World AIDS Day

Florence Eshalomi Excerpts

Wednesday 27th November 2024 Westminster Hall

[Danny Beales]

I completely associate myself with my hon. Friend’s comments. Particularly in rural settings, if getting to a sexual health service means travelling for miles and sometimes for hours, a lot of people, especially on the lowest incomes, will put off getting the test until another day. Unfortunately, we are seeing persistent rates of late diagnosis and of undiagnosed HIV outside major cities. I completely agree with my hon. Friend.

What about those who make it through the complex online systems—the 8 am call queues, only on a Thursday—and actively go out and seek a test, or those who are fortunately now being found in our amazing opt-out testing pilot? If they are diagnosed with HIV, they are not always getting the support that they need to access HIV treatment in the long term.

We have some of the best—if not the best—HIV treatment and specialists in the world. HIV is now a treatable long-term health condition. “U = U. Undetectable = untransmittable.” We need to say that over and over again. In simple terms, it means that when someone is on HIV treatment, they cannot pass HIV on. That is a powerful and life-changing message. Despite the advances, 14,000 people living with HIV in England are essentially lost to the health system. They have been diagnosed with HIV but are not being seen by their clinic because of stigma, poverty and other barriers that are holding them back from getting that life-changing treatment.

[Florence Eshalomi (Vauxhall and Camberwell Green) (Lab/Co-op)]

I thank my hon. Friend for calling this debate and for his powerful speech. Does he share my concern that the communities that we need to come forward are the very same communities that are not accessing treatment because of that stigma? Organisations like the Fast-Track Cities network, Sophia Forum and One Voice Network are doing fantastic work reaching black women and other black and minority ethnic groups.

[Danny Beales]

I thank my hon. Friend for that comment and for her leadership on the all-party parliamentary group on HIV, AIDS and sexual health, on which I know she has been championing that issue and many others; I think she helped to host the important meeting and discussion about the recent report on disproportionality by the One Voice Network and the National AIDS Trust. If we look at the figures, the disproportionality of HIV is stark. We have made so much progress, including in access to PrEP, testing or treatment, but not all communities are benefiting in the same way. Particularly among black African and Caribbean communities in the UK, the rate of late diagnosis is far too high and the rate of accessing PrEP is far too low. It is completely unacceptable. We have to take on that disproportionality, those inequalities and the stigma that persists in holding people and communities back from accessing those vital measures.

From a public health perspective, the people who are not accessing successful treatment are potentially also passing on HIV and are at risk of getting seriously ill. Many already are. The rates of people not in treatment and not going to their clinic appointments have increased through the covid period. I hope that the future action plan will fill in the gaps in the last plan. One major omission was action on that very challenge.

There are already lots of examples of successful local projects that we can learn from, such as amazing outreach services with nurses going out to find patients lost to care. The value of consistent peer support comes through, time and again, from people living with HIV. We must ensure that every HIV team is proactively finding everyone lost to care and supporting them in a holistic way to overcome the barriers to continue with HIV treatment.

All of this, it must be said, takes place against the backdrop of a wider crisis in our national health service, which is putting historic strain on health services and affecting outcomes across the board. Our task is an immense challenge, but it is not insurmountable. Although we are not on track, it is still possible to end the epidemic in this country by 2030. We already have all the tools we need. This week, my old colleagues at the National AIDS Trust released a report with THT and the Elton John AIDS Foundation with some clear recommendations for the new HIV action plan in England. I am pleased that the Minister has already engaged with them, welcomed them and attended the report launch, which I am sure was much appreciated. It is a clear sign of leadership on the issue.

None of this is rocket science. We are talking about simple, deliverable actions. First, there should be a nationwide, year-round online HIV and STI postal testing service, which would be cheaper than the current patchwork of services that vary from place to place. Secondly, opt-out testing in all emergency departments should be expanded to other health settings, such as GP practices and termination-of-pregnancy services, and elsewhere so that we can find everyone living undiagnosed with HIV. Thirdly, we should broaden access to PrEP beyond sexual health services, starting with a digital service to ensure that those on long-term prescriptions get timely access to the medication. That will then reduce demand on sexual health services for appointments. Fourthly, we need an NHS England programme to find everyone already living with HIV and support them back into care, with proper care co-ordination, peer support and appropriately trained staff. None of this is unprecedented: it is happening or being piloted somewhere. We have all the tools we need; we must now implement them everywhere consistently.

I emphasise that it would be an incredible achievement to meet our 2030 goal and become the first country in the world to end new HIV cases. Of course, that achievement would occur in the context of a deeply concerning global picture—with 1.3 million new cases in 2023 and 650,000 deaths from what is now a treatable long-term condition, as has been said. Much more work clearly needs to be done on the international front, so international development funding is vital.

Ending new cases in England would make a remarkable contribution to the global effort to eradicate HIV by providing a replicable road map to prevent transmission elsewhere—learnings that can be exported and shared. It would also simply show that it is possible. Britain has historically been a world leader on HIV treatment and sexual health. Now let us be a world leader on this too.

One of this Government’s key missions is to rebuild our NHS so it is there for everyone when they need it. Fixing HIV care and ending new transmissions must be an integral part of that vision. I am pleased that the public health Minister is already working on a new HIV action plan. I have seen at first hand the passion and determination of those working to make this happen—from campaigners to clinicians and MPs across the House. We now need that same determination from the new Government. The Government have a unique opportunity to make history, and I hope that they will seize it.