HIV Prevention

Nigel Evans Excerpts

Thursday 12th March 2015 Commons Chamber

[Mike Freer]

The right hon. Gentleman makes a good point. If he bears with me for just a minute, he might find that I am in agreement.

We have to accept that many teenagers will become sexually active, yet sex and relationship education—SRE—remains poor. The National Aids Trust recently published a report showing that in SRE there is little teaching about, among other things, same-sex awareness or HIV transmission. Teachers can be nervous of sex education full stop, let alone same-sex issues, sexual health or, in particular, HIV. That is compounded when schools struggle with homophobic bullying, which can contribute to teenagers feeling uncomfortable about seeking advice or information about their attractions or about having a safe sexual relationship when the time comes.

[Mr Nigel Evans (Ribble Valley) (Con)]

Is my hon. Friend as alarmed as I am by recent newspaper reports in which it appears that an increasing number of youngsters are being bullied or harassed at school for being gay, and in some cases even being taunted by teachers? Surely there has to be a completely different attitude in the 21st-century UK.

[Mike Freer]

My hon. Friend makes a very good point, and I agree entirely. In the Department for Education—I apologise to my hon. Friend the Minister for straying away from health, but this is a cross-Government issue—work has been done to fund teacher training on dealing with homophobic bullying, but we need to go one step further and make it integral to teacher training, not an add-on paid for by schools and local education authorities. One of the problems is that if gay men or men who declare as MSM are bullied for showing any form of attraction to other men, for seeking advice or for showing that inclination in any shape or form, they will simply not seek that information. In school they may be afraid of being bullied, whether by other schoolchildren, teachers or other members of staff. They will close down and withdraw, and as a result they might make ill-informed decisions about their sex lives.

In my view, therefore, it is time for SRE to be made compulsory and inclusive. I appreciate that that is not the view of my colleagues in the Department for Education, but I think that they are wrong and that they need to reassess that. We are talking about people’s health and future relationships, so this is too important to get hung up about the ideology of compulsion.

There is also the issue of new technology. When I was at school, in the dim and distant past, sex education was skirted around and pupils, if they were lucky, were given a rather dusty old book with some rather dodgy drawings—clearly that did not teach me very much. Today, teenagers have access to technology. They are accessing sex differently, and accessing information differently, so we need to educate and inform differently. The increasing use of dating apps—I use the term loosely —means that increasing numbers of teenagers are finding sexual partners through their phones. Are colleagues in Government and in health authorities nimble enough in using that technology effectively to ensure that appropriate sexual health messages are there too? Are we constantly playing catch-up, or can we innovate too? How can we intervene differently to support those who are HIV-positive? I said that we need to start with education and that we need to use technology, but when people present as HIV-positive, how can we intervene differently?

It is true that new anti-retroviral drug treatments—ARVs—have transformed the lives of those who are HIV-positive, and they help most people to live near-normal lives, but it is still a life-changing diagnosis. ARVs have to be taken every day for the rest of the person’s life. Relationships can be harder to find and to maintain because potential partners often reject someone who is HIV-positive. Despite anti-discrimination laws, few employees volunteer their HIV-positive status. To my knowledge, only one Member in the history of this House has ever declared his HIV-positive status. That former Member is now in another place. People will not volunteer their HIV-positive status for fear of discrimination—not just overt discrimination but the subtle passing over for promotions or snide comments in the workplace. Then there is the fear of shunning or harassment by co-workers. Despite all the work over the years, some people still believe that HIV can be transmitted through saliva or through sharing crockery and cutlery— 30 years after a major education programme.

All these factors combine such that the human cost of HIV-positive status can be significant. Despite the medical breakthroughs and ARVs, the costs of depression, isolation and the fear of being open remain. We still have work to do to ensure that health education is provided in the workplace, and not just in health education teaching or clinics. The impact on mental health is often missed by health services and sexual health clinics. Sexual health clinics should be more about general well-being and not just sexual health. It should not just be about treating a symptom. If someone goes in with gonorrhoea and comes out with a pill, it is “Job done” for many clinics, but what if they are treating someone who is presenting as HIV-positive? What is the back-up? What about their mental health? Are we providing that total well-being package?

I mentioned chemsex, where men use drugs that enhance sexual performance combined with drugs such as crystal, methedrone or GHB. This can lead to reduced sexual inhibitions and so increased risk-taking. I understand that someone presenting at a sexual health clinic who has chemsex is more likely to have broad sexual issues, and the clinic will deal only with those issues, while the drug-related issues will often be subject to referral to a drug treatment facility. That is often a separate facility and the referral may take six, eight, 10 or 12 weeks, during which time the person who has been interested in seeking treatment falls through the cracks. The separation of treatments, particularly for those involved in chemsex, not only breaks the treatment plan but increases the chance that the patient will not take up the treatment referral, and so behaviours are not changed.

Only this week I had the chance to visit 56 Dean Street and Dean Street Express in Soho. They are absolutely stunning facilities that look nothing like what we imagine the NHS to look like. It was not clinical and there was no plastic seating—it looked for all the world like an attractive boutique hotel. Dean Street Express has harnessed technology. Rather than someone having to go into a clinic, stand at a counter and announce to the world why they are there, or having to sit in an open waiting room, with everyone looking sheepish because they may recognise somebody else, they can book in using technology. They can also swab themselves, and then use the technology. That is the way forward if we are to make the system friendly and receptive, to innovate and to make it worth while and easy for people to seek help and treatment. Most importantly, it provides help on total well-being, not just sexual health. In my view, the Department of Heath should look at rolling out that innovative technique.

I have mentioned the black African community. It is a difficult community to reach, and I do not have any answers, but we need to work harder to reach it, whatever the method—perhaps through its community groups or churches—both to educate and to support those who disclose themselves as MSM or those who are afraid of doing so for fear that their own community will reject them.

We have to accept that people will make poor choices and have unprotected sex, which leads me on to intervention. I pay tribute to the PROUD report. Its initial studies show that post-exposure prophylaxis and pre-exposure prophylaxis—treatments taken immediately after suspected exposure to HIV or as a preventive measure—work. The initial findings show that they are cost-effective approaches to the prevention of transmission, or at least to ensuring that infection rates drop dramatically.

I accept the fact that the use of PEP and PrEP has cost implications. I understand that PrEP costs up to £6,000 a year, but we should compare that with cost of treating someone who is HIV-positive. The lifetime cost of treatment for a person with HIV is between £250,000 and £330,000 a year, so a £6,000 investment could save between a quarter and a third of a million pounds a year.

I have outlined some of the human and financial reasons for understanding what is driving up infection rates, and the action we could take. That brings me to my last point, which is that we need to increase testing. We need to make it easier and less clinical so that people do not fear that it means always having to go into clinics. A clinic is not a friendly—to overuse the pun—environment.

If clinics are used, they should at least make routine tests for HIV across the board so that people who are HIV-positive can have early intervention. Early diagnosis and early treatment dramatically improve the lives of individuals and reduce transmission rates. Let us remember that 25% of those who are HIV-positive do not know it. Easier and faster testing will help to reduce the number of transmissions and new infections. That should include the roll-out of home testing, because it must be right to make testing accessible and easy.

We often shy away from talking about sex, and we certainly find it uncomfortable to learn about sexual practices outside our own experience. Yet if we are to tackle the issues, we have to deal with the problems that exist and with the world as it is, not as we might like it to be. That is why I call on my hon. Friend the Minister to explain how we can redouble our efforts to educate and innovate in HIV prevention.