HIV Prevention

Jane Ellison Excerpts

Thursday 12th March 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer)—my friend in every sense—on securing this debate on a very important subject. As he said, it is one that we perhaps do not discuss enough. I am delighted to have the opportunity to respond. I pay tribute to him for his long and distinguished record of campaigning in this area, and for the important work he has done in our party on equalities and in this Parliament in championing HIV prevention and other important matters.

Other distinguished colleagues are in the Chamber this evening. The right hon. Member for Exeter (Mr Bradshaw), a former Health Minister, has done long and distinguished service in this field, and it is good to see him in his place. It is also good to see my hon. Friend the Member for Ribble Valley (Mr Evans) in his place, and he highlighted the important issue of homophobic bullying in a telling intervention. I also wish to place on record my thanks to my hon. Friend the Member for Brighton, Kemptown (Simon Kirby), who has done great work, with others, in lobbying Ministers extensively on the subject of HIV prevention.

Many good points have been made, and I will pass on the passionate views on sex and relationship education to my right hon. Friend the Secretary of State for Education. I am sure that she will want to be aware of those comments, but I shall not attempt to respond to them myself.

I am proud of the Government’s record on tackling HIV, including on prevention. In 2012-13, the Government spent an estimated £630 million on HIV treatment and care, which has been key in enabling people with HIV to live long and healthy lives. The success of that treatment is shown by that fact that 90% of those on treatment are virally suppressed, substantially increasing their lifespan and significantly reducing their risk of passing HIV to others. However, as my hon. Friend the Member for Finchley and Golders Green said, we need to do far more to stop people getting HIV in the first place.

On top of the money I have just mentioned, we have given local authorities a ring- fenced public health grant of £8.2 billion over three years and mandated the provision of sexual health services as part of that. We welcome the fact that new HIV diagnoses have fallen from 6,333 in 2010 to 6,000 in 2013, and the proportion of late diagnoses continues to decline—down to 42% in 2013 from 50% in 2010—but we have a lot more to do, and my hon. Friend outlined some of the concerns in his speech.

The Government have taken action beyond awareness-raising and testing, for example through lifting the ban on the sale of home testing kits. Reducing the number of HIV infections, especially in men who have sex with men—MSM—is important because we have seen a worrying trend in new infections. In 2013, there were an estimated 3,250 new diagnoses, the highest number ever reported. That really is a cause for concern and one of the reasons why it is good that we are debating the subject this evening. We also know that transmission is continuing among black African men and women who are acquiring their infection within the UK.

It is estimated that one in eight gay men in London are HIV positive, and while that might sound alarming, it also reflects the success of treatment and that more and more people are now living into old age with HIV. My hon. Friend rightly put a focus on being more innovative, and the importance of preventing the spread of HIV is one of the reasons why the Government have committed to protecting the HIV prevention budget—but I am clear that we need to be more ambitious and innovative. That is why we are redesigning our HIV prevention programme for England in 2015-16. I see this as a transitional year towards the updated long-term strategy for HIV prevention and sexual health promotion more widely. In future, this work will be led and managed by Public Health England, which is consistent with its wider work on health promotion and social marketing. I expect PHE to work closely with local authorities to promote the health of their populations.

One of the most exciting innovations to promote HIV testing is postal home sampling kits. Public Health England and local authorities will establish, for the first time, a national home sampling service. Through this, we will be able to deliver up to 50,000 home sampling kits in 2015-16, around three times as many as last year. That will augment the continued growth in HIV tests performed in genito-urinary medicine clinics—more than 1 million tests in 2013, which was 100,000 more than in 2010. People knowing their HIV status is important not only in getting treatment and allowing them to live a long and healthy life, but, critically, in preventing HIV from being passed to others. We now know that being on treatment substantially reduces the risk of passing on HIV. That testing is critical and a key component of our public health response to HIV.

We will continue to contract with the Terrence Higgins Trust in running public awareness campaigns. Changes to that contract have been made for 2015-16, but it is a respected charity in the field and its work remains an important strand of our HIV prevention programme. THT will have an increasing focus on digital platforms to meet the needs of the 21st century, including using Facebook and Twitter. The potential is huge. A single push on a phone app has consistently generated more than 1,000 postal test orders. In addition, those contacted through Facebook have turned out to be three times more likely to return a postal test than those contacted through any other route. Facebook is used by all age groups. It is therefore an important access point, particularly given the middle and older age profile of many of those diagnosed HIV positive.

THT will also continue to work with local partner organisations to talk to those at highest risk face to face, particularly those without access to the internet or to more traditional media. Those conversations include encouraging tests in GUM clinics, use of postal test kits and offering point of care tests in a diverse range of settings, including in churches and shops. That work is particularly important in reaching black African populations who are less likely to attend GUM clinics, but more likely to be diagnosed late.

[Mr Bradshaw]

I thank the Minister for her kind comments about the Terrence Higgins Trust. I refer hon. Members to my declaration in the Register of Members’ Financial Interests—I am a trustee. Can she clarify whether she has announced specifically how the Government’s public health HIV prevention budget will be spent? If not, will she tell us when she expects to make that detailed announcement?

--- Later in debate ---

[Jane Ellison]

In about four paragraphs’ time, if the right hon. Gentleman will bear with me.

As I have said, I want to be more innovative in how we prevent the spread of HIV. I am pleased to announce tonight an innovation fund up to £500,000. We want to give grants of £50,000 to £100,000 to local organisations or groups of organisations, who want to work in new and innovative ways to tackle HIV. As of tomorrow, those who wish to apply can contact PHE and register their interest. PHE will work with chosen organisations to ensure the work they are doing is aligned with the work local authorities are doing to prevent HIV infections in their area. Applicants must seek endorsement from their relevant local authority before submitting a final application. The grant awards process will take place through late spring and early summer this year.

In addition, PHE has invested £150,000 in new innovative work on reducing late diagnosis of HIV, and the Elton John AIDS Foundation has generously matched funding. My hon. Friend the Member for Finchley and Golders Green mentioned the Dean Street Express model. We also think this is an excellent model. We support that approach and will promote it in other areas.

Turning to the long-term strategy, as I have said I want the HIV prevention programme in 2015-16 to be a transition towards our longer-term strategy for HIV prevention, and for sexual and reproductive health more widely. PHE has today initiated a process of engagement with stakeholders in this field to seek their views in drawing up the strategy from 2016-17 and beyond. That will set out the short and medium-term priorities for HIV prevention and sexual and reproductive health promotion. It also considers how all of this work needs to pull together and highlights the level of need that will need to be met in the future. As part of that engagement plan, PHE will meet key stakeholders in this field in the next Parliament to discuss its plans in more detail and be able to give them more information.

Turning to pre-exposure prophylaxis, which my hon. Friend mentioned in his speech. The results of the PROUD research trial are very encouraging: 86% of the men, many of whom were at very high risk of acquiring HIV, remained HIV negative. Importantly, those taking PrEP in the trial did not have an increased rate of sexually transmitted infections. The PROUD research trial results are an important first step and the work continues. NHS England has set up an expert group to consider whether PrEP should be managed on the NHS and how this might be practically delivered.

[Mike Freer]

I am grateful to the Minister for that announcement. Is she able to give us any indication of how quickly the expert panel will report?

[Jane Ellison]

I am sure we would all want the panel to do that work in a timely fashion. I am not able to provide a date tonight, but I will convey the sense of urgency here in the Chamber to NHS England.

Hon. Members made important points about stigma and discrimination. I can only support everything they said. There is some encouragement: in the latest Ipsos MORI poll in 2014, the National AIDS Trust reports that overall public support for people with HIV is higher than ever, with 79% agreeing that people with HIV deserve the same level of support and respect as people with cancer. That is up from 2010. There is room for improvement, however, and a need for engagement across the spectrum. The NHS, local authorities, the Government, community and faith groups, the media—everyone has a part to play in eliminating HIV-related stigma. I note the comments about the role of schools—I will convey them to my right hon. Friend the Secretary of State—and the intervention about homophobic bullying. The Government have invested money in tackling such bullying and take it extremely seriously. It remains a concern for all of us.

It is positive that the number of new HIV infections overall continues to fall, and I believe that the Government can be proud of their record in this area, but the rise in the number of new MSM infections and the high levels of late diagnosis among black African populations are of great concern. Today I have set out how we will be more bold and innovative with the HIV prevention programme, including through a new national home sampling programme—one of the first of its kind in the world—increased use of social and digital media platforms and the setting up of an innovation fund to trial new approaches. Importantly, we are working in partnership with local authorities in taking this work forward. I see this as a transition to a long-term plan for HIV prevention and sexual and reproductive health promotion, and it is our ambition to see infection rates falling, not rising, and late diagnosis becoming a much rarer event. I thank all right hon. and hon. Members for their contributions to this excellent debate.

Question put and agreed to.