HIV Treatment

Martyn Day Excerpts

Wednesday 29th March 2017 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mrs Main, and to take part in today’s debate. I am grateful to the hon. Member for Finchley and Golders Green (Mike Freer) for securing the debate, and for his detailed and informative speech, as well as for the work of the all-party group on HIV and AIDS in producing an excellent report, “The HIV puzzle”. The report notes, on the basis of evidence from charities, civil society groups and the pharmaceutical industry, significant upheaval to HIV and sexual health services since the Health and Social Care Act 2012 was implemented.

The findings of the report are very worrying. A joined up, multi-sector approach to support and care for those at risk of or living with HIV is crucial to its prevention. The UK Government should reflect seriously on how they can improve HIV services in the light of that body of evidence. The report is concerned with HIV services in England, but its findings will be of interest throughout the UK. Communicable diseases do not, after all, recognise administrative or national borders. The report recognises:

“In Scotland sexual health sits under Blood Borne Viruses in the health system, which Dr Gordon Scott argues makes it easier to set priorities.”

In that spirit, and given that the issue is devolved, I hope that the comments of a Scottish Member about HIV in Scotland will also be of interest to Members from other parts of the UK.

There were 6,095 new diagnoses of HIV across the UK in 2015, and 300 of those were in Scotland. The latest figures for NHS Lothian, which covers the West Lothian part of my constituency, tell us that there are 1,589 people diagnosed and living with HIV, and that 70 of those were diagnosed in the past year. At the other side of the country, Glasgow has experienced its biggest rise in HIV infection for three decades. The issue will affect every community in the country. We all have our challenges, especially when we consider that it is estimated that about 13% of people may be undiagnosed, with all the consequent risks of onward transmission, as well as the impact on those people of being unable to get access to care and treatment.

Lifetime treatment costs the NHS between £280,000 and £360,000 per patient—a not insignificant amount. Prevention of HIV infection remains a priority for the Scottish Government. There is no room for complacency on communicable diseases such as HIV. We continue to provide funding to NHS boards for HIV prevention, as well as supporting organisations such as HIV Scotland, with £270,000 in funding this year. There is of course no one-size-fits-all approach to HIV prevention. That is why in Scotland we are providing Waverley Care with £45,000 in funding this year for its HIV prevention and support work with African communities.

A joined-up approach to HIV care is vital to ensuring that infected people can get the care they need to live life as independently as possible. The Scottish Government’s sexual health and blood-borne virus framework 2015 to 2020 is continuing to build on achievements made under the original framework document of 2011. The HIV Testing Kits and Services Revocation (Scotland) Regulations 2014 lifted the ban on the sale of instant-result testing kits in Scotland. In the light of that change, and following leadership on the issue by HIV Scotland, a subgroup of the executive leads group published a questions and good practice document on instant-result self-testing in March 2014. The good practice document was the first of its kind in the world and has since been recognised internationally as an example of good practice by the World Health Organisation.

All NHS boards in Scotland have protocols in place in relation to HIV post-exposure prophylaxis—PrEP—for sexual and non-sexual exposures. The framework makes clear the importance of a multi-agency approach to sexual health and blood-borne viruses. Truly delivering on the framework outcomes in the long term will require the involvement of patients and service users, NHS boards, local authorities, the third sector, academics, the media and, indeed, the general public. The integration of health and social care in Scotland is one of the most significant reforms since the establishment of the NHS. We are the only UK nation to have legislated to put NHS boards and local authorities under statutory duties to work together. That is helping to tackle priorities in the framework to work towards as joined-up an approach as possible to caring for people with long-term conditions and disabilities, such as HIV.

Evidence generated in late 2014 and early 2015 indicates that the HIV infection is being transmitted among a small population of highly chaotic, vulnerable and often homeless people who inject drugs. These transmissions reinforce the importance of prevention work with such populations. The Scottish Government are working with health boards, schools and the police service to ensure that vulnerable groups can get the right support to prevent and treat infection. The framework update includes commitments on development of care services with local authorities; tackling social stigma through education; encouraging HIV testing to be regarded as routine; and NHS boards and partners offering testing to vulnerable groups using innovative approaches such as delivering testing in the communities themselves.

The Scottish Government are also considering the recommendations of an independent review of PrEP. The European Medicines Agency has granted a licence for Truvada as PrEP for HIV in adults at high risk. The Scottish Government’s chief pharmaceutical officer has written to its manufacturer to ask it to make a submission to the Scottish Medicines Consortium. The Scottish Government’s position is that all medicines must be licensed before they can be made routinely available on the NHS, but we recognise that some people are already buying PrEP drugs privately in Scotland. It is important that people who are doing so receive appropriate advice from and are monitored by clinicians. The executive leads network for the sexual health and blood-borne virus framework is considering the findings of the PrEP short life working group, which considered a range of issues associated with the use of PrEP. I look forward to hearing about the outcomes.

In conclusion, I commend the work of the APPG and its report on this issue. There are undoubtedly lessons for us all within it.