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House of Commons

Friday 13 January 1989

The House met at half-past Nine o'clock

PRAYERS

[Mr. Speaker-- in the Chair ]

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. John M. Taylor.]

9.34 am

AIDS

[Relevant documents : Third Report from the Social Services Committee on Problems Associated with AIDS, House of Commons Paper No. 182-I of Session 1986-87, and the Government responses to that Report, Cm. 297.]

The Minister of State, Department of Health (Mr. David Mellor) : This is the first time that the House has had a full debate on AIDS since November 1986. I suspect that I shall not be alone in welcoming the opportunity that the debate presents for me to update the House on such recent advances as have been made in the knowledge of the disease and to listen to views on a matter in which I know Members on both sides of the House have taken a real interest. In particular, we shall want to consider, in as much detail as time permits, the threat that AIDS poses to public health and to analyse the action that the Government and other authorities are taking to meet that threat. It had been the intention of my hon. Friend the Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), to be present for the debate and to make a contribution at the end of it. There is a significant Scottish dimension to the issue. I know that a number of Scottish Members wish to take part in the debate. Sadly, my hon. Friend has had a bereavement and has to attend a funeral today. That is why he is not here. If, therefore, I am able to catch your eye, Madam Deputy Speaker, I may have to subject the House to a second dose of me. I regret that ; I had not intended that that should be so. I shall try to deal with Scottish points, but I assure the House that any points with which I do not deal will be dealt with in correspondence by my hon. Friend. I know that the House will understand his reasons for not being here.

Since we last discussed the matter in 1986, all of us have heard a great deal more about AIDS and HIV infection. The initial impact on the public of the existence of this disease and the threat that it posed was very striking. The date of 1 December 1988 was designated World AIDS Day. It gave us all a further chance to refocus our attention on AIDS and to prevent increasing familiarity with the disease breeding indifference. However, there is a danger that as AIDS becomes an accepted fact of everyday life it will lose its impact.

Preventing the spread of AIDS depends crucially on people changing behaviour that puts them at risk. That will not happen if people become complacent. We must not lose, therefore, the momentum generated by the public education campaign that the Government have sought to sponsor with vigour, by the many contributions to the

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debate in the media, and by the efforts of those who are working in this area to ensure that proper attention is focused on the disease. We must not relax our attention or lessen our commitment. Once again, let me say how much I welcome the debate. In some ways it is perhaps an overdue opportunity for hon. Members on both sides of the House to reiterate their collective awareness of the disease and their willingness to join in a sensible and, I trust, non-partisan way in devising effective strategies against it. When I was responsible for the Government's policy on drugs a few years ago I always said that there was no monopoly of wisdom in any part of the House on the issue ; all of us have a contribution to make. Hon. Members know that their contributions will be treated seriously and that, where appropriate, they will be acted upon.

I have happy memories of the Drug Trafficking Offences Act 1986, which was passed after a great deal of discussion between Front-Bench Members. It had the support of both sides of the House. The Act has had considerable success in ensuring a flow of information from financial institutions about suspected drug trafficking transactions. It has also helped to ensure that there is a formidable further disincentive to drug trafficking--not just heavy prison sentences but the confiscation of the proceeds of drug trafficking by what remains one of the most forthright legal procedures anywhere in the world. I hope that that kind of spirit will imbue this debate. Certainly it is the spirit in which I am approaching the debate, together with a willingness to listen to and to learn from each contribution. I first became aware of AIDS when dealing with the drugs issue. Since returning to such topics on becoming Minister for health matters in July, I have sought to update and deepen my awareness of AIDS. I have visited St. Stephen's hospital, the National AIDS Helpline, the London Lighthouse, the Terrence Higgins Trust and other major facilities throughout the country and have attended major functions arranged by the National AIDS Trust and others. I have been greatly impressed and encouraged by the commitment and skills of the people whom I met. Inevitably, though, the recital of the facts of this disease, and personal witness of the suffering it causes, has been a sobering experience for me. On that basis, I want to give the House some account now of the situation as I see it, before listening with care to what other hon. Members say.

Our knowledge about HIV and AIDS has greatly increased since November 1986. We now have much more epidemiological information, and more is known about the clinical course of the disease. There have been movements forward in treatment. For example, the drug zidovudine--or AZT as it is more generally known--was licensed in March 1987. That and other things have improved the treatment and management of opportunist infections and cancers associated with AIDS. However, those are palliatives and, although they have improved, I fear that the plain truth is that we are no nearer either to a cure in the generally accepted sense of the word or to the vaccine on which so many pinned their hopes in the earlier days of the epidemic. I am advised that the chances of a breakthrough on developing a vaccine in the near future remain very small. The only certain protection against AIDS is not to get the virus in the first place. None of us can stress that too often.

Something else that has changed throughout the period, and worryingly so, is the fact that the predictions

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about the proportion of people infected with HIV who will go on to develop AIDS or AIDS-related conditions have become markedly more pessimistic. Five years ago I remember being told that somebody infected with the AIDS virus had a one in 10 chance of developing the disease. Two years ago--about the time that the House was having its last debate on this subject--information suggested a 30 per cent. chance. The latest evidence now suggests that at least 80 per cent. of those people infected with HIV may eventually go on to develop AIDS. Some experts are even more pessimistic than that. That is a sobering and troubling development.

Expanding our focus to the world, the picture is grim. The virus continues to spread and the World Health Organisation, with which, as the House knows, we keep in the closest touch and consider ourselves to be one of its more active members in relation to this topic, now estimates that between 5 million and 10 million people worldwide are already affected by the virus. Furthermore, although the numbers of reported cases of AIDS known to the World Health Organisation are only 130,000, it is estimated that the true figure is likely to be over 350,000. The World Health Organisation predicts that during 1989 and 1990 more than 400,000 new AIDS cases will occur worldwide. Against that background, we in the United Kingdom have sought to develop effective policies. We believe that clear and determined action is needed in response to the challenge posed to our society by the virus and AIDS. We have a four-part strategy to achieve that, consisting of public education ; infection control and surveillance ; research ; and the development of care and treatment services. That strategy is backed by a strong commitment to international co-operation to combat the disease.

Before saying a little more about Government action to open the way to the advice that I know will be given by colleagues about what else we can do, I should like to make it clear once again that we are all on a learning curve in this matter. None of us should hesitate to put forward new ideas, because in the end our only defence against AIDS is the generation of new ideas.

I shall now set out the factual background of my understanding of the extent of AIDS infection in this country. Our surveillance systems show that at the end of last year in the United Kingdom 1,982 people were reported as having AIDS, of whom 1,059 had died. Also at the end of December, just over 9,600 people had been found to be HIV positive. As I shall mention in a moment, those figures undoubtedly underestimate the true number of people who have become infected. We passed our first sombre milestone in October 1988 when deaths passed 1,000. We are just about to pass --I suspect this month--the figure of 2,000 reported AIDS cases. I fear that, alas, there will be many more such milestones.

One of the great uncertainties has always been accurately predicting the likely future spread of the disease. That is why my predecessor, my right hon. Friend the Member for Braintree (Mr. Newton), asked an expert group under the chairmanship of Sir David Cox, the distinguished statistician, to make predictions of the number of cases of AIDS which are likely to occur in England and Wales in the next two to five years. As the House knows, the group's report was published at the end

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of November 1988 and concluded between between 10,000 and 30,000 cases of AIDS are likely to be diagnosed in England and Wales by 1992. It recommended a figure of 13,000 cases as the basis for planning. By the end of 1992 the report estimated that between 7,500 and 17,000 people are expected to have died from AIDS. Those figures are lower than earlier estimates and reflect the welcome fact that the rate of increase of new AIDS cases has been slower than some once thought, largely we think due to changes in the behaviour of homosexual men several years ago when that community became aware of the AIDS threat. The report also estimated that by the end of 1987 there were between 20,000 and 50,000 people infected with HIV, compared with the 9,500 reported under the reporting system at the end of December 1988. Hence our concern that the official figures will always be an underestimate for a whole range of reasons with which the House is familiar.

We have accepted the Cox report as the best basis we have for future planning. We hope, having established the data base, to update and republish figures annually. I hope that that will be seen as a useful step forward. We took the opportunity at the end of last year to announce further improvements in the monitoring and surveillance of HIV infection and hope therefore to be able to narrow some of the ranges of prediction as we get better data and as our experience grows.

Before leaving the Cox report, I should say that it makes several important points that we should not forget. First, it makes it fundamentally clear to sensible folk how serious a problem we face in this country from AIDS.

Those who inject drugs and share equipment are putting themselves at possibly the highest risk. There is no great evidence that drug users are heeding the warnings and changing their behaviour. I know the concern about that in some Scottish cities. However, drug users need to change their behaviour. Professor Cox suggests that HIV infection amongst drug users in England and Wales could give rise to 1,000 AIDS cases by the end of 1992 and warns that a large scale epidemic among that group could lead to a rapid rise in the numbers of new cases. We must always remember that that group is a bridgehead into the wider community, being predominantly heterosexual in orientation. The tragedies that then unfold, with sexual partners and babies being infected, is alas becoming not unfamiliar in some of our cities. We must recognise the extent of the threat from that quarter.

As I said earlier, there is welcome evidence that many homosexual men have been heeding the warnings and changing their lifestyles to protect themselves and others against infection. I welcome that, too. It shows clearly that the one truth that we must never lose sight of, perhaps the one ray of light in what is otherwise a rather dark picture, is that there is nothing inevitable about the spread of HIV. It all depends on how we respond to a common-sense message. As the homosexual community is showing, the rate of spread of infection can be reduced by changes in personal behaviour. But all this depends on not dropping our guard. Sir David Cox says :

"It would be a gross error to regard even the lower predictions as grounds for complacency".

I wholeheartedly endorse that sentiment. Behavioural changes amongst homosexual men need to be sustained. Heterosexuals need to recognise that, while there is a small risk of catching HIV in Britain today, it could become much greater in future if the warnings are not heeded. The potential threat is serious, especially for those who change

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partners frequently or who get conditions which cause genital ulcers, and possibly other sexually-transmitted diseases. The evidence from overseas--and especially from Africa--indicates the seriousness of the risks of heterosexual HIV infection. Coming much closer to home, the proportion of AIDS cases thought to be the result of heterosexual contact is at least twice as much in France as in this country so far ; and in several other European countries such as Belgium it is higher still.

The writing is on the wall. We should be sure to read it. Perhaps it would be helpful if I said a little more about heterosexual spread. I am advised that heterosexual transmission of HIV is a complex matter which we do not yet fully understand. It is not clear why the facility of transmission between heterosexual people in central Africa is so much greater than within, for example, New York city where the virus has been well established among heterosexual drug misusers, including many prostitutes, for at least 10 years. That is an extremely important gap in our knowledge. There is some evidence that the higher prevalence of conditions which cause genital ulcers may be a factor, but it is probably not the only one. AIDS is a developing problem about which our knowledge is constantly changing. When we look at the proportion of those with HIV who are likely to go on to develop AIDS, and in the absence at this time of clear data on infection via heterosexual contact, it becomes clear that we all must be cautious, especially as we know that a single act of unprotected vaginal intercourse can spread the infection. AIDS is a sustained and growing threat and people should not take false comfort from the current low rates of heterosexual spread in the United Kingdom or the differences in rates of spread abroad. Where uncertainty exists, the prudent err on the side of caution, especially when, as I have already made clear, most of what we have learnt in recent time about the disease makes it seem even more serious than was once thought rather than less so. There is no room for false comfort.

On that basis, I have to say that there is potential for the spread of the infection throughout the population and we cannot ignore that. Yet there are few signs that heterosexuals and drug users are changing risky behaviour to protect themselves. But protect themselves they must.

In trying to assess the extent of the disease, we thought it necessary in November to improve our monitoring and surveillance system. In doing so, we were greatly assisted by the recommendations of an expert group chaired by Dr. Joe Smith, director of the public health laboratory service. I should like to emphasise the care we try to take in obtaining and assessing expert advice before taking any initiative in what is a difficult and complex field.

We have asked the Medical Research Council to draw up, by the end of February, detailed proposals for a comprehensive programme of surveillance studies. Those studies will be designed to give us better information about how the epidemic is developing both in the general population and in those specific groups that are or may be at risk. They will include studies based on anonymous testing, that is, the testing of blood samples taken for other purposes in a way which preserves the total anonymity of the donor.

Those studies will be in addition to the surveys of pregnant women which the MRC has recently begun in Edinburgh and Dundee, as well as studies of other groups such as those who attend drug misuse services and sexually- transmitted disease clinics.

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I am glad that the number of those who expressed reservations about anonymous testing has been less than some initially thought. Such worries as there have been have centred on the impossibility of informing and advising those who prove to be HIV positive. I should emphasise that the purpose of these anonymous tests is to obtain general prevalence data, not to make clinical diagnoses, and this is, in our view, the only way in which this can sensibly be done. But anyone who wants to have a named test can have one, and any doctor who thinks that a named test might be in the best interests of a patient can offer one free. Therefore, anonymous surveillance testing is in a category of its own and does not affect people's rights to know whether they have the virus and have their minds put at rest if they think that they may be carrying it. That is a crucial point. Anonymous testing will provide valuable information about the prevalence of HIV infection by age and sex in various parts of the country and the rate at which it is spreading in the population.

Mr. Toby Jessel (Twickenham) : Is my hon. and learned Friend saying that if an anonymous test takes place and a person is found to be infected there is no way in which the doctor handling the test and the patient can be informed that his blood is infected, and, if not, why not?

Mr. Mellor : I have already sought to explain the matter. The basis of anonymous testing is that, when the AIDS test is given, a sample will have been taken for a completely different purpose and will have been anonymised. If people feel that they may have had a chance of contracting the virus, they can go to their doctor and, with proper counselling, have a test. But the purpose of anonymous testing is to discover how far the virus has spread into the broader community. We cannot have anonymous testing yet have the ability to tell someone, "I am afraid that your blood is positive." However, that is in addition to all the other measures we are taking to ensure that no one need be in any doubt. It is not as if we are withdrawing from any of the arrangements that have already been introduced.

I hope that most hon. Members will agree that the general public are not preoccupied by the ethics of what we are proposing. They would be much more troubled if they felt that we had shied away from taking the necessary steps to get an accurate measure of the problems we face.

I am anxious not to outstay my welcome, but equally I am anxious to give the House the best possible account of where we stand as perceived from my Department, so I shall turn to other aspects of our strategy, particularly public information.

Mr. Tim Rathbone (Lewes) : There was a worrying report in this morning's papers that the Soviet Union would require testing and a negative result for all those visiting the Soviet Union for longer than four months. Has my hon. and learned Friend considered what that could lead to? It breaks through the principle of anonymity and raises the incredibly complicated question of the social drawbacks of individual testing. Although I do not expect that my hon. and learned Friend has had a chance to consider that information since it was published, I hope that he will look into it.

Mr. Mellor : We have sought to prevent a lot of arbitrary barriers to the free passage of people being put

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up around the world. Given the complications of AIDS tests, the time lag between getting the virus and the antibodies showing up, the difficulties of the test itself, which has a number of faults, and the problem that in some countries having a test puts people at some health risk as a result of some of the equipment used, we are very sceptical of such unilateral initiatives. Although it is not a matter for me, I suspect that there will be those elsewhere in government who may wish to make representations about the matter. We have sought to avoid unilateral acts by countries that, in my judgment, simply make the problem more difficult to deal with. Arbitrary barriers to travellers offer totally illusory protection against a disease that I suspect we shall have to combat in other ways.

Turning to the question of public education, I believe that we have taken some measures that we can be proud of to slow down the epidemic and prevent its spread. The Government have spent more than £20 million since March 1986 on the biggest ever campaign of public education on a health issue. Follow-up research has shown that it has greatly increased awareness of HIV and AIDS and public understanding of how it is and is not spread. It is just as important that people should know how it is not spread as how it is spread. We want to avoid problems in the workplace and some of the happenings in the United States. I remember one youngster in the United States who acquired the virus from a blood transfusion and was treated most disgracefully at his school. People must know how they can contract the disease, and equally they must know how they cannot.

Politicians are not always grateful to the media, but I am. The media have played their part in ensuring that a wide range of facts about AIDS have come forward, not all of which have been entirely accurate although much has, and that has been most welcome. We are now at a critical point. The initial impact has begun to wear off and apathy must not rule. Familiarity must not breed indifference. That is why we look to the Health Education Authority, in association with health education agencies in Scotland, Wales and Northern Ireland, to carry forward the development of a United Kingdom- wide public education campaign. We hope that the Health Education Authority will be able to develop strategies that will command the support of all hon. Members. The aim is to ensure that the policies could be conceived outside the Government machine to avoid any mix-up of criticism of the Government with criticisms of the campaign. I hope that everyone will lend their support to the campaign.

The HEA launched a new campaign just before Christmas with three aims : to influence behaviour among young sexually active people ; to encourage people to act responsibly with regard to their sexual behaviour ; and to provide information that people need to protect themselves and those close to them. All the material will be evaluated by independent researchers to see what happens. I believe that the campaign so far has received widespread public support. However, it needs to be backed by initiatives targeted at particular sections of the population. I attach special importance to giving youngsters inside and outside school the facts about AIDS

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and a healthy lifestyle. That is a key part of preparing them for some of the difficult choices that they will have to make in future. Just before Christmas, we launched the latest phase of the Government's anti-drug campaign which focused on the dangers of injecting drugs. I hope that the vividness of those advertisements has struck a chord with my colleagues. We will continue to tackle the problem of drug misuse with the greatest determination because the fewer injecting drug misusers there are the smaller will be the chance of HIV spread among them and from them into the wider community. Of course, we must be realistic. Some people will continue to misuse drugs. If they are not immediately willing or able to stop, we must ensure that they are helped to reduce the risk of infecting themselves or others.

We believe that many initiatives must be local. That is why we have asked every health authority in England to work with local authorities and the voluntary sector to develop local community-based initiatives aimed at dealing with the problem in their

neighbourhoods. We have announced £14 million worth of new money for schemes next year, and some funds have been made available immediately so that staff can be recruited or redeployed at regional level to begin the necessary planning. Each district will be expected to nominate an office responsible for the planning and co-ordination of that work.

It is no good expecting people to change their behaviour if we cannot prevent the spread of infection in health care or other settings. Obviously there are few more deeply distressing problems that we must come to grips with than the spread of AIDS to people who have used factor 8 and similar preparations. We have taken measures since that tragedy to protect the blood supply and tissues and organs donated from transplantation, and we have asked health authorities to improve their infection control. We believe that infection through blood transfusion in this country is now virtually non-existent. Of course, there is no risk whatsoever from donating blood. Information pamphlets have been directed to other groups such as tattooists and ear piercers so that they can take steps to prevent HIV spreading. I want now to refer to service development and the money that will be available next year. We made £25 million available in the last financial year and nearly £62 million this year, and nearly £130 million will be available next year. That is the scale of the increases that we think it is appropriate to make to combat the problem.

We are giving money to local authorities to encourage services in the community, and a circular is being issued today inviting each local authority in England to bid for a share of £7 million available for AIDS-related social services expenditure with grants on the usual 70 per cent. basis, with local authorities meeting 30 per cent. of the costs from their general revenue. The money will be targeted particularly on the 25 local authorities which currently face the greatest AIDS-related demand.

We have told regional authorities how we intend to disperse the remainder of the £130 million. North West Thames regional health authority will continue to receive the lion's share--more than £36 million--because it has nearly 800 AIDS patients already. The other 11 regions will receive allocations as best as we can grant them which best reflects the problem in their own communities. We are

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also including a substantial new element, not just to treat AIDS patients, but to build up services which play a crucial role in preventing the spread of HIV.

I expect that at least £68 million will be spent on providing services for people with HIV infection and AIDS. Of the remainder, more than £50 million, I expect health authorities to build up services to prevent the spread of HIV by spending money on local prevention initiatives, genito-urinary medical services and drug misuse services. We are talking about quite substantial sums of money, I am glad to say.

We know the extent of the drugs problem. It is not simply a Scottish problem as 26 per cent. of those tested at the St. Stephens drug dependency unit have proved seropositive. The disease is spreading. We established 14 experimental needle exchange schemes in England and there are now 60 schemes in all the country. If injectors cannot be persuaded to stop, in the interests of individual and public health we must do everything possible to stop them sharing. Hon. Members may have noticed that the final report from the research team evaluating the needle schemes was published yesterday. It shows that schemes are quite successful at attracting injectors, although not perhaps so good at keeping them in regular contact. They are attracting people who otherwise would not have contacted drug services and they are helping some people to stop or reduce sharing. As someone who was very much in favour of those experimental schemes during my time at the Home Office, I am glad to see that the researcher considers that, although the schemes have limitations, they can potentially make an important contribution to preventing the spread of infection. We are considering the report to see what more we need to do, and I dare say that my colleagues will want to comment on it because, in the past, the policy, although I believe the right one, has been controversial.

We also want to expand accessible advice and treatment services where drug misusers can receive help with their drug problem and reducing their risk of contracting HIV. Substantial additional resources both north and south of the border have been made available for that this year.

We are particularly asking health authorities this year to strengthen their genito-urinary medicine services. That is the term given to the old VD clinic, the Cinderella service in so many hospitals. We believe that Cinderella must be put behind us because those services have a vital role to play in combating the spread of HIV and AIDS. Their clients include many people who are most at risk because their behaviour has led to sexually- transmitted diseases and because of the evidence that I have already mentioned that the transmission of HIV is more likely to take place if people are infected with some sexually-transmitted diseases.

We must remember that, in the past five years, some 2 million people contacted genito-urinary medicine clinics, so we are not talking about a small number of people. The workload has been rising significantly. It is a crucial service and it is under pressure. However, it should not be hidden away in places that might not be seen by patients as attractive places to visit or by staff as good places in which to work. In order to assess whether the clinics are playing a key role, the chief medical officer asked a small team to carry out a study of the current and forecast workload. The report has now been received and makes specific

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recommendations about resources, siting, quality of accommodation, manpower and training of staff. The recommendations show that health authorities will need to give much higher priority to the services. We accept that, and I am pleased to be able to say that we look to the health authorities to take full account of the report in using the new resources that have been made available. The services need to be improved to benefit those who use them now and in the future. I am sorry if I have spoken for a long time because I know that many of my colleagues want to speak. However, there are many other points that I could make. In conclusion, I want to draw attention to the work of the Overseas Development Administration. It has committed over £16.5 million, through the World Health Organisation, other non-governmental organisations and research workers, to support programmes to help to understand and contain the spread of AIDS in developing countries.

International co-operation on AIDS is not optional ; it is a necessity, as it is in many other areas. That is why the Government and, I am sure, the House, are pleased that last year we sponsored, with the WHO, a world summit of Health Ministers on programmes for AIDS prevention. We want to continue to take the lead in that. I look forward to hearing the views of hon. Members. I hope that what I have said establishes some new points which may be helpful to my colleagues when shaping their contributions. The Government have tried to take the lead in publicising the threat of AIDS and helping the development of services to combat it. Obviously, there is a limit to what the Government alone can do, and it is only by continuing to work with the voluntary bodies, local authorities and so on and by individuals taking personal responsibility that we shall make progress in defeating AIDS.

If two years ago the message was, "Don't die of ignorance", today our message is, "Now you know the facts, act upon them".

10.12 am

Ms. Harriet Harman (Peckham) : I welcome this opportunity to debate such an important issue and I thank the Select Committee on Social Services for the report it produced in 1987 which stressed that we need regular debates on AIDS.

The Minister has given the House the benefit of a useful description of the spread of AIDS. However, preventive and community services remain inadequate in most areas and non-existent in some. Unless we prepare a network of support services, including housing--which I was sorry that the Minister did not even mention--we shall inevitably drift towards the situation that now exists in the United States where AIDS sufferers are dying on the streets. The Government must sharpen their approach to education on AIDS. The increase in AIDS among young people means that conveying the message to school children is especially important. The Government have made that more difficult in two ways. First they have allowed schools to opt out of providing sex education to pupils and, secondly, they have made it more difficult to discuss anything to do with homosexuality by passing section 28 of the Local Government Act 1988.

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I should like to put into context the sums of money announced by the Minister. Michael Adler, professor of genito- urinary medicine at Middlesex school of medicine, estimates that, up to 1992, cumulative costs of AIDS to the health services will be between £134 million and £1.4 billion. As the Minister said, the pivotal services are genito-urinary medicine, drug dependency services and community services, which are now and have been for many years,

underfunded--Cinderella services. Therefore, we are building from an underfunded and inadequate base.

We cannot meet the unprecedented public health challenges that AIDS presents if we drip-feed small sums into the system. We need to plough into the infrastructure, especially into the services that I have mentioned, substantial sums which must not be clawed back from other services. I hope that the Minister will guarantee that the sums he mentioned today will be fresh money from the Treasury and not snatched from somewhere else in the Health Service.

The Minister said, and I welcome it, that he recognises that the problem of AIDS relates to men and women, and that heterosexual transmission is likely to spread the problem to all regions. I should like to draw the attention of the House to a plan produced in an article in the British Medical Journal which shows that 44 Edinburgh drug users who attended the city clinic then shared needles in different parts of the country. They went to Oxford, Bristol, London, Cambridge, Newcastle and Manchester. Therefore, there are no departmental boundaries between Scotland and England, Wales and Northern Ireland. It must be recognised that the disease will spread into all regions and we must plan and prepare on that basis. The Health Education Authority has been charged with trying to convey the message, particularly the threat to heterosexuals. I hope that the Government and the Minister will reinforce that message by constantly contradicting reports which still appear in newspapers that stress that this is a problem only for drug abusers in Edinburgh or gay men in London. I bring to the Minister's attention an article in The Sun on 20 October 1987 written by the paper's supposed medical adviser. I give the Minister an opportunity to say that he disagrees with it. It says :

"The only people really at risk are promiscuous homosexuals and drug addicts.

The DHSS and the BMA have drummed up hysterical campaigns designed to scare heterosexuals and put us all off sex. But the facts show that they were wrong."

I hope that the Minister will say that such reports are not only wrong but dangerous. The fact that AIDS is likely to spread to all regions means that we must have a finely tuned and sensible regional distribution of funds. Will the Minister explain the regional distribution of funds? The figures that I shall give to the House were presented by Professor Maynard, director of the centre for health economics at York university. He has calculated how much each region has received per AIDS case. The northern region received £59, 500 per AIDS case as at August 1988, Yorkshire region received £52, 500, Trent £58,000, East Anglia £75,000, North West Thames £74,500, North East Thames £79,500, South East Thames £60,000, South West Thames £53,000, Wessex £62,000,

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Oxford £72,500, South Western £30,000, West Midlands £42,000, Mersey £49,500, North Western £50,000 and Lothian £20,000. We must have an explanation of the regional disparity in the allocation per AIDS case. One per cent. of all men in Lothian between the ages of 15 and 45--not just drug abusers or gay men--are already HIV positive. That is why, unfortunately, Edinburgh has been called the AIDS capital of Europe. It is hard to understand why Lothian should receive one quarter of the amount received by one London region. Either there has been some awful error, which the Government must undertake to put right, or there is a more sinister motive. I hope that it has been an error and that the Government will announce that they intend to correct that inequity of distribution.

Mr. Jessel : Is the hon. Lady aware that some people who are infected and who need treatment for the disease will come into regions such as North West Thames, which covers the centre of London, to obtain treatment? There is, therefore, not only the cost of that treatment, but the cost of treatment for patients suffering from other illnesses and who need operations, who might otherwise be displaced. Why should not authorities such as North West Thames have a larger share per case of available resources?

Ms. Harman : I am not criticising the levels in the London regions, but the low level put into other regions, particularly Lothian. The argument that was put so cogently by the hon. Member for Twickenham (Mr. Jessel) about people coming into city centres when the problem is discovered applies to Edinburgh as well.

Either the Government must correct their mistake or there is a more sinister motive underlying the imbalance. I have listened time and time again in the House to Ministers complaining about the amount spent on health services in Scotland. When I saw the figures, it occurred to me that the Government might be trying to level down health spending in Scotland at the expense of AIDS patients. If the Minister has another, innocent explanation, such as that a mistake has been made that he would like to put right, I hope that he will say that to the House. I hope that he will not submit to the temptation to rubbish the figures or to say that he does not know about them. The figures were given by Professor Maynard at a conference at which the Minister himself spoke, so if he does not know about the figures it can only be because he did not listen to the other speeches.

Mr. Mellor : I am sorry to hear the hon. Lady playing to the Scottish gallery and making essentially spurious points. I shall ensure that the hon. Lady is advised by the Scottish Office about the details. She would be the first to complain if English Ministers were responsible for running policy for Scotland. A substantial amount of resources are available in Scotland. The hon. Lady should bear in mind one figure that appears to have escaped her. I said nothing to imply that I underestimated the size of the problem in Scotland. The problem there is large, and requires a large amount of effort to be devoted to drug-related issues. However, as of December, the number of full-blown AIDS cases for the National Health Service to treat in the whole of Scotland was 75. In the North West Thames Region alone, there were nearly 800. I should have thought that she would see that one does not have to reach for McCarthyite explanations to see why that amount goes to the North West Thames Region.

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Ms. Harman : I gave figures not for the total amount for each region, but for the amount per AIDS case for each region. It is a pity that the Minister has accused me of playing to the Scottish gallery in expressing that concern. The health problem of HIV and AIDS in Scotland is a problem not only for Scotland, but for the rest of the United Kingdom, because of the transmission of the disease, which I have previously explained. I await, with interest, a further explanation from the Minister. I am not the only person to be concerned. My concern is prevalent among those who are involved with AIDS and AIDS services in the country as a whole.

I welcome the emphasis that the Minister said that he placed on education, and sex education especially, because, as he said, we are no nearer to a cure. He also said plainly and straightforwardly that youngsters must have the facts about AIDS, and I endorse that fully. With the spread of the disease among young people, the message for school children is especially vital.

I endorse wholeheartedly the Social Services Select Committee report on AIDS. It said that sex education and education about AIDS must be given to all school children. Yet the Government introduced the Education (No. 2) Act 1986 to allow schools to opt out of providing sex education. It is extraordinary that at a time when sex education and public health education about sex have never been more needed by school children the Government have provided an opportunity for such education to disappear from the curriculum.

I hope that the Minister, who is charged with dealing with the spread of AIDS, will agree that that is disastrous. Will he monitor the situation? I should like to know how many schools are opting out of providing sex education in the curriculum and, of those schools that are providing it, how many are informing the pupils about AIDS. The Minister needs to do more than simply endorse such education ; he must find out what is happening in schools. It is not enough simply to quote, as he has in the past, the number of education authorities that have appointed AIDS officers. We need to know the number of school children who are receiving the AIDS message. I hope that he will confirm to the House that, if it is discovered that many schools are opting out of sex education and that a significant number of school children are missing the message, he will reconsider, with his colleagues in the Department of Education, the provision that allows schools to opt out of sex education.

The climate that has been generated by section 28 makes the task of reaching school children with such information more difficult. Those who work in schools fear that it will be difficult to find the dividing line between explaining about safe sex and promoting homosexuality. Perhaps the Minister can tell us, using examples, what the dividing line is between describing safe sex and promoting homosexuality. It would be useful for him to take the opportunity to make that clear and to reassure those who feel that they are under the shadow of section 28.

Another arm of prevention that is being directly undermined by Government policies is the family planning services, which are being cut. Those services have, for many years, played an important role in sex education, dealing with sexually transmitted diseases and providing public health information. Many women will not go to their general practitioners to discuss sexual matters or are not registered with a GP, and that is particularly the case among drug addicts, although many of them find their way

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to family planning clinics. The financial squeeze on district health authorities has been so great that many are cutting family planning services.

The Family Planning Association has said that 25 per cent. of all district health authorities have made cuts in the past four years or are planning them. In the past week, three district health authorities--North East Essex, Hampstead, and Barking, Havering and Brentwood--have proposed 50 per cent. cuts in family planning services. I hope that the Minister will acknowledge that this is the wrong time to be cutting family planning services because we should be looking to them to play an enhanced role in the fight against AIDS. I hope that the Minister will take the opportunity to stress the importance of family planning services and that he will undertake to reverse those cuts.

I welcome the fact that the Minister mentioned needle exchange schemes, but I should have liked him to go further and to recognise that experiments with needle exchange schemes show that it is imperative that such schemes are widespread. Such schemes remain limited and patchy at present and I hope that the Minister will ensure that GPs become part of needle exchange schemes. That must mean that all GPs should be prepared to care for patients with HIV or AIDS and that needle exchange schemes must be in places and operate at times that are most convenient to intravenous drug users. It is hard to overstate the importance of care in the community in relation to this issue. After the diagnosis of AIDS, the average time spent by a person in hospital is 20 per cent. compared with 80 per cent. in the community. A study by the Polytechnic of the South Bank has shown that fewer than 5 per cent. of people with AIDS are cared for by the family because of the way in which AIDS breaks up family ties and because of its prevalence in the gay community and among drug users. We have, therefore, an additional challenge to provide care in the community without a high level of family support. The Social Services Select Committee issued a strong warning about this, but I am sorry that it does not appear to have been heeded by the Minister.

In addition to meeting the needs of an ageing population, social services departments have to plan to provide care for a new group of people who need their services 20 to 30 years earlier than might have been expected. Community care will involve close liaison between health authorities and local authorities. It seems to me to be madness that, as we understand it the Government's review of the NHS, plans to take local authority representatives off district health authorities. When planning community care and the response to the growing number of people with AIDS, we should tighten the links between district health authorities and local authorities, not loosen them by taking off local authority representatives.

Because AIDS will affect all regions, all social services departments need to prepare. Preparedness is vital. The Government promised guidance about the development of local authority services, particularly social services, as long ago as April 1987, but it has yet to appear. I hope that the Minister will tell us when it will appear. I suggest that he uses the social services inspectorate. Care in the community will involve home care staff, training and recruiting new staff. The Minister should use the inspectorate to establish good practice and to develop it in all social services authorities.

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The Minister should also ensure that social services departments have the resources necessary to develop the home care services which AIDS will demand. He has mentioned the £7 million, for part of which all social service authorities can apply. That figure is just a fraction of what the Government have taken away from my local authority-- Southwark. The £7 million is derisory. If we are serious about care in the community, we need proper funding, not a pittance. We also need more resources for the health part of community care. Health visitor posts in my district health authority have been frozen. How can that authority and health visitors play a part in developing services for people with AIDS when there are not enough in post to do the present job?

I should like all general practitioners to be trained. The British Medical Association has conducted a useful pilot scheme which should be taken up as a national initiative. We do not want GPs to have to learn by experience, at the expense of the first AIDS patients they see, how to provide decent care.

There was a note of complacency in the Government's mention of community services. I had the opportunity this week to talk to Joy Roulston, the director of the Abenour Trust project in Edinburgh. It took her three years to get funding for a project involving just six flats. We should remember that Edinburgh has been called the AIDS capital of Europe. She tried to establish a project involving just six flats for pregnant women--or women with small children--who have a drug problem. It is a short-term recovery unit for mothers and, helps to establish how the children are to be cared for. It is just the sort of community-based project helping with care and prevention on which the future strategy for dealing with AIDS depends. Despite the fact that she was in Edinburgh, it took three years to get funds for the project, although the project is excellent, she says that it is merely a drop in the ocean.

A new challenge is presented for social services departments by children who are HIV positive and--or have AIDS. We must have initiatives on fostering and adoption for the children whose mothers die. If we are not prepared we shall find ourselves in the situation which I saw in New York when I visited the city last year. A drug addict mother dies homeless on the streets and her child spends its entire life in a paediatric ward of a public hospital in New York. We must learn the lessons and prepare outselves with proper community care for mothers and children.

Community care also depends on the community's preparedness to care. The community will not be prepared to care if it is poisoned by prejudice. The Government should take a lead in speaking out against those, especially in the press, who bask in AIDS hysteria. We cannot have community care and a witch hunt. The Government have to choose. I hope that they will put themselves firmly on the side of community care and speak out at every possible opportunity against the witch hunt. Sadly, I feel that the Government have fed the witch hunt through the climate generated by section 28 of the Local Government Act 1988.

I am sorry that the Government have not mentioned AIDS and housing. It is impossible to have home care

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without a home. AIDS often means a notice to quit. People with AIDS suffer a serious problem of discrimination in housing. Most people with AIDS are young, and young people are least likely to have secure housing. Even if they have sufficient income, they are often discriminated against in applications for a mortgage.

I was told by a young man from Frontliners that young single people with AIDS are able to find a hostel place only until their disease becomes visible. As soon as it is visible, it represents a notice to quit, so even substandard hostel accommodation is no longer available.

It is important for people with HIV and-or AIDS to have good housing. Good housing and healthy living can lengthen the time between HIV infection and the onset of AIDS, and people with AIDS are prone to infection, so they obviously need a good diet. They need good housing. They are also likely to need adaptations to their homes.

Many people come to London, voting with their feet against the lack of services provided in their own regions, but when they arrive they find that they are homeless, that they have spent their money on travelling and that they have no friends. Michael Adler, the professor of genito-urinary medicine at the Middlesex hospital, has said :

"I wonder whether the Department of the Environment has yet heard of AIDS."

That view is widely shared by doctors, local authorities and voluntary organisations. The Department of the Environment is failing to respond to the challenge of AIDS. The Government should take a lead in providing resources for housing for people with AIDS and in encouraging local authorities to create sheltered housing themselves and through voluntary organisations. The Government must ensure that they have the resources necessary to do that.

The Government must also spread good practice among local authorities and voluntary organisations on such issues as confidentiality and non- discrimination. I should like the Government to call in the building societies and get a bit of sense out of them in a fair allocation of mortgages for people who are HIV positive. We need a national housing initiative, as housing is an essential part of care in the community for people with AIDS. Without one, we shall end up with the situation that exists in New York, which I have described.

It is when public fear is at its greatest that human rights are most threatened. I should like the Government to take a lead and to announce that, through their strategic role in data collection as an employer and as a provider of housing and other services, they will guarantee privacy and freedom from discrimination for people with HIV. The Government are a signatory to the European convention on human rights, which guarantees privacy and freedom from discrimination. I should like the Government specifically to acknowledge that they will guarantee the entitlement to those rights of people with HIV.

Mr. Jessel : Is not the most important human right the right to stay alive? With that in view, surely the highest priority in regard to human rights is the need to stop the spread of infection?

Ms. Harman : I do not like competition between human rights. The hon. Gentleman identified an important right, but there is no contradiction between it and the human rights of those with HIV and AIDS.

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I hope that the Minister will not brush aside my proposals. They reflect wide consensus outside the House. The Minister must resist the temptation, to which I am afraid he has sometimes fallen prey in the past, to write off as party political any proposal that he has not heard of or thought up. I hope that he will join me in recognising the urgent need for a strategy that reaches into all regions and covers prevention, treatment and care.

10.39 am

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