HIV/AIDS

Lord Fowler Excerpts

Thursday 5th March 2015 Grand Committee

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what steps they are taking to meet the continuing challenge of HIV and AIDS.

[Lord Fowler (Con)]

My Lords, we are nearing the end of a Parliament, which is, perhaps, a good time to assess what progress has been made in this important area, where we are and where we want to be. I start by congratulating the Government on two measures of immense importance. The first was their decision to enable equal marriage, which did a vast amount not only to encourage equality but at the same time to fight prejudice against gay people, which stands against progress in fighting HIV and AIDS literally around the world. The second was to double their contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which brings invaluable help to areas where the death toll has been immense. AIDS alone has been responsible for 35 million deaths around the world since the epidemic began. Frankly, the criticism of the National Audit Office that this was an example of a last-minute decision was about as far from the mark as it was possible to get. It was first promised not by the current Secretary of State but by her predecessor, Andrew Mitchell, and it was, as I say, extraordinarily welcome.

However, in this short debate I want to concentrate on this country and ask whether we are making the progress that we should. In bare statistics, last year there were almost 6,500 new HIV diagnoses. I have just come back from Russia, where I looked at the position there. Indeed, they were kind enough to present me with a medal for 25 years service. It is a damn sight more than I ever get from the Department of Health, I can tell noble Lords, but I fear that it makes me no more sympathetic to their policies, which last year resulted in 85,000 new HIV diagnoses. The figure goes up remorselessly each year.

The temptation is, against that background, to say about Britain, with fewer than 6,500 new HIV diagnoses, what are you worried about and what is the problem? The problem, basically, is that today in Britain there are 100,000 men, women and children living with HIV. That is almost double the number accessing care a decade ago. The National Health Service now spends £860 million a year on treatment and care: almost £1 billion a year. Worst of all, of those 100,000 with HIV, about a quarter are undiagnosed. They do not know that they have the virus and, of course, other things being equal, they spread HIV further. In other words we have, in my view, an undoubted public health crisis and, although we now have antiretroviral drugs which prolong life, we still face the situation which we faced, frankly, in the 1980s, with no cure and no vaccine.

Against such figures, what can we do and what are we doing? The obvious step is to put the maximum effort into prevention. We save £320,000 in lifetime costs for every infection which is prevented. Top of the list in prevention policy is to persuade ever more people to be tested. We are not going to win when we have around 25,000 people untested and undiagnosed in the community. Second to that is that we also need to persuade people to continue with their treatment once they are on it. Too many drop off. The point to recognise, generally, here is that persuasion can work, provided that sufficient imagination is put into the messages and it is backed by sufficient resources. We established that back in 1986-87 with the promotion of condom use and the warnings against shared needles.

The Select Committee that I chaired in 2011—I am glad to see that one of its members, my noble friend Lord Gardiner, is sitting very near me—raised this point with the Government. We said that publicity was inadequate and should be increased, so what did the department do? It cut it further. Today, the department spends about £2.4 million a year nationally on promoting prevention. I repeat that the cost of treatment and care is £860 million a year. It is, frankly, a ludicrous position. We spend hundreds of millions on treating the casualties but next to nothing on trying to prevent those casualties coming about. The defence for this is that, in addition to the national campaign, another £10 million or £11 million is spent by local authorities, although the figures suggest that some of the most affected local authorities are spending next to nothing, if anything at all.

Frankly, making every allowance in the book, the amount we spend on trying to prevent infection is seriously inadequate. Prevention is simply not being given the priority that it deserves. If it were not for the NGOs and the volunteers, our overall national policy would, in my view, be not only in trouble but in tatters.

Therefore, I say to the Government that we need a new campaign to encourage testing, which is the obvious glaring gap in our policy. A few weeks ago, I proposed to the Minister on the Floor of the House that a task force should be set up to explore how to take that forward. The Minister, as is his custom, was courteous—even encouraging—but, frankly, I have heard no more, doubtless because he was planning the detail of the campaign that I set out. Perhaps this afternoon he might come forward with those proposals.

I would like to make two further points. The first is on drugs and harm reduction policy generally. We introduced clean needles and then methadone as a policy back in the 1980s. Methadone is not injected and therefore has an obvious use in reducing transmission. It has been demonstrably successful as a policy. For the last 25 years the number contracting HIV in this country through shared needles has been around 1% of the total—almost imperceptible. Therefore, it is vastly important that that policy is maintained and that there is no lurching away from it. Why do I say, “lurching away from it”? In recent weeks there has been a suggestion that policy is changing. There has been a hint that drug users should be forced into taking treatment—taken not only off injecting drugs but off methadone as well. I say to the Minister that my only advice on this is to go very cautiously indeed.

Of course, we all want to see as many people as possible living a drug-free life, but we should not underestimate the difficulties, which are not going to be reconciled by a speedy review of a few weeks. If you want to see the alternative, again, go to Russia: see the treatment centres there and the attempt at rehabilitation, and look at the figures. They show that after 12 months of treatment and rehabilitation 80% or 90% go back to injecting drugs, and after five years virtually everyone does.

Given that drug users have never really been able to be forced off drugs in the way that seems to be imagined, I think we might also remember that methadone can lead to a recovered life. I remember visiting a clinic in Ukraine, where the doctor in charge basically said just that—that, although some of them had been on methadone for six, seven or eight years, they had at least been restored to society: they held down jobs and were relating to their families again. Basically, I would like an assurance that there is no intention on the part of the Government to turn their back on sensible harm reduction policies.

My last point I make in précis. The latest research shows that the drug Truvada can very substantially cut HIV for men who have sex with men. It prevents HIV infection. Given that men who have sex with men are the group most affected by HIV in this country, it seems obvious that we should develop that policy as quickly as we can. Of course, there are costs to the policy, but there are even greater costs in doing nothing.

My conclusion is this. On a number of issues, such as the increased contribution to the Global Fund, this country has been among the leaders in the world, but I fear that nationally, inside Britain, there are too many gaps in our policy to say that we lead the world. What we can say is that we have some of the finest and most devoted clinicians, NGOs, voluntary organisations and officials. If I had one word of advice for the Government, it would be that Ministers should raise their general policy game to the level of those doctors and volunteers who work so tirelessly in this country to eliminate HIV and AIDS.