HIV Action Plan Annual Update 2022-23

Debate between Nicola Richards and Lloyd Russell-Moyle

Tuesday 18th July 2023 Westminster Hall

[Nicola Richards]

I thank my hon. Friend for his intervention. I know that opt-out testing is already making improvements and that that will benefit his constituents in Blackpool. We have the blueprint for how to do this; we just need to roll it out further.

The numbers do not lie. The annual update revealed that more than 2,000 people have been diagnosed with HIV, hepatitis B and hepatitis C in 12 months alone. It is very likely that without opt-out testing many of these people would not have been diagnosed until a much later stage. That includes diagnoses in parts of London classed as having a “high” rather than a “very high” prevalence of HIV. Let us imagine what can be achieved if we now extend the roll-out to areas of high HIV prevalence, such as in my constituency of West Bromwich East.

The west midlands have several high-prevalence areas outside Sandwell, including Wolverhampton, Coventry and Birmingham. That is why, for World AIDS Day last year, West Midlands Mayor Andy Street joined the calls to fund this scheme in the west midlands. The way to end this virus is to find exactly these people—those who are unaware that they are carrying the disease but who are in fact passing it on to others—so that they can get the care they need and do not increase transmission further.

Opt-out testing in London, Blackpool, Brighton and Manchester has also revealed a quiet but growing crisis by identifying people who have previously been diagnosed with HIV but are not receiving the treatment they need. The UK Health Security Agency estimates the number of people who have fallen out of the HIV care system since 2015 to be an alarming 22,670. The Terrence Higgins Trust, which I take this opportunity to thank for all its excellent work, estimates the number of those who are alive and remain living in the UK as somewhere between 10,650 and 13,006. They are all at risk of becoming seriously ill and further transmitting the virus. In fact, hospitals in London are reporting that this has overtaken undiagnosed HIV as the primary cause of HIV-related hospital admissions.

This is totally preventable. Once someone living with HIV is on effective treatment, they can live a long, healthy life and do not pass on the virus. The annual update shows that more than a third of those found with HIV by opt-out testing were previously lost to care. That is another 473 people who can access treatment, prevent further serious illness and help to stop the spread of HIV. This is an important step forward, but we should not only be finding people when they need emergency care; we should be supporting them to stay in care in the first place. Without finding and providing treatment to those people, we cannot realise our ambition of ending new cases by 2030.

Opt-out testing is helping not only to save lives, but to save money in our health system. The initial investment to set up opt-out testing is dwarfed by the amount saved by providing treatment earlier and preventing serious illness. There is a huge saving to be made, and it is truly making a difference to health outcomes in the places in the country that already have opt-out testing.

[Dame Caroline Dinenage in the Chair]

Furthermore, the Elton John AIDS Foundation has done fantastic work with hospitals in south London on a pilot scheme that can inform a national programme to re-engage people who have been diagnosed with HIV but who are lost to care. Clearly, finding and restarting treatment for those lost to care is an urgent consideration and, at a cost of £3,000 per person, it would be significantly cheaper than providing emergency care if their condition worsened.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

The hon. Lady highlights an important study from the Elton John AIDS Foundation, which found that, with a low amount of money, people can be returned to care. The problem is that sexual health and HIV services are under strain. That money needs to be ringfenced and provided by the Government so that we can spend now to save later.

[Nicola Richards]

The hon. Gentleman does a lot of work in this area and is a voice to be listened to.

I have shown that the key benefits of extending opt-out testing and further lost-to-care work are threefold: saving lives, saving money and reducing the pressure on the NHS at a time when every effort must be made to reduce waiting lists.

At the time of the World AIDS Day debate last December, I was assured that the Minister would look closely at the outcomes of the trial once 12 months of data was available. I hope that he agrees that the trial has been a success, as the annual report states, and that we should extend the roll-out without delay.

We already have an excellent programme in place, ready to support the expansion of combined blood-borne virus testing. After the Government initially invested £20 million in opt-out A&E testing through the HIV action plan, funding from the hepatitis C programme made it possible to add hep B and hep C to the programme. The success of that has been remarkable, and the hepatitis C elimination programme is already funding opt-out hep C testing in further areas. However, without specific funding for HIV we are missing an opportunity to save even more lives by testing for HIV at the same time.

For example, a pilot programme that took place in the Leeds Teaching Hospitals NHS Trust, where opt-out HIV testing was rolled out alongside hepatitis testing, found 25 people with HIV in just 17 months, along with a combined 297 people with hep B and C. After the end of that pilot, the hospital has been able to secure funding from NHS England to reinstate hepatitis C testing in the emergency department whenever blood is taken. However, it is disappointing that no funding has been provided for HIV testing to go alongside that, especially when the area is one in which there is a high prevalence of HIV. These opportunities to test are currently being wasted.

If we are to expand HIV testing further, it has to be combined with blood-borne virus testing—there is no hierarchy when it comes to the elimination of viruses, and it is important that we make progress against both. We are showing that combining testing is not just better; it is cheaper, more effective and de-stigmatising. I would therefore appreciate it if the Minister could confirm that a national expansion of opt-out hepatitis C testing would include HIV and hep B, as should be the case.

Another way in which we can stop the spread of the virus is by better utilising PrEP, which has been proven to be very effective at preventing the transmission of HIV. As part of the HIV action plan, we committed to an innovation in PrEP delivery to improve access for key groups, including provision in settings outside sexual and reproductive health services. However, we continue to await a date for when that will start, and I strongly urge the Department to outline when that will be as soon as possible.

The Prime Minister recently committed to making other prescription medications, including contraception, available directly from pharmacies. Please can the Government consider doing the same for PrEP, which would make a massive difference to so many? By making it easier to access, we can prevent those most at risk from ever being infected with HIV. PrEP needs to be available to people in GP surgeries, pharmacies and online to truly harness its potential to stop HIV spreading and to end the inequalities in access to the drug. I hope that that is something the Minister can provide an update on when responding to this debate.

[Lloyd Russell-Moyle]

The hon. Lady is dreadfully kind for giving way. I hope she will acknowledge to the Minister that many people end up buying PrEP online, anyway, so there is already a market for it where people access it outside of clinics. The Government are taking a cautious approach, and the people have already marched two miles ahead. The Government should take a more reactive approach, follow where the people are and allow them to buy it over the counter, with advisory blood tests rather than compulsory ones.

[Nicola Richards]

I thank the hon. Member again for his intervention, and I totally agree.

I would also like to raise the plight of those who are living with HIV but who feel unable to access healthcare for a variety of reasons—mainly as a result of the stigma surrounding the virus and concerns over their mental health. Engagement with this group is an important part of the action plan. Can the Minister please use this opportunity today to reassure colleagues that people living with HIV have the opportunity to seek support, and that tailored measures will be introduced to combat the issues I have raised?

Finally, all parts of the health system are responsible for delivering on the action plan. Shortly this will change, with adult HIV services moving from NHS England to integrated care systems in April 2024. As may be evident, the lines of responsibility are somewhat blurred. For that reason, it is key that we clarify as soon as possible the exact lines of authority, so that work can be accelerated to deal with the disparity in HIV support across different areas of the country. Again, I strongly encourage the Minister to provide the House with information on what the Government are doing to deal with this issue.

It is vital that we deliver on the HIV action plan, which gives us a genuine opportunity to be the first nation in the world to end this epidemic, which has both taken and harmed so many lives. By working together and implementing the reforms the action plan sets out, some of which I have mentioned today, we can stop the spread of the virus and, instead of allowing transmission to go undetected, we can stop the virus in its tracks. Many of these measures are non-burdensome but highly effective, so it is vital that we act before it is too late. We have a social responsibility to do all we can now and not to delay the implementation of the plan. I look forward to hearing the Government’s response.