any specific rejection of discrimination based on sexual orientation or gender identity, nor does it make reference to the decriminalisation of homosexuality. I understand that some officials of the Commonwealth Secretariat interpret the phrase “on other grounds” in the passage of the charter that covers the rejection of discrimination as a condemnation of anti-gay laws. If so, they should be encouraged by our own and other Governments to make this more explicit.

To that end, as my noble friend Lord Black requested, our Government should make decriminalisation a specific policy priority, with the Foreign and Commonwealth Office and the Department for International Development working together with equal resolution and tenacity to promote it. Operating in close association with other countries, our Government should also monitor closely the progress of central Commonwealth institutions in carrying forward agreed plans throughout this unique association of nations.

It is not enough simply to back the general interests of LGBT people throughout the world, as the Government now do; decriminalisation should be made an explicit goal of government policy for the sake of humanity as a whole, and in particular for the thousands of young people—teenagers even—who at the moment face great suffering and then death as a result of HIV/AIDS. I ask, too, that the Government review their policy on asylum to provide full and equal protection to those throughout the Commonwealth on whom inhumane laws bear so heavily, destroying their hopes and ambitions in their own countries. In addition, many have asked the Foreign and Commonwealth Office to update its dossier of information and advice, the “toolkit” about promoting the human rights of LGBT people, which I understand has remained unchanged since the previous general election.

Sixty-five years ago, the newly formed United Nations issued its Universal Declaration of Human Rights. Its first article states:

“All human beings are born free and equal in dignity and rights”.

For the good of all its peoples, the Commonwealth today should pledge itself to bring those of LGBT identity fully within the scope of that great promise to mankind made to straight and gay alike.

Treatment of Homosexual Men and Women in the Developing World

Lord Lexden Excerpts

Thursday 25th October 2012 Lords Chamber

Asked by

[Lord Lexden]

To ask Her Majesty’s Government what assessment they have made of the treatment of homosexual men and women in the developing world.

[Lord Lexden]

My Lords, I bring before your Lordships an international issue of great importance. Injustice and inhumanity stalk our world and, sadly, they take many forms. I have sought this short debate in order to draw attention to one of their cruellest and most pervasive manifestations: the gross discrimination suffered by homosexuals in many countries of the world.

Millions of our fellow human beings today are liable to arrest, conviction and punishment—punishment of great severity—because of their sexual orientation and that alone. Their human rights, enshrined in internationally agreed conventions for the benefit of all mankind, are breached many times over. Equality, privacy, dignity, freedom of expression, assembly and association, freedom from torture and from inhuman and degrading treatment—all these and other rights which form part of the established code of human rights law are being flouted in many countries where homosexuals are concerned.

Under international law, popular dislike or moral disapproval of homosexuality can never be a sufficient justification for setting aside human rights. As the head of the Supreme Court of Zimbabwe, Chief Justice Gubbay, stated, in 2000, as regards equality rights:

“The courts cannot be dictated to by public opinion … Those who are entitled to claim the protection of rights include … the marginalised members of society”.

Yet in many developing countries, homosexuals are marginalised, unprotected and oppressed because of the lack of respect for their human rights in the laws under which they live. In at least 76 countries, consensual, adult, same-sex relations are criminal offences for either men or women, or in some cases both. Punishment can be death in seven countries, including Iran, Sudan, and parts of Nigeria and Somalia. In six others, including Malawi and Malaysia, same-sex relations are punishable by hard labour or by corporal punishment.

Long terms of imprisonment, often far in excess of 10 years, can be imposed on homosexuals in 38 countries, including Jamaica, Barbados, Kenya, Gambia, Tanzania, Libya, Pakistan and Bangladesh. Even if they are not enforced rigorously, these grossly discriminatory laws create a climate of grave anxiety and fear for homosexuals in the many countries where they are on the statute books. It is a climate in which violence and persecution can flourish virtually unchecked. Its victims cannot seek protection from the state, for the state regards them as criminals, and the forces of law and order may well collude with their persecutors. Many instances of persecution and suffering have been carefully recorded and documented by the Human Dignity Trust, an international non-governmental organisation dedicated to challenging discriminatory laws against homosexuals, with which I have worked closely in preparing for this debate.

Here are just two case studies. The first relates to Uganda where a young man, Toby, was attacked at school for being gay. The police were called; they beat him severely. Returning home, he told his parents about his sexuality. Fearing for his safety, they hid him in the attic of the house. That night a mob, accompanied by the police, came to the house. Unable to find Toby, they turned on his family. When Toby came out of hiding after the attackers had departed, he found, in his words, “The house covered in blood and his own family, his mother, father, two brothers and two sisters dead in the sitting room. They had all been shot”. Toby now lives in the United Kingdom.

My second shocking story, which comes from the Human Dignity Trust’s thick files of cases, is set in Jamaica whose criminal code prohibits sex between men. A wave of persecution and violence has been suffered by gay people connected with the Jamaican Forum for Lesbians, All-Sexuals and Gays, known as J-Flag. Its co-founder was brutally murdered in 2004. But a 30 year-old social worker, Gareth, refused to be deterred from working for the organisation, despite sustained threats. “No matter where you go”, he was told, “we are going to find you, kill you and burn J-Flag down”. Yet for years Gareth remained in Jamaica, committed to promoting the welfare of the homosexual community. Eventually, with many misgivings, he felt forced to claim asylum in Canada. The Human Dignity Trust is now bringing a case on behalf of Gareth and J-Flag before the Inter-American Commission on Human Rights. Last week, Gareth and a group from Jamaica came to Westminster. It was a privilege to listen to them describing in calm, resolute and unemotional terms their determination to secure humane and just treatment for homosexuals in the land they love.

There are many Tobys and many Gareths in many countries in our world today. They are the inevitable consequence of laws which criminalise homosexuality. The Organisation for Refuge Asylum and Migration has this year estimated that more than 175 million people—nearly three times the population of the United Kingdom—live in circumstances where they are at risk of persecution because of their sexual orientation or gender identity. But as we grieve and as we protest at this state of affairs, we must also remember where the laws criminalising homosexuals in many countries came from. They came from Britain, which alone among the European empires of the 19th century possessed a criminal code under which homosexuals faced severe penalties just for expressing their love and physical desire for one another.

In India in the 1820s, Thomas Macaulay, later the greatest of all the Whig historians, devised a legal system which incorporated Britain’s then firm and unbending intolerance of homosexuality. The Indian penal code became the model for the legal systems of Britain’s colonies in most of Africa and Asia. The love that had freely spoken its name and found expression in their native cultures became, in the definition of their new British-imported law, an unnatural offence. Thus it is that today, 42 of the 54 nations of the Commonwealth criminalise same-sex relations.

A wind of change has blown briskly and steadily in other parts of the world since that remarkable turning-point in 1959; the publication of the Wolfenden report. The strength of the movement for change has been powerfully assisted by rulings of the European Court of Human Rights, most notably, as far as the United Kingdom is concerned, by the case brought by my friend Jeff Dudgeon which extended the legalisation of homosexuality to Northern Ireland. The crimes for which homosexuals were once punished for simply being homosexuals no longer exist in any European country from the Republic of Ireland in the west to Vladivostok in the Russian Federation in the east, although the threat of discriminatory laws remains in some parts of the east. They have also been eliminated from the older countries of the Commonwealth.

Voices of compassion are being heard strongly in the world today, particularly in the Christian churches. The most reverend Primate the Archbishop of York has affirmed,

“the equality of all human beings, ‘heterosexual’ or ‘homosexual’”.

The Anglican Church of Southern Africa has made clear its opposition to the criminalisation of homosexuality. In 2008, the Vatican’s delegation to the UN General Assembly called for the elimination of,

“every sign of unjust discrimination towards homosexual persons”.

Many people the world over are now asking the Churches to put their position beyond all doubt by saying simply and clearly: criminalisation is wrong.

How is the message of justice and compassion that is coming from so many quarters, particularly our Churches, to be translated into action? It has been, and continues to be, done through the courts of law. Judicial challenges have helped to overturn laws criminalising homosexuality in countries as diverse as Fiji, Ecuador, the United States and India. This very day, a challenge is being mounted in the Belize courts supported by the Human Dignity Trust, the International Commission of Jurists and the Commonwealth Lawyers Association. Their leading counsel is the noble and learned Lord, Lord Goldsmith, who is as a result unable to contribute to this debate as he wanted to do. He has authorised me to say on his behalf that “the case, if successful, is likely to have an important impact on similar laws in other former British territories. In my view there is no conceivable legal or moral justification for continuing in the 21st century to criminalise homosexual activity between adults. To treat this as criminal conduct has no single redeeming feature”.

The time has come for all the world’s principal international institutions to commit themselves unequivocally to this important cause. The United Nations has this year given a ringing endorsement of the case for urgent action. Speaking in March, the Secretary-General gave powerful support to decriminalisation. Clear plans are now needed to put his strong and most welcome words into practice.

Here in Britain, we look naturally to the Commonwealth too, not just because of historic ties, but because under this Government it features more prominently in our foreign policy. In 2010-11 an Eminent Persons Group was established to consider the future of the Commonwealth. Its report called for the repeal of laws criminalising homosexuality. Their existence, the report said, called into question,

“the commitment of member states to the Commonwealth's fundamental values and principles, including fundamental human rights and non-discrimination”.

This is probably the first debate to be held in a national legislature on the global persecution and criminalisation of the LGBT community. I pay tribute to all the organisations and campaign groups which strive for the full application of human rights to the LGBT community. On many occasions, the Government have underlined their strong belief that compassion and justice must prevail. I ask my noble friend the Minister to make it clear in her reply to the debate what action the Government are taking now, and whether they are considering fresh initiatives to help rid the world of laws which have sustained inhumanity and injustice for far too long.

Global Fund: AIDS, Tuberculosis and Malaria

Lord Lexden Excerpts

Wednesday 4th July 2012 Lords Chamber

[Lord Lexden]

My Lords, my noble friend Lord Fowler has done this House another profound service by bringing before us this evening the state of this important and ambitious Global Fund on the anniversary of the death of Terrence Higgins. I repeat some of the astonishing figures that he gave.

By the end of last year, the fund’s work had given more than 3 million people access to antiretroviral drug treatments to combat HIV, almost 8 million people had been treated for tuberculosis, and more than 230 million mosquito nets had been distributed to help to combat malaria. These are truly impressive figures, and they underline the importance of securing effective solutions to the fund’s recent administrative and internal problems. As the International Development Select Committee of the House of Commons noted, donor contributions fell as the fund attracted some negative reports about the misappropriation of some limited funds. A body which has come to be regarded, in the committee’s words, as,

“an effective international financing institution”,

and which has helped to save 7.7 million lives in over 150 countries was forced to cancel its latest round of funding applications, as we heard from my noble friend, anticipating significant shortfalls as a result, in part, of growing doubts among donors about the organisation’s management.

The pace of reform at the fund has been significant. My right honourable friend the Secretary of State for International Development said recently that,

“strong leadership is now in place and action is being taken to begin a process of robust reform”.

He made it clear that the Government are,

“prepared to agree a significant increase”,

in their contribution to the fund if the reforms succeed. If the British contribution is increased, a clear signal will surely be sent to other donors that Britain believes that the fund has established itself firmly as a strong and efficient organisation capable of providing the continuity of care which millions in the world’s poorest countries need so much. As the Bill and Melinda Gates Foundation stressed at the height of the allegations over fraud, while,

“dealing with these hard-to-reach places is challenging ... not trying to save these lives is unacceptable”.

Now that the fund is committed to,

“better financial and risk management”,

and to delivering the best possible returns on taxpayers’ money, Britain should prepare itself to lead a global recommitment to support an institution upon which so many depend.

This coalition Government pledged at the outset to strengthen our country’s contribution to tackling the problems of the developing world. It is to the Government’s credit that, even during a time of severe economic stringency at home, they have held fast to that pledge. Compassionate conservatism is in fruitful alliance with liberal democracy. In Milton’s words from Paradise Lost:

“good, the more

Communicated, more abundant grows”.

EU: Healthcare

Lord Lexden Excerpts

Wednesday 11th January 2012 Lords Chamber

[Lord Lexden]

My Lords, there can be no doubt about the importance of the issues which my noble friend Lord Kakkar raised for debate and introduced with his customary eloquence.

As is well known, where the European Union is concerned, the tendency is often for difficult practical issues to be subordinated to well intended political ideals. As the Social Policies and Consumer Protection Sub-Committee, of which I am a member, pointed out in its report on the mobility of healthcare professionals last year, nowhere is it more important for this tendency to be resisted than in matters relating to patient safety.

The sub-committee concluded that the mutual recognition of professional qualifications directive,

“fails to command the confidence of patients and professionals”,

and that the increased desire for mobility, which we all share, was nevertheless resulting in the admittance of individuals who do not meet standards required to be considered to practise in the United Kingdom. We should keep the sub-committee's conclusions firmly in mind and continue to push for the development of a competence-based approach for the recognition of qualifications across the EU.

More positive, to my mind, are EU proposals for enhancing cross-border access to healthcare—proposals that do more justice to the principles of open markets and free movement. The proposals have the potential to reduce waiting times for patients facing unduly long delays. The principle that patient reimbursement should not exceed the value of the cost of the same or equivalent treatments on the NHS should exert pressure to keep the new directive’s costs under control.

As ever, though, we must be vigilant. As the NHS devolves increased local powers to patients and professionals, the importance of thorough and transparent pricing structures becomes greater. It is easy to imagine a situation in which two patients receive differing levels of reimbursement for the same treatment, performed at the same hospital abroad, based on differences in British local costs. It will be hard to justify such differences to the electorate. As we seek improvements in service, we must always be alert to practical difficulties that may arise.

HIV and AIDS in the UK

Lord Lexden Excerpts

Thursday 1st December 2011 Lords Chamber

[Lord Lexden]

My Lords, I join other noble Lords in congratulating my noble friend Lord Fowler most fervently on the excellent work of the Select Committee that he has chaired and on securing this debate on World AIDS Day. I approach any event involving my noble friend with trepidation. To my shame, I did not always have the answers to the perfectly straightforward questions that he asked me at Conservative Central Office, where I worked when he was party chairman nearly 20 years ago, yet with his customary kindness he always seemed to forgive me.

This is an immensely important occasion that should be noted by people and organisations that share the deep concerns that have been expressed so movingly in this House today. The Motion before us refers to the whole United Kingdom. The matters that we are considering affect all parts of our country. I am above all conscious of their impact on Northern Ireland, the place that has been closest to my heart since the 1960s when I began to study its history and went on to teach, along with British history, at Queen’s University Belfast. Political responsibility for all health services rests of course with the devolved Northern Ireland Executive, but on this day above all the interests of those suffering as a result of HIV/AIDS in the Province should surely form part of our general UK deliberations.

Northern Ireland has just one laboratory dealing with the results of tests carried out throughout the Province. It therefore enjoys a high degree of accuracy in its data. Equally importantly, the lab can gather evidence of rates of testing from all sources, enabling it to pinpoint areas where the most rapid improvement can be made. Over the years, Northern Ireland has enjoyed a relatively low prevalence of diagnosed HIV, but recent trends suggest that this may well be changing. The Health Protection Agency recorded 79 new diagnoses of HIV in Northern Ireland in 2010, which is a 316 per cent increase on new diagnoses in 2001. The increase for the United Kingdom as a whole over the same period was around 20 per cent. Rates of testing in Northern Ireland are not increasing in response to the state of affairs as rapidly as they should. Less than 10 per cent of all HIV tests are being performed in primary care settings. The vast majority are being done in clinics or in hospital.

As our Select Committee’s report has made clear in comments endorsed so firmly by noble Lords speaking in this debate, the stigma and discrimination that continues to surround HIV must be eliminated. That is absolutely crucial in Northern Ireland if the number of tests performed in GP surgeries is to increase significantly. As my noble friend Lord Fowler stressed, and as other noble Lords have said, early diagnosis improves the chances of more effective management of this disease. Too many deaths of HIV positive adults are due to the diagnosis coming too late for effective treatment. As has also been pointed out, early diagnosis of a patient is also of major importance in preventing the spread of infection to others.

How might earlier diagnosis be promoted in Northern Ireland? First, there is a strong case for the increased availability and accessibility of testing in areas where people might otherwise go untested. Almost one-fifth of GP practices in Northern Ireland did not perform a single HIV test last year. Of those that did, half performed three or fewer. In some places, the story is more encouraging. Northern Ireland’s south-eastern trust has made particularly good progress in increasing primary care testing, with a new clinic being established to serve the local community. It will be instructive to take note of the successes of the south-eastern trust and to consider how its innovations might best be extended to the rest of the Province.

There is also a strong case for the advocacy of point-of-care testing among targeted groups. Point-of-care tests such as the well known “determine” are easy to perform and can offer results within 15 minutes, which can be life-saving where time is of the essence. At-risk groups, such as the homeless, are not easy to contact and help if longer tests are employed, but we will not get the major increases in testing and early diagnosis that are needed in Northern Ireland without increased awareness among clinicians and staff of the issues surrounding HIV and AIDS, which often include the difference between them and the dispelling of misinformation.

Here too, there is some good news in the Province. The in-service HIV awareness training project began in Belfast during the hard-hitting campaigns of the 1980s initiated by noble friend when he was Secretary of State for Health. The project has made steady progress ever since. Around 60 HIV awareness trainers help staff and practitioners to understand the basic issues surrounding HIV and AIDS. They promote methods of early detection and diagnosis and address the changing character of the virus.

Since the project began, more than 40,000 staff have received training and the project has expanded to take in the south-eastern and southern trusts. The Belfast trust hopes that by 2013 the entire Province will be able to benefit from the training, which is devised in consultation with a wide range of organisations. In areas such as healthcare, which can have a high turnover of staff, projects such as this are vital in securing the quality and, importantly, the continuity of care that patients faced with an HIV diagnosis need.

In Northern Ireland, as in the rest of the United Kingdom, the advances that we have seen in medicines that help people to cope with HIV and AIDS must be accompanied by similar advances in the public understanding of the disease. If that does not happen, the disgraceful social stigmas that surround the issue will persist. The social aspects of HIV and AIDS are central if the goals advocated by this widely applauded report are to be met.

Public understanding, as we have heard, has certainly increased, but many of the stigmas that campaigns during the 1980s highlighted still persist for those with a positive diagnosis. Research carried out by the HIV support centre in Belfast on 40 of its clients reveals that over half have been verbally assaulted, harassed or threatened in the past 12 months as a result of their HIV status, and over 25 per cent had felt suicidal. One respondent to the 2010 people living with HIV stigma index said, “We are all afraid of rejection. The moment you tell someone you are HIV positive they just run a mile and never look back”.

These are the attitudes that we must change. Not only are they hurtful and harmful to people with a diagnosis, they are also likely to deter people from seeking a test in the first place. It is shocking to think that someone might prefer to wait until a test is carried out in an intensive care unit than come forward at an early point because of the risk of being stigmatised and rejected by those around them, including their families and friends. Sadly in Northern Ireland this remains all too common.

If only we could create new antiretroviral medicines overnight. Sadly, as we have heard in this debate, it could be many years before the next great leap forward in helping people to live with HIV and AIDS. What we can begin overnight is a redoubled commitment to increasing public education on HIV and AIDS, a commitment to reducing the stigmas that HIV-positive people face, and a commitment to preventative messages and projects such as needle exchanges as highlighted in this report.

We must continue to press for three things. First, more accessible testing is needed in places where people are unlikely to go to a clinic or hospital until it is too late for effective treatment. Secondly, more training is needed for staff and professionals in order to increase the level of testing that is being performed outside hospitals or clinics. Finally, unequivocal support must be given to organisations, voluntary or publicly funded, that are helping to break down the barriers associated with HIV and AIDS today, and helping those struggling with the condition to lead happier lives. We must end the situation in which people considering being tested must perform some kind of social versus medical cost-benefit analysis. Only then will people with HIV receive all the benefits of early diagnosis. Only then will the public at large become fully aware of the true nature of HIV in the United Kingdom and the great steps forward that have been taken. Only then will those who follow us in the next generation be adequately equipped to protect themselves against its threat.

Keats's beautiful poem, To Hope, contains the following poignant lines, which seem particularly apt today, and I conclude with them:

“Whene'er the fate of those I hold most dear

Tells to my fearful breast a tale of sorrow,

O bright-eyed Hope, our morbid fancy cheer;

Let me awhile thy sweetest comforts borrow”.