World AIDS Day

Caroline Nokes Excerpts

Thursday 1st December 2022 Commons Chamber

[Lloyd Russell-Moyle]

I agree exactly. I will come on to the Global Fund at the very end of my speech, but let me move on now to the picture globally, which I am afraid is totally different.

Back in 2018, I said that

“one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes.”—[Official Report, 29 November 2018; Vol. 650, c. 496.]

The situation globally has become bleaker. Last year, an adolescent girl or young woman was newly infected with HIV every two minutes. In the past year alone, 650,000 people have died of AIDS-related illnesses and 1.5 million people became infected with HIV. Only half of children living with HIV have access to life-saving medication. Inequality between children and adults in HIV treatment coverage is increasing rather than narrowing.

Why are people still dying unnecessarily of AIDS? Why are there so many new HIV infections year after year, globally? It is too easy to put the blame on current crises such as covid and war; the reality is that we were already off target before many of those crises hit. The lack of a comprehensive healthcare system, a lack of education and the growing influence of evangelical Christian churches in Africa—often American-backed—have led to an environment that is hostile to an effective HIV response.

Uganda was the first country to host the world AIDS summit—it was a revolutionary leader. The same President is in power now, but has completely rolled things back. When Uganda hosted the world AIDS conference almost 30 years ago, condoms were given to every delegate and given out into community settings. When I went to Uganda only a few years ago to visit aid projects that we were paying for, I sat at the back of a classroom with Stephen Twigg, the then Chair of the Select Committee on International Development. We heard a teacher tell children that they could prevent AIDS if they washed the toilet seat and observed “sex only after marriage”. I am afraid that things have gone backwards because of the influence of some malign groups. It is concerning.

One of the inequalities standing in the way of ending AIDS is access to education, particularly for young girls. Six in seven new HIV infections among adolescents in sub-Saharan Africa occur among girls who are outside formal education. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV by more than 50%. All children, including those who have dropped out because of covid and those who were out of school anyway, should get a complete secondary education, including comprehensive sex education.

[Caroline Nokes (Romsey and Southampton North) (Con)]

The hon. Gentleman makes such an important point. Does he agree that we cannot shy away from talking about sexual and reproductive health in the developing world, because that is the single most effective way to ensure that girls stay in school, stay not pregnant and stay free from diseases that will affect them in future? It is crucial that in our role as providers of international aid we do not step back from programmes that talk about contraception.

[Lloyd Russell-Moyle]

I totally agree. As dark forces around the world try, I am afraid, to withdraw money from programmes that talk in a rational and evidence-based way about sex and reproductive rights, we have a greater responsibility. We must step up, because if we do not, others will not. As the right hon. Lady points out, there are two sides to the coin: providing better sexual health education means that girls stay in school, and staying in school allows them to get better education about their health. Those are both positive things. Both issues need to be tackled together.

Another inequality standing in the way of ending AIDS is the inequality in the realisation of human rights. Some 68 countries still criminalise gay men. As well as contravening the human rights of LGBT+ people, laws that punish same-sex relations help to sustain stigma and discrimination. Such laws are barriers preventing people from seeking and receiving healthcare for fear of being punished or detained. Repealing them worldwide is vital to the task of working against AIDS.

Of the 68 countries that outlaw homosexuality, 36 are Commonwealth countries. The majority of Commonwealth countries are still upholding laws that we imposed and that never originated in the countries themselves. In fact, before British colonialism—British imperialism, I should say—many of those countries had better customs and practices around homosexuality than they do now. These customs and practices are not native to people’s home countries; they were imposed. They should be discarded with the shackles of imperialism, which we all now recognise was wrong. One in four men in Caribbean countries where homosexuality is criminalised have HIV. Globally, 60% of people with HIV live in Commonwealth countries. Collectively, we have a responsibility to tackle that in the Commonwealth. Barriers undermine the right to health: a right that all people should enjoy.

Beyond the human rights implications, the laws criminalising homosexuality also have an impact on public health. LGBT+ people end up not seeking health services for fear of being prosecuted. Those who do seek health services often have to lie about how they were infected. Astronomically high numbers of people with HIV in Russia say that they were infected because they were drug-injecting users; that is widely believed to be partly because of the attitude in Russia that it is better to be a drug-injecting user than an LGBTQ person. Without accurately knowing the source of infections, we cannot accurately run public health programmes to save people. Putting people undercover in the dark, hidden in corners, means that the virus lives on. That is a danger for us all.

In some countries, people living with HIV are at risk of being criminalised even when they take precautions with their sexual partners. That opens them up to blackmail and fraudulent claims from former partners. People with HIV in the UK are not immune to that either, as we have seen in some high-profile cases. We have known for at least 20 years that antiretroviral therapy reduces HIV transmission, and for the past few years we have known that it stops it completely, so there should be no doubt that a person with sustained undetectable levels of HIV in their blood cannot transmit HIV to their sexual partner, and laws should not punish them. However, under Canadian criminal law, for example, people living with HIV can be charged and prosecuted if they do not inform their partner about their HIV-positive status before having sex. The law does not follow the science, and it puts people at risk.

Laws requiring disclosure perpetuate the stigma against HIV-positive people. With the advent of PrEP and with “Undetectable = untransmittable”, the law should now reflect the fact that everyone has a role in protecting themselves against HIV and everyone must step up. The criminalisation of drug-injecting users and sex workers has an equally negative effect on HIV prevention and treatment, as I have outlined, in LGBT communities. In all these areas, a health and human rights-based approach must be taken if we truly want to see the end of HIV.

Beating pandemics is a political challenge. We can end HIV and AIDS by 2030 in this country, but only if we are bold in our actions and our investments. We need courageous leadership. We need people worldwide to insist that their leaders be courageous. That is why last month it was so disappointing not to see courageous leadership from this Government. The UK Government were the only donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria to cut their financial settlement—by £400 million. The fund asked donors to raise their pledges by 30% this year, and almost all the G7 nations—which are suffering economic problems that are, in many respects, similar to ours; as the Government often remind us, this is a global crisis, not a crisis of their own making, although in our view it is a bit of both—increased their amounts. For decades the UK was the leader in the global response to these infections and diseases, but that is no longer the case. When our allies met the fund’s request for a 30% increase, the UK went for a 30% cut from their 2019 pledge.

--- Later in debate ---

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to follow the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), who speaks with such passion, knowledge and indeed experience. I vividly remember being in the Chamber four years ago when he spoke of his own diagnosis, and of how he had coped with the emotional stress and trauma and the physical challenges. Of course it is always a privilege to follow any Member who speaks with such a depth of knowledge.

I apologise for the fact that my speech will focus almost exclusively on women. As Chair of the Women and Equalities Committee, I am very conscious that some of the people who are diagnosed at the latest stage, and some of those who are afraid of going for a test, are women. It has always been a humbling experience for me, in my role as Chair of the Committee, to meet those women living with HIV who have spoken of the barriers that they felt prevented them from taking a test. That is why I commend the work done by organisations such as the Terrence Higgins Trust and, indeed, the all-party parliamentary group, which has always led the way in trying to break down the stigma associated with testing.

There should be no such stigma. After all, there has been no stigma attached to covid tests over the past two years; and making oneself aware of one’s own HIV status is actually one of the most empowering actions that an individual can take. That is why, as Chair of the Select Committee and indeed before that—I was about to say, “I have never been afraid”, but that is the wrong term to use. I have always been keen to ensure that I use my role to emphasise to others that it is perfectly okay to go and get a test, and it is also much easier to do so nowadays than it used to be.

I was going to say that I had never been afraid, but I vividly recall that Simon Kirby, the hon. Gentleman’s predecessor as Member of Parliament for Brighton, Kemptown, used to arrange in this place, every year, a testing session for Members. I remember Simon telling me, years ago, “Nokesy, you have to go along and get a test”, and I remember rolling my eyes and saying, “I don’t really fancy that.” I was rather terrified of the prospect of going. However, I also remember coming away after the test and thinking, “That was the right thing to do. I now know that I don’t have HIV, so I can relax about that, but I also know how important it is to talk about it.”

I remember, too, the grief that I was given on social media from the ill-educated, ignorant and—to be frank—bigoted people who used that as a stick with which to beat me: “Ooh—why did she need an HIV test?” Why did I need one? First, to know, and secondly, to be a voice for everyone else who felt anxious about getting an HIV test. I wanted to tell them, “There is nothing wrong with it; there is no stigma attached to it; you are doing it for your own wellbeing.” That is why I now act as a champion for all women, telling them how important it is to go and get a test.

The hon. Member for Brighton, Kemptown made a very important point—I dwelt on it a little when I was thinking about what I wanted to say—about the prevalence of online and postal tests. I think that they are great innovations. Earlier this year, however, I received a little package through the post with the message “Give HIV the finger”—which was a wonderful message, but it was hard to get the required amount of blood out of my finger, and I felt slightly concerned about whether it was enough. I thought, “Will this be effective? Who knows?” For me, much of that process was about being photographed proudly holding up the box, having taken an HIV test. However, another part of it was to do with the fact that we need these testing programmes to be effective, we need people to be confident enough to use them, and we need them to be available in all sorts of locations.

That brings me to my next point. We need people to be culturally competent and aware. We know from statistics that a third of the people living with HIV are women, and we know that 25% of the new diagnoses are in women, but we also know of the prevalence of HIV in black African communities. Covid taught us—and I am an absolute advocate of this—that we must learn the lessons of really difficult experiences. We learnt through covid about the importance of speaking to people in languages that they understand, in a way that they can relate to, on the media channels that they instinctively use. It is no good broadcasting our public health messages exclusively on the BBC; we have to find different channels in order to communicate with the audiences who are most at risk, where the prevalence is highest, and where people might not be engaging with the traditional forms of media that you and I, Madam Deputy Speaker, might use. That is a really important message that I would like to give to NHS England and the Department of Health and Social Care. We must keep up the pressure, and talk to communities in which there is high prevalence and where there might be barriers, cultural or otherwise, to getting a test.

I have an important wider point on research. It was crucial that a great deal of the research on HIV and AIDS be done on those who were most likely to be affected by them, so of course, a massive wealth of research has been done on men. I absolutely acknowledge that that was right, but there are knowledge gaps when it comes to women with HIV and which drugs might be most effective for them. There is certainly still a barrier to women accessing PrEP; that is borne out by the numbers. They are simply not using it. We have to understand why that is, and how effective that drug and indeed other HIV drugs may be on women. We have to make sure that the DHSC and NHS England not only have sufficient data, but disaggregate it, so that it can be broken down by gender and ethnicity. Often when I talk about health, I find myself complaining and browbeating others about the lack of data that is relevant exclusively to women, the lack of women coming forward in drug trials, and the lack of research done on women. Those things are true when it comes to HIV.

I turn to what we have been good at. The action plan for HIV talks about the successes on vertical transmission; a tiny number of children are now born with HIV in this country. A big part of that is down to opt-out testing of pregnant women; the take-up has been absolutely enormous. The figures show the result: of the 60 people diagnosed in 2019 who acquired HIV through vertical transmission, only five were born in the UK. That is a huge step forward, and we have done brilliantly on vertical transmission, but it is crucial that we never let up on that, and that we get the message out that effective drugs taken during pregnancy can prevent HIV transmission to a baby. The mother has to be mindful of risks to do with the method of birth, be that natural delivery or via caesarean, and there is a risk factor involved in breastfeeding. All those pieces of information can effectively and easily be communicated to expectant mothers, and they absolutely should and must be.

I am conscious that my knowledge is not as great as that of other Members in the Chamber, so I have deliberately kept my comments relatively brief. We need to keep up the pressure. The hon. Member for Brighton, Kemptown referred to approaching the finish line. When I do anything that involves running, there is definitely a slowdown, usually due to exhaustion, as I approach the finish line, but we cannot afford a slowdown here. We must accelerate to the finish. We can now see a UK without HIV. He made important points about the developing world and the efforts that still need to be made there, but the end is in sight, and it is absolutely crucial that we reach it and see a world that is free of HIV.