HIV

Diane Abbott Excerpts

Wednesday 1st December 2010 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I am pleased to have the opportunity to speak in this important debate on world AIDS day, and I congratulate my hon. Friend the Member for Inverclyde (David Cairns) on securing the debate.

Let us remember that some people who are suffering from HIV/AIDS, or suspect that they are, will have supportive partners, be in supportive communities and face the future with some positivity. Many, however, will be very frightened and very alone. It is a good thing that we in this Chamber can openly debate this issue and its ramifications, because it will reassure not just communities, activists and lobbyists but individuals who may read and see the debate this afternoon.

We must remember that we have moved some way since the early frightening adverts in the 1980s. No one who saw those adverts, with the tombstones collapsing and the voice of doom, has ever forgotten them. We should congratulate Norman Fowler on taking up the cause and using the power of his Department to put it in front of the public.

When we look at some of the indices around HIV/AIDS, we see that there has been an increase in HIV testing among gay men. Testing rose from 58% in 1997 to 72% in 2008. We have seen a plateau in new diagnoses among gay men, and we now see a consistently high rate of condom use among them—at least nine out of 10 now use condoms. The fact that we have seen such progress is partly a tribute to the people who took up the issue all those years ago. It is also a continuing tribute to the communities, activists and health providers who provide both care and commitment, and we need to acknowledge that today in this debate.

However, there is still some way to go. How we go forward on HIV/AIDS will be a test of the reorganisation of both the NHS and public health that has been announced in recent months. In principle, I do not think that anyone in this Chamber is opposed to the reorganisation, but it is just this sort of issue, which is not consistent across the country, that is not necessarily well represented in GPs’ lists and has different levels of information across the country; there may not be as much information in rural areas as there is in Brighton and London. That will be a test of the reorganisation’s effectiveness.

We know that AIDS can affect anyone, and that apart from the gay community the largest community affected by HIV/AIDS is that made up of black African men and women; currently, 38% of new HIV diagnosis is among that group. The stigma attached to HIV in that community cannot be overstated, and it very much hampers efforts to reach out to people and achieve early diagnosis.

The problem among black African men and women—and among other groups, as well—is that they present late and are therefore diagnosed late. That not only gives them a poor prognosis; it means that the cost of treatment is much more expensive than it need be. That is true of any individual or any group that presents late.

Another issue with black African men is that, even though they may be having sex with men, they refuse to consider themselves as gay. They think that HIV is something for the gay community and not for them, so they end up presenting very late indeed. They are more likely to be undiagnosed and to live in areas in which a relatively high proportion of the population are not on their GP’s list, so they are not really interacting with the authorities.

I should like to use this debate to stress the importance of educational and informative work generally and with the black and African community in particular. We must do more with the Churches, because that is probably the most effective way to reach those groups. Any Sunday morning, there will more people in African-led churches in Hackney than at any political party meetings for 12 months of the year.

We need to normalise testing and offer it in a much wider range of settings—not just for black and African men and women, but for the population as a whole. I was routinely tested when I had my son 19 years ago and thought nothing of it. We need to make testing more routine so that people do not think, “If I go for this test, it will badge me as someone at risk.” Universal testing may well be a step too far, but we need to make testing available in a wider range of contexts.

My hon. Friend the Member for Inverclyde said that he did not want to talk about international issues, but given that 38% of new HIV diagnosis is among black African men and women, I do not apologise for raising the issue of funds for the Global Fund to fight AIDS, Tuberculosis and Malaria. I know that that is not a matter for the Minister and I do not expect her to respond on the specific point. None the less, will she pass on to her colleagues the very concerning fact that the global fund is £13 billion short of what it needs? If the UK was to raise its pledged amount in line with France and other western European countries, the fund would be able to go to private sector donors such as the Gates Foundation and reach the amount of money it needs.

In that context, I should like to mention—again, I do not expect the Minister to respond on this point—that in the next few weeks we will have EU trade talks with India in Brussels. There is a great concern that as a consequence of the trade talks, India might not be able to produce the cheap generic drugs that have played such a huge role in the fight against AIDS in Africa. That would be a blow not so much for Indian industry, but for the millions of people in Africa who have benefited from access to cheap generic drugs.

HIV/AIDS is no longer a death sentence, which is good news. Thanks to new drugs, research and greater understanding, people are now living with HIV. As one of my hon. Friends said earlier, we have 65,390 people in the community living with HIV. In fact, it is increasing faster among the over-50s than among any other group, which raises new issues that were not considered in the era of the adverts with the crashing tombstones and the voice from above.

My hon. Friend the Member for Ealing, Southall (Mr Sharma) mentioned the issue of depression and how that interconnects with sufferers of HIV/AIDS and the support that they need in relation to that. There are ongoing concerns about care and support that were not an issue 20 years ago. If we are to offer sufferers from HIV/AIDS equity of health care and, as far as possible, a good quality of life, we must consider care and support, within the new health service and local authority structures, as we have not in the past.

As I said at the start of my remarks, the reorganisation of the commissioning of health care and of the public health service will be tested by this issue. Many ordinary people on the ground will judge the reorganisation by how issues such as this are dealt with. I stress, as my hon. Friends have stressed, the importance of a national strategy. We need to consider how it can go forward under the new arrangements. Will the Minister tell us who will be responsible for commissioning and funding the information work that is needed now more than ever—in particular, the specific education work that goes into the communities that I have mentioned? Who will be responsible for commissioning preventive work, care, treatment and support? I will listen with interest to the Minister’s responses to those questions.

I welcome the new public health arrangements in principle. Public health has been a core activity of local government since the 19th century and so, as a former local councillor, I am glad that public health has “come home” to local authorities. However, because I know local authorities and how they work, I want to be convinced that it is possible effectively to ring-fence the public health funds that they will receive.

I imagine that what some local authorities will do—or will be tempted to do, conceiving themselves to be under financial pressure—is to rebadge existing work in the areas of social care and environmental health as public health expenditure, and the new funds that all of us in Westminster Hall imagine are there for public health will melt away in the current climate. So this will be a test, as much as anything else, of how far it is possible effectively to ring-fence public health funds once they fall to local authorities.

Then there is GP commissioning, and the issue of HIV/AIDS will be a test of that system. The important thing with GP commissioning is that GPs should commission for their community and not for their list. As an east end Member of Parliament, I know that there are many public health issues that manifest themselves more extensively among people who are not actually on GPs’ lists, for a whole number of reasons. Tuberculosis is a case in point. A disproportionately high number of people who suffer from TB are not on a GP’s list, for a number of reasons. HIV will be a test of the extent to which GP commissioning consortiums will commission for the community as a whole and not just for the people who are on GPs’ lists and present themselves for treatment.

It will be important to know what will happen to some of the survey work that is carried out by organisations such as the London Health Observatory; I had a meeting with representatives of that organisation this morning. That survey work is the only way of seeing what the trends are in issues such as HIV. It is easy for us to say this afternoon that 43% of HIV/AIDS sufferers are in London, many more are in Brighton and so on. However, we live in a globalised environment and there are trends and changes. Only survey work—not only national survey work, but sometimes precise survey work—can track what is really happening with HIV/AIDS.

[Jim Shannon (Strangford) (DUP)]

I understand that some of the figures that have been released in the past year for those who have just been diagnosed with HIV show that it is not just a young person’s disease any more; it also affects those who are 50-plus or 55-plus. I wonder whether the hon. Lady is aware of that. If she is, what does she feel should be done to address that issue of those in an older age bracket who are now succumbing to the disease?

[Ms Abbott]

That is an important point, and it is one that I touched on earlier. It shows that anyone can find themselves—

--- Later in debate ---

On resuming—

[Ms Abbott]

In conclusion, I congratulate all those who have campaigned, worked and raised consciousness on this issue over 20-odd years. Improvements have been made, partly through the efforts of communities and campaigners and partly through the commitment of people in the House, but we face new challenges due to the reorganisation of the NHS and the fact that a generation of people are now living with AIDS.

I look to the Minister to answer some of the questions asked in this debate, particularly about how the reorganisation will affect the treatment of HIV/AIDS, and to reassure us that the information needed in a range of communities will be publicised. I will listen with interest to her response.

--- Later in debate ---

[Anne Milton]

My hon. Friend the Member for Hove also mentioned the specific problems with late diagnosis, which I shall return to. The outlook for most people with HIV in the UK is more positive than it used to be, and the vast majority can now plan for their future with a great deal more certainty, which is to be welcomed. We must not forget that we have the dedicated work of many scientists around the world to thank for that, along with action from Governments from both sides of the House.

However, challenges remain. As Members have pointed out, despite our successes, a quarter of people with HIV do not know that they are infected and so are unable to benefit from the treatment available, and they can unwittingly infect others. Around half of the newly diagnosed infections are diagnosed late, after the point at which people should have started treatment. The hon. Member for Ealing, Southall (Mr Sharma) raised that as an ongoing and growing problem, along with the fact that many of the people affected have serious mental health problems. The mental health and well-being of people with HIV and AIDS is seldom mentioned, but it is extremely important to recognise.

I share the concerns raised in the debate about the need to reduce the number of people with HIV who are undiagnosed or diagnosed late. We need to increase testing, especially in those areas that have a higher prevalence of HIV. We have seen a good uptake of HIV testing in sexual health clinics and antenatal settings, but all health care professionals need to be alert to the importance of offering appropriate HIV tests.

[Ms Abbott]

Does the Minister have any practical proposals for increasing testing, such as different contexts in which it can occur?

[Anne Milton]

I thank the hon. Lady for raising that point, which is important. I will return to it later in my remarks. The hon. Member for Cardiff Central (Jenny Willott) mentioned the automatic testing when she had her baby. The Department of Health has funded eight pilot projects, which have now been completed, that looked at the feasibility and, importantly, acceptability of providing an HIV test as part of routine services offered to newly registered adults. I am encouraged by the findings from those projects, which confirm that offering HIV tests in GP practices, hospitals and community settings is acceptable to patients.

The pilots picked up a significant number of previously undiagnosed people in high prevalence areas. It is good news that people are happy to be tested, because it means that we can pick up cases of HIV that would otherwise be missed. We are working on the best approaches to expand HIV testing in a variety of settings and, as the hon. Member for Hackney North and Stoke Newington said, that is really important. If a wide variety of settings was available, a GP practice is not necessarily where people would go for a test—far from it, I would say.

I am also pleased to note that, thanks to the leadership and drive of local HIV clinicians and others, findings from the pilots in Brighton, Lewisham and Leicester have now been embedded in local practice, which is to be congratulated. The Health Protection Agency will publish its final report on the pilots early next year, which many people will look forward to seeing. We need to see what we can do to put into practice what we have learnt. It is vital to increase testing for HIV, as it is for a number of sexually transmitted diseases, so we continue to fund targeted programmes for the groups most at risk from HIV in the UK. We have also funded the Medical Foundation for AIDS and Sexual Health to provide training resources for health care professionals in secondary care.

I would like to thank the hon. Member for Dudley North (Ian Austin), who kindly sent me a note to explain that he has had to leave the debate, for raising the work of Summit House Support. We will be looking at the findings of the pilots I have mentioned, and I would certainly not like to miss an opportunity to go to Dudley, should the opportunity arise, to have a look at what Summit House Support is doing.

For HIV, as for all STIs, prevention remains the most important response. In the UK, the majority of HIV infections are sexually transmitted, and the vast majority of those could have been prevented; that is a message that we really must hang on to.