HIV/AIDS

Lord Collins of Highbury Excerpts

Thursday 5th March 2015 Grand Committee

[Lord Collins of Highbury (Lab)]

My Lords, I, too, pay tribute to the noble Lord, Lord Fowler, for his outstanding work on HIV and AIDS both here and globally, advocating action on prevention, treatment and care while attacking discrimination and stigma. As we have heard in this debate, it is estimated that 35 million people are living with HIV worldwide, with 1.5 million AIDS-related deaths in 2013. Here, 6,000 people were diagnosed as carrying the HIV infection in 2013, and 320 people were reported as having AIDS. An estimated 107,800 people are now living with HIV.

As we have heard in the debate, the UK is one of the world’s leading funders of global health. If we are to move beyond investments to control HIV and towards eradication, we desperately need new tools. Where there is an affluent market, as is the case with adult HIV drugs, we can see significant private investment. By contrast, there are very few formulations of paediatric HIV drugs, where the market is smaller and more heavily based in developing countries. UNAIDS highlights the fact that only 24% of children living with HIV currently have access to HIV treatment. Will the Minister support within government the recommendation from the HIV/AIDS APPG that the UK commissions an economic paper to contrast the total costs of developing and purchasing medical tools using the current R&D model with the costs of a delinked model?

As was asked by other noble Lords, including the noble Lord, Lord Crisp, can the Minister explain how the Government will address the growing problem in middle-income countries whereby funding is being pulled out from all directions, including from the Global Fund, while the pharmaceutical industry continues to expect MIC Governments to afford higher prices for ARV treatment?

In England, the Health and Social Care Act changed the commissioning and monitoring of HIV prevention, testing, treatment and care services. Conditions that require specialist expertise and medication are the responsibility of NHS England, including HIV treatment. In its Five Year Forward View, NHS England states that it plans to let local commissioners share responsibility for commissioning specialised services, incentivising them to direct funding towards local priorities.

Naturally, many patient groups are concerned about the impact on service standards leading to a possible postcode lottery. Their concern is heightened by the fact that there are so many outstanding questions about what co-commissioning will look like and no specific announcements related to HIV. What steps will the Minister take to ensure that the overall responsibility for the provision of services is clearly defined? It is also vital that standards of care are maintained across the country.

As we have heard in this debate, particularly from the noble Lord, Lord Fowler, the Government have funded national HIV prevention programmes since 1996. In recent years, funding for these programmes has been progressively reduced. The current English national prevention programme HIV Prevention England—HPE—has been funded for three years until the end of March 2015. Funding for HPE is £2.4 million per year, which is less than the combined funding received by the previous prevention programmes in 2011 and 2012. In December 2014, the Government indicated that they intended to reduce funding for HPE by 50% to £1.2 million for 2015-16.

That decision was criticised by many organisations, who led a public campaign seeking reconsideration, and shortly afterwards it was reversed and a commitment made to fund the programme at current levels for a further year. Will the reallocated budget support a new programme of work or existing activities that are currently paid for with other budgets?

In addition to the national HPE programme, local authorities should be investing in complementary prevention initiatives as part of their public health responsibilities. However, National Aids Trust research shows that less than 0.1% of local funding allocated to public health in high HIV-prevalence areas is being spent on primary HIV prevention. A total of about 1.2 million men have sex with men and black African adults living in England. A budget of £1.2 million means that the national programme has only £l to spend a year for each person in its target audience. Does the Minister believe that that is enough to achieve the programme’s objectives? The estimated lifetime cost of treating someone with HIV is £360,777. That means that even if a £2.4 million programme prevented only seven new transmissions a year, it would save the NHS money. Is there not a strong case for increasing the funding rather than cutting it?

Finally, I raise the issue of pre-exposure prophylaxis—PrEP—to which the noble Lord, Lord Black, referred. Really impressive research from England was released last week. I read it at the international retrovirus conference in Seattle. The study recruited men who have sex with men and trans women who were at elevated risk of acquiring HIV. They had multiple partners; condom use was inconsistent or irregular; rates of sexually transmitted infections were high; many participants had needed post-exposure prophylaxis before and recreational drug use was common. Participants were generally well-educated and in full-time employment. The fact that the study has demonstrated such a high and statistically significant level of efficacy with a few hundred participants tells us both about how effective PrEP is and how high the rate of infection is in some groups of gay men.

What is being done to ensure that this highly effective HIV-prevention intervention is made available to those who need it without delay? What work is being done to ensure that prescribing of PrEP is appropriately targeted to those who are most likely to benefit from it?