HIV Action Plan Annual Update 2022-23

Debate between Caroline Nokes and Lloyd Russell-Moyle

Tuesday 18th July 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Dame Caroline. I, too, would like to congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on securing the debate and on her comments. She has already said much of what I wanted to say, so that will spare us some time.

I apologise if anyone thinks I am about to drift out of order—I am not—but I want to focus on the women’s health strategy. We know that the HIV action plan has been incredibly effective in increasing the number of men diagnosed with HIV. We have seen a fantastic and sustained fall in HIV incidence for gay, bisexual and other men who have sex with men, but not for women. That is because there seems to be a lack of joined-up thinking when it comes to breaking down some of the stigmas and taboos that still exist for women, and we need to do more to ensure that they are tested.

This is where I drift off into the women’s health strategy, which is a comprehensive and excellent document, and I pay tribute to you, Dame Caroline, for ensuring we saw it get over the line. It clearly states:

“independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.”

The document contains some important and crucial points around tackling taboos and stigma and addressing disparities in outcome that might be affected by age, ethnicity or where the woman is from. It says clearly that those factors should not impact a woman’s ability to access services, but they do.

We know that women are less likely to have access to PrEP and that they are the least likely group to have their need for it identified—only 33% in 2021 had had their need identified. They are also the least likely to continue taking PrEP. The HIV action plan told us about making PrEP available from GPs, and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) commented on making medication more readily available from pharmacies. We have already done that for a range of conditions. Some contraception is readily available from pharmacies. For women, some forms of hormone replacement therapy are available from pharmacies. The morning-after pill is available from pharmacies. What we need to do, to break down the stigma and taboo, is to ensure that PrEP is more accessible from pharmacies. It seems to be a complete no-brainer.

[Lloyd Russell-Moyle]

The right hon. Lady makes some very good points about PrEP. But is this not also about a problem with sexual health and reproductive testing in clinics? In Britain, only one in 10 clinics offers online testing. That means that many people who cannot take time off work, or who cannot get away at the right time, are never able to get tested.

[Caroline Nokes]

The hon. Gentleman makes an important point, and one that I had completely forgotten about but that I wanted to highlight. Online testing and receiving test packets through the post is incredibly discreet, quick, easy and efficient. I know that because even I have availed myself of those services—that will send the Twittersphere into an absolute frenzy. It is a really important point: to be in control of their own health, a person needs to know. Annually, I have an HIV test provided to me—I believe it is Terrence Higgins Trust that does that, because it is a brilliant charity that does fantastic work, not least in providing us with up-to-date information. It also promotes relentlessly the need to make sure that testing kits are readily and easily available through the post and online. It is absolutely critical that we have that. We learned during the pandemic, did we not, the importance of test, test, test?

That moves me on to tests, tests, tests of the opt-out variety. My constituency in Southampton does not benefit from opt-out testing at present. It is classified as having a high prevalence of HIV, with 2.4 adults per every 1,000 living with HIV in the area. We know that opt-out testing finds people living with HIV and brings about an earlier diagnosis in many cases. We all know that earlier treatment is the most effective and that once somebody on treatment has got to the point where their viral load is undetectable, it is untransmissible. Of course, we have to do the maths backwards; we know that if people are not diagnosed and not receiving treatment, they are more likely to be transmitting HIV.

We know that opt-out testing works. We know that it works in Blackpool and London, but we know that in Southampton, more than a third of HIV diagnoses are late, which puts people at much greater risk of ill health and death and increases the problem of onward transmission. We also know that women, black Africans and older people are more likely to be diagnosed late. My plea to the Minister is to ensure that we have an expansion of opt-out testing so that we can identify those people from groups who are less likely to be identified. We know that opt-out testing means that a higher proportion of women and older women are also likely to be identified.

That takes me very neatly back to the women’s health strategy, which puts people into three stages of life. There is the early stage, from puberty up to about 24; the mid-stage of life; and older people, such as me, who have passed their 51st birthday. The important thing about the women’s health strategy is that it is absolutely explicit in saying that sexual health and wellbeing is relevant across all three of those age groups. I make a big plea that we do not forget older people; the hon. Member for Vauxhall (Florence Eshalomi) mentioned a woman of 85 going through opt-out testing. It is absolutely, crucially important. Representing Romsey and Southampton North, it would be remiss of me not to make a quick plea for those living in rural areas, who wait an average of 19 days to get an appointment with a sexual health service. That is far too long to wait.

Much of this comes down to education and information. We know from the women’s health strategy that there is a big emphasis on relationships, sex and health education and that the Department for Education is conducting a review into that at the moment. We must teach boys as well as girls about sexual and reproductive health. The best place to do that is via RSHE, yet a written answer from the Department of Health and Social Care tells me that there has not yet been any contribution to the RSHE review from the Department. That is remiss of the DHSC; it should feed into the review in the same way that every other Government Department that has even a passing interest in the wellbeing of our young people and their ability to respect themselves and each other should. Notwithstanding the fact that I had a very negative answer from the Department, dated earlier this week—it might have been the latter end of last week—will the Minister take back to the Department how crucial that is if we are to hit the target of living HIV-free? Government Departments must work together to ensure that that happens.

World AIDS Day

Debate between Caroline Nokes and Lloyd Russell-Moyle

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.