House of Commons Hansard Debates for 13 Jan 1989

Mr. Charles Irving (Cheltenham) : In the 16 years in which I have served in the House I have not become renowned for paying compliments and tributes to Ministers, but, on this occasion, I make a heartfelt exception. I pay tribute to my hon. and learned Friend the Minister of State. Since he has been in office, I have watched his progress in dealing with this awful matter. He has been courageous and has done an enormous amount in his search for resources for which he has to fight every inch of the way. I am delighted to tell my hon. and learned Friend of my appreciation. The extra money is exremely welcome, but, unfortunately, it is evident that it will prove to be nothing like enough. There has been a slow spiral from the very beginning.

It is interesting that, although the Government's education programme may be criticised--every such programme is criticised--it has brought AIDS out of the closet and into public discussion. AIDS is no longer whispered about. The more openly AIDS is talked about and the more freely views are exchanged, the greater will be the likelihood that the powers that are available to us will be taken with renewed vigour. It is important that AIDS is discussed and given proper credence as the nation faces its most serious health threat for about 400 years.

Despite my initial praise for the Government, I must stress that much more needs to be done. The Minister recognised that fact. It is extraordinary that the nation has been riveted to the front-page treatment that has been accorded by the newspapers to the so-called health risks of salmonella. As genuine as the concern may be, it pales into insignificance when compared with the problems and difficulties of AIDS sufferers.

AIDS is a scourge of the medical world. It threatens civilised life as we know it. Men, women and children are affected every day. I accept the Minister's point that the Government cannot travel alone down that path, but they must face up to their responsibilities. A national system of free condoms and needles is essential to save those most at risk.

I suspect that AIDS is rampant in prisons. I have said that before, and I believe it to be so. Rightly or wrongly, those of us outside the Home Office with our feet on the ground accept that prisons are probably one of the most fertile AIDS breeding grounds. We cannot pretend that the problem is contained within the walls of any of our corrective institutions. There is a danger that, when inmates are released, they will unleash the disease on an unsuspecting heterosexual populaton. They may not even know that they have the disease.

I hope that the Home Office will take on board the more realistic approach that its chief medical officer has privately expressed to me and to other hon. Members who have been extremely concerned, which is that we should find some dignified way of issuing condoms. Such a system prevails in other countries.

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Another distressing fact is that, on an issue of such national importance, one would have expected more than this select group of hon. Members in attendance. However, at least the nation can be sure that the cream are present.

I saw a report in The Guardian the other day about there being 10,000 HIV carriers in Britain. In a sense such figures are bunkum, because they tell us only of those who are actually known. The greatest difficulty is that nobody knows where the problem begins, where it ends, what resources will be needed, whether we will overprovide, or whether we will underprovide. Perhaps the Minister will allow me to express a note of appreciation to his Department and his colleagues who work on this sensitive issue. The figure of 10,000 is merely the tip of the iceberg. Nobody knows what horrifying situation may emerge. AIDS has claimed thousands of people who did not even know that they had contracted the disease. The first time we know about it is when they are virtually dead.

The issue is above party politics. I have visited several projects in the United States and here, just as the Minister has. On my last visit to New York, I was told that it is estimated that one in 60 children are born with the virus. That is a terrible figure, but we are still in the dark and have no idea of the true situation. The picture in California is even more bleak. One in six children may die of AIDS before they are even old enough to go to secondary school. I have no way of knowing whether those figures are correct. Unless we take the lead, a holocaust will erupt. Thank God a vital start has at least been made. The Minister has paved the way for a health education programme.

My local authority has taken an early lead. Cheltenham borough council has paid for the first mobile AIDS education caravan. I pay tribute to the chief environmental health officer, Clifford Ride, who has been a leading light all the way. We are extending the support that should be given to people in the community. The Gloucestershire county council has also responded to pressure and is pioneering major health education developments, but the burden is still falling on voluntary organisations, to whom I pay great tribute. Some housing associations have already been mentioned, and I refer to the Stonham housing association. I support the views that have been expressed. The Department of the Environment has had ample opportunity to go to the forefront and say that housing is an important ingredient in the supportive assistance that is required by sufferers. I hope that we will have the chance to put a number of questions to the Secretary of State of that Department. Housing is essential to the care that must be provided in the community.

I am sorry to say that providing housing from scratch is likely to take two or three years under present bureaucratic procedures. I hope that something will be done and that housing associations specialising in caring for those in greatest need will be given the resources to enable them to move more quickly. The Stonham association has all the administrative know-how to do just that. I want to mention one or two projects in which we should take an interest. As chairman of the Stonham housing association I say that we want to join all who are prepared to be realistic and who know about the awful harassment and inhuman treatment--and eviction--that is sometimes meted out to patients suffering from the virus. The National Association for the Care and Rehabilitation

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of Offenders is another organisation with which I have been happy to be associated since its foundation. It will soon open a small unit for women ; even before it has opened, a long waiting list has been drawn up. Both the organisations I have mentioned care and want to do something about the problems, and I associate myself with them wholeheartedly.

Local authorities have tried, but their resources are scarce. Many of their budgets have been pared to the bone. I put in a special plea to the Department of the Environment and to my hon. and learned Friend, hoping that he will be able to persuade that Department to invest more in housing projects.

A few words about the future. My hon. and learned Friend mentioned the importance of safe sex and of a programme to encourage people to recognise the dangers in which they place themselves. We must resist the persuasive siren calls of the well-meaning moral brigade, which maintains that we must pretend that extra-marital sex does not happen. More thought must be given to the free distribution of condoms. Clean needles are needed by people who have not weaned themselves off drugs, which were killers long before AIDS. I have visited many of the facilities in London. It has been a moving and tragic experience to see them run under the splendid care of dedicated people such as Michael Adler, who has already been mentioned, John Galway and Charles Farthing, to name but a few who are struggling on with few resources. My hon. Friend the Member for Plymouth, Drake (Dame J. Fookes) and I returned from these visits completely drained. We set down the views that we formulated in a report that the Minister has not yet seen.

Many organisations deserve great praise for their preventive work and counselling. I shall refer briefly to two, the first of which is the London -based organisation Streetwise. Many hon. Members will have heard of it. I have visited it twice recently ; it is anxious to provide a hostel of some sort for its clients. I do not know whether the House realises that, because of various socio-economic problems, youngsters come to London, imagining that the streets are paved with gold, from the age of 10 onwards. Young boys and girls of 11 and 12 are on the game. Streetwise picks up a large number of these youngsters and counsels them. Some want to come off the game, some do not. Streetwise has one tiny crowded room. At 6 o'clock, whether the organisation has been successful or not, all the children have to go out on the streets because there is no provision for short-stay housing. So a crash pad is vital--and it cannot wait for two years. I also had the privilege of visiting Lighthouse. I strongly recommend anyone who has not done so to visit it. My hon. Friend the Member for Drake and I were immensely impressed by the work it is doing. It is bewildering to think, given the size of the problem, that Lighthouse offers the only modern hospice of its kind in Europe. I congratulate its staff, who are backed up by a large army of voluntary workers who want nothing more than to help their fellow creatures in distress.

I strongly emphasise the need for a crash pad, not only in London, but in all our major cities.

The Minister has displayed considerable tenacity in the face of opposition even from his own Back Benchers in his

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efforts to enlighten the great British public. This is not an easy cause to espouse. Many of us who have espoused it in our communities have received unpleasant letters and telephone calls. To judge from some of them, I have neither father nor mother. Nevertheless, we believe firmly in what we are doing, and I pay tribute to my many colleagues on both sides of the House who work every week to provide what help they can and to stand up to this sort of vulgar abuse. AIDS is Britain's most rampant killer. Over the years, measures have been taken to reduce the scourges of cancer, TB, dysentry, rubella, and, lately, salmonella. It is time we devoted resources and ministerial attention to ridding our shores of AIDS.

I do not denigrate the efforts that have already been made. I hope that it is not too wild to suggest to my hon. and learned Friend, with the greatest respect, that in the next Cabinet reshuffle a ministerial post might be created with sole and special responsibility for AIDS, given the massive threat that it will pose to the nation in the next decade. The costs of sensible preventive measures taken by the Government today cannot begin to compare with those of caring for terminally ill patients later.

We have not brought out the figures but they are astronomical. The cash implications will be dwarfed by the social devastation of the continued unchecked spread of the virus. We cannot rely all the time on the voluntary organisations who soldier on with great courage. Daily they are taking in sufferers from the streets of our cities, but now AIDS is beginning to rear its head in our towns and villages.

I recently visited Tanzania, and reference has been made to Africa, where in some areas entire villages have been wiped out. I hope that we do not see anything like that here. We must act now. The Government and the House owe it to the nation's children and grandchildren. If we do not act now, thousands of people will be wiped out through ignorance. That ignorance will be a terrible price to pay for lost future generations, especially if it were proved that we, as custodians of the nation's health, had failed to respond. 11 am

Mr. Gavin Strang (Edinburgh, East) : I am grateful for the opportunity to speak at an early stage of this debate, not least because of the importance of the subject to my constituents and to the city of Edinburgh.

I am happy to follow the hon. Member for Cheltenham (Mr. Irving) not just because of his interest in and deep knowledge of the subject, but because I strongly share his general attitude towards the people who suffer from AIDS. I believe that, when the British people understand fully the facts about the disease, a majority of them will agree with the hon. Gentleman's view.

The Minister has made a valuable contribution to the debate. A suggestion has been made in some quarters that, since the debate we had in November 1986, somehow the issue is not quite as serious as hon. Members--and certainly Ministers--had viewed it then. The Minister has refuted that. This is an enormous crisis in public health. As the Minister said, it is important to recognise that this is a new disease and, although we have learnt a lot about it, we have still a great deal to learn, not least about its transmission in normal heterosexual intercourse.

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While only 1,059 have died of AIDS so far, as indicated in the Government's figures to the end of 1988, the reality is that many thousands are infected with HIV. The Government's figure is slightly higher than mine. They say that 80 per cent.--they have indicated that it may be higher--of the people infected with HIV will die of AIDS. In Germany a view has been expressed that it may be 100 per cent. if we wait long enough.

What must be understood is that what makes the disease difficult to combat is the delay between infection and development of the full AIDS syndrome. Although not much is known about it, it appears that minor symptoms sometimes occur after infection, but the average time between infection and the development of AIDS is between seven and eight years, but cases have developed between 18 months and 12 years after infection. Therefore, we cannot rule out the possibility that AIDS might develop a great deal later than 12 years after infection. The report produced by the Lothian health board under the AIDS (Control) Act--I was grateful for the Government's support in introducing that Act prior to the last election--has given an excellent account of AIDS in Lothian. I would go so far as to say that, if hon. Members would like to read a good summary of the position with respect to HIV and AIDS throughout the United Kingdom, and Scotland especially, they could do a lot worse than reading that valuable report. I was glad to hear Dr. George Bath being interviewed on Radio 4 this morning on a programme which included comments from the Minister and my hon. Friend the Member for Peckham (Ms. Harman) because he rightly took the opportunity again to spell out just how important this issue is to the people of Edinburgh. As my hon. Friend the Member for Peckham reminded us, in Edinburgh--the incidence of the virus is higher in Edinburgh than in the outlying parts of Lothian--1 per cent. of young men between the ages of 15 and 44 are reckoned to be HIV positive, which is a startling figure. To put it another way, the area with the highest incidence of HIV after Lothian is the North-West Thames regional authority, but Edinburgh has more than twice the percentage rate of infection recorded in that regional authority.

Mr. Matthew Carrington (Fulham) : I do not want to enter into a competition on statistics, but it is worth bearing in mind that for the North-West Thames region, as for other regions in London, the concentration is very much on the health districts in the Inner London area. In the North -West Thames area the concentration is very much in my own health district, which is the Riverside area.

Mr. Strang : The hon. Gentleman will know that, under the AIDS Control Act, we have not only the report of the North-West Thames authority, but the reports of each district health authority, and that point is very well highlighted. One might well make a comparison between Edinburgh and the district health authorities rather than just the North- West Thames region.

I was grateful for the remarks of my hon. Friend the Member for Peckham. We need additional resources in Lothian. I accept that we shall never have enough resources, but we have a serious problem in the Edinburgh area and we want resources to tackle that. I was interested to hear the Minister speak about the Government's objectives for the area, which are common to both sides of

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the House. He said that there was a need to build up services to prevent the spread, which of course is part of the solution. As my hon. Friend the Member for Peckham said, a lot of the resources are taken up in looking after the people who have developed AIDS. We have a tremendous opportunity in Edinburgh to slow down the rate of transmission of this virus throughout the community, especially between the injecting drug abusers and also into the wider community. I welcomed the Minister's statement about the needle exchange schemes.

Way back in September 1986 the McClelland report was published by the Scottish Home and Health Department. I shall quote one sentence from that report which was subsequently the view taken by the Government's Advisory Council on the Misuse of Drugs. We debated the ACMD report in my Adjournment debate last March. The report of the Scottish Home and Health Department said :

"On balance the prevention of spread should take priority over any perceived risk of increased drug misuse."

Of course, we want to reduce drug abuse, but the priority must be to reduce the rate of spread of HIV infection.

Mr. Mellor : The hon. Gentleman is making a most attractive speech, which I am greatly enjoying. All of us are only too well aware of the particular problems in Scotland. As I understand it, my hon. Friend the Under-Secretary of State for Scotland announced in December a further £6.5 million for AIDS-related services. That will in effect mean that those services in Scotland will have £12 million funding this year as against £6 million last year. I am sure that that will include a basis for doing much more work in the areas he has mentioned.

I also know that I can say for my hon. Friend the Under-Secretary because it is what I say to colleagues in England, that when a legitimate basis for expenditure is found our task is to find the resources to meet it. I see the AIDS budget as one which will inevitably increase as the scale of the problem increases, and money is especially well spent in dealing with many of the areas that the hon. Gentleman has identified.

Mr. Strang : I am most grateful to the Minister.

We can use money effectively in the development of more needle exchange schemes. I believe that there is a strong case for establishing such a scheme within the prison in Edinburgh, although I accept that that is a controversial point. I was interested in what the hon. Member for Cheltenham said about the provision of condoms. We are aware that drugs are used in prisons and that, therefore, there is a risk of the HIV virus being spread in that way. I believe that we still have a great deal to do in Edinburgh to establish needle exchange schemes and to make them effective.

I was interested to read the remarks of the director of environmental health for Edinburgh district council, which is responsible for the housing authority and the environmental health authority, as opposed to the social services authority, which is run by the Lothian region. The director is not persuaded that the provision of needles through pharmacies is a substitute for the needle exchange scheme. The distribution of needles through pharmacies had been proposed by a Scottish Office Minister in an earlier debate, but I am not suggesting that there is any disagreement between him and the Minister of State, Department of Health.

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Mr. Mellor : When I referred to funding I was talking about the service provision generally and what the hon. Gentleman said about the need for more to be done to deal with the spread of HIV infection. Obviously, I was not purporting to alter any of the bases of the specific issue of the needle exchange schemes. Obviously, that matter must be considered by Scottish Office Ministers and by other Ministers in the light of the evidence from the report that is now available. I am sorry to have interrupted the hon. Gentleman, but I wanted to make that point clear so that there is no misunderstanding.

Mr. Strang : I am grateful to the Minister.

I hope that when the Minister replies he will say something about the reports that have been published as a result of the AIDS Control Act 1987. In correspondence with me the Minister has said that the Government believe that it will be possible to improve the reports in future years. I was interested to read the report of the North East Thames regional health authority, which took the trouble to suggest how it thought the data in the reports could be better presented in the future. I commend that report to the Minister.

The authority suggested that the reports should be collated nationally, which was always the intention of the AIDS Control Act. We have had reports from the health boards and from the district and regional health authorities of England and Wales, and I had hoped that there would be a national compilation of them. This is only the first year in which the reports have been published and I accept that things will improve next year, but I hope that the Minister will accept that it would be beneficial if the reports were established on a more standardised basis so that there was a proper, national compilation of them.

When we discussed the AIDS Control Act we decided to place a requirement on health authorities not only to report the number of AIDS cases, but to give the best available information on the estimated number of HIV cases in their areas. The Minister's predecessor accepted the enormous importance of trying to get better information on the incidence of HIV in different parts of the country rather than working backwards from the number of AIDS cases in each area. That was the method used in the early days, but it was unsatisfactory. The Minister has accepted that the Government have recognised the need for the provision and publication of the best information obtained on the national incidence of HIV.

The main issue facing the Government at present on AIDS is prevalence screening or anonymous testing. I support the Government's acceptance in principle, of anonymous testing. We must consider prevalence screening because of the enormity of the disease. Everyone who gets AIDS dies and there is no dispute about the seriousness of it. There are other diseases, but prevalence screening is important, precisely because of the long delay between infection and the actual development of AIDS. On the grounds of measuring the Government's and the community's actions to control and reduce the rate of spread of the disease, and on the grounds of assessing how well we are dealing with it over the years to come, there is an overwhelming case for obtaining data on the incidence of HIV. We must address that issue. It has been argued that none of the information obtained from prevalence screening will be useful, but I cannot accept that. The best examples of the use of such

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information are the tests that have been carried out in New York. Every baby born in New York has the polimerase chain reaction test and in practice it is a test of the mother. The blood samples that are taken from the babies are tested for HIV and what is obtained is a good measure of the incidence of HIV infection among the mothers. There can be no doubt about the value of that information, which will increase over the years.

Of course, the information from anonymous screening is not random. If one is aware of the nature of the data and it is collected over a number of years, it is incontestable that the information obtained will be valuable to the Government and the nation in monitoring the spread of the virus. Therefore, we will know what is happening long before some of the positively tested people develop AIDS. As I have said, it can take as long as 12 years for an infected person to develop AIDS.

We must be careful about how we implement prevalence screening and it must be anonymous. People must not be allowed to opt out, however, because the value of the data would be enormously undermined if it were a voluntary test. If we are interested in receiving useful information, we must remove that element of subjectivity. We must have genuine, anonymous screening. We could, for example, take a blood sample from every women who is expecting a child or test every patient from a specific hospital for HIV.

It is crucial that such tests are anonymous and I support what the Minister said in reply to an earlier intervention. If people are to accept prevalence screening, we must ensure that there is no way that the medical staff or the technicians can find out, when a test is positive, the name of the person tested. If anonymity is not achieved, we shall not command the support of the wider community for the implementation of such a scheme.

Each blood sample must be labelled, but it is important to consider what information is put on the label. I believe that the person's sex and age should be on the label. The geographical area or the name of the hospital should also be on the label. Obviously there are complications about which the Medical Research Council must advise the Government regarding whether the label should say where the test was taken or where the tested person lives. There could be difficulties because of double testing and so on.

The fourth element that must be included on the label is the reason why a person had a blood sample taken--the reason why the person was in hospital. We need to know, for example, whether the person is a neo-natal mother or a casualty. There can be no doubt that we need those four elements, but that is all. Certainly there is no case for information on race or socio- economic group. If we put more information on the label, people will lose confidence in its being anonymous screening. I suspect that a substantial amount of scientific opinion would agree that those four elements will be sufficient to give us over a period of years valuable and important information on the incidence of HIV in the community and, thus, on the degree of spread, the rate of transmission and the success of the Government's policies in various geographical areas.

I support the Government's statements on anonymous testing. If I have a criticism it is that it has taken so long to reach this stage. The bullet should have been bitten earlier. I know that these are difficult issues and that many questions need to be addressed and I know that there are ethical considerations and that there is a need for complete

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anonymity. But when the Medical Research Council gives its advice to the Government, I hope that Ministers will give priority to proceeding on this issue.

I support the view that this should be a non-party issue, and I appreciated the support of the Minister's predecessor and the Government in the enactment of the AIDS Control Act 1987. I hope that the hon. and learned Member who has taken over from the previous Minister, who has moved to higher things at the Department of Trade and Industry, will continue the valuable support which I received from his predecessor. At the end of the day, this issue will be non-partisan only if the Government address it with the urgency that the British people know it requires and allocate the resources which the community perceives as necessary to counteract the rate of spread of the infection and to meet the needs of the tragic cases who have become infected and are about to develop, or have developed, AIDS. This is a major crisis. It is the biggest crisis in public health for over half a century. It is up to the Government, Parliament, and the community to meet the size of the challenge.

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Mr. Chris Butler (Warrington, South) : I apologise in advance because I shall have to leave the debate early to battle through our congested motorway system to a constituency engagement in the north, but I shall read Hansard carefully when I return to the House next week.

I am disappointed that so few hon. Members are present for this important debate and I wonder whether this is a sympton of the denial that is often associated with this disease. The Chamber should be full. I hope that if these debates become an annual event, which I hope they will soon, the Chamber will be full in recognition of the importance of the issue to the whole nation.

The Prime Minister, with her usual prescience, said that by the year 2000 AIDS would be the major problem facing our country. The World Health Organisation estimates that by 1991, in two years' time, 2 per cent. of the world's population will be infected with AIDS. In sub-Saharan Africa the position is even worse, with 10 per cent. to 15 per cent. of many villages and townships already infected. That will devastate both the existence and economies of those nations and nothing can be done to stop it. The damage has already been done. No longer can we write off AIDS as something foreign and across the Channel, or as something confined conveniently to high-risk groups, such as homosexuals and drug takers.

We have already heard about the experience of Scotland. I understand that the disease is officially out of control among the heterosexual population there. Nowadays the major mode of transmission world-wide is heterosexual, not homosexual, activity. I believe that in one Paris hospital 85 per cent. of patients with AIDS show no sign of contact with high-risk groups.

The Cox report, which I welcome and which points to a certain under- reporting of AIDS cases, states that, bearing in mind that under-reporting, between 19,000 and 56,000 AIDS cases are expected in the United Kingdom within the next 10 to 15 years among people who are already infected.

The report of the Institute of Actuaries produced in 1988 looks further forward. It is interesting because the whole of the insurance industry depends for its survival on

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its figures being correct, so I assume that its figures carry particular credibility. The report states that by 1994 there may be up to half a million HIV positives in the United Kingdom. That is in the high range of its estimates, but it depends on what I would suggest is an optimistic assumption that the disease will be confined to men and to homosexuals.

Mr. Chris Smith (Islington, South and Finsbury) : That is not true.

Mr. Butler : That is true and afterwards I shall show the hon. Gentleman the report. The assumption is certainly not true. So far the Government's approach to the disease has been sadly ad hoc and responsive, which is disastrous because the damage is done for seven to eight years ahead. We must be pro-active rather than reactive. I wonder where the sense is in closing some of our hospital capacity now rather than mothballing it, because if the institute's projections are right--I accept that AIDS patients will spend only 20 per cent. of their time in hospital--in the foreseeable future we may need an extra 100,000 hospital beds.

My hon. and learned Friend the Minister spoke at the World AIDS Day conference on 1 December, and I congratulate him because he went further than I have heard any other Minister go previously. I welcome the fact that he will update and publish regularly the Cox report and succeeding reports. He called for dispensing with the complacency that has characterised the debate on AIDS. He admitted that too often there was a process of denial in the approach to this disease. The history of plagues and epidemics through the centuries is of initial denial and of thinking that it cannot happen here, but it is happening.

The preconditions for success against this disease will be a belated recognition of the towering urgency and crisis that we are already facing. Information is as yet the only vaccine that we have. In the United Kingdom the public information campaign has increased awareness of the means of transmission of the disease, but sadly it does not seem to have affected behaviour among the heterosexual population. The Government's relative reticence so far has been reflected in many written answers that I have received.

The Minister mentioned that some years ago it was recognised the 30 per cent. of HIV positives would eventually develop the disease. I asked a written question on that when I was in possession of the facts of the Frankfurt and Redfield reports which show that up to 80 per cent. of HIV positives will develop the disease, but the Government gave me the figure of 30 per cent. That characterises the evasive attempts of his Department hitherto not to emphasise the threat and crisis of this disease. It is critical to our success in fighting the disease that we have the information for our "vaccine". That information is the AIDS status of the sexually active population. I believe that there is a case for mass testing. I know that people say that it might drive the disease undergound, but it is underground already. Up to 90 per cent. of those who are HIV positive do not know that they are and are infecting others unknowingly. Another objection is that mass testing would impose a considerable cost on the Exchequer, but the cost would be small compared with the eventual cost of the disease. I believe that it costs about £30,000 per patient, and I also

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believe that there will be a massive loss of productive power from the economy. I predict that one way or another mass testing will come about in this country, and we can approach it either reactively or pro-actively.

My hon. Friend the Member for Cheltenham (Mr. Irving) mentioned prisons. Prisons are a major source of crossover between the homosexual and heterosexual populations. They are breeding grounds for infection : levels of homosexual behaviour, tattooing and needle sharing are higher than those in the outside community. Prisons in the United States already bulge with HIV positives. I understand that in a New York federal prison between 30 and 40 per cent. of the inmates are HIV positive. The Spanish have tested all their prisoners and have found 18.7 per cent. HIV positive. About 120,000 people pass through our prisons every year, and even if the infection rate is half that in Spain it is clear that there could be an alarming outflow of potential infectivity into the population at large, threatening the wives and girl friends of prisoners who return to more normal behaviour patterns. By definition, prisoners have lost their civil liberties.

I believe that this is an overriding public health issue and that they should be compulsorily tested, although I accept that it should be done with full and appropriate counselling. Prisoners need the facts on which to base their behaviour, both inside and outside prison. It could be objected that prisoners' rights would be affected, but the population outside prison walls also has a right to protection against the disease.

I have heard from several quarters the call for condoms to be distributed in prisons, but I am very suspicious of such a move. The authorities would object that it condoned and perhaps even encouraged illegal acts inside prisons, but my objection is that it would be fruitless. Even the London International Group admits that no condoms are suitable for such use, and even among heterosexuals condoms fail all too regularly. I believe that the failure rate is between 12 and 15 per cent. Much of the propaganda telling people that they are safe if they use condoms misleads the public : it does not ensure safe sex.

Prisoners need a radical education programme on which to base their behaviour. Prison staff are very overstretched, and with the best will in the world I do not think that the job will be done properly if it is left to them. There may be an opportunity for voluntary bodies to become involved in educating prisoners.

Although I have not seen any reference to the defence implications of AIDS, I consider those implications increasingly important. The World Health Organisation has estimated that by 1991, two years hence, between 50 million and 100 million people will be infected worldwide.

Hon. Members should note the geographical distribution of the disease. In the middle east, eastern Europe and Asia its incidence is very low. So far, those areas contain only 1 per cent. of the total number of cases. If we are to believe the figures given by the USSR, it has only 90 seropositive citizens. My hon. Friend the Member for Lewes (Mr. Rathbone) may have latched on to a straw in the wind when he said that the USSR was now demanding testing for immigrants. Let us contrast that with the position in the United States, our major ally, where the

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disease is officially out of control and 2 million to 4 million people are already infected, 500,000 of them in New York alone. It should also be noted that the group among whom the infective pool will be concentrated are men of military age, between 18 and 50. The United States has already tested the majority of its army, and in September 1987 it found that over 1.2 per cent. of single men over 35 serving in the army were already HIV positive. The rate of increase in the United States is accelerating, not decelerating, and the doubling time of the disease fell last year to 13 months. At that rate it will not be long before an unacceptably high proportion of men of military age face premature disease and death.

I am not suggesting that AIDS is a commie plot. I subscribe to the cock-up rather than the conspiracy theory of history. Nevertheless, although it is a bleak scenario, there is the potential for military destabilisation. The eastern European countries can afford to sit back for some years, given their low rate of infection. If they then took the kind of measures that are so much easier in totalitarian countries--such as enforced mass testing, shifting of populations or internal exile--they might find it far easier than we would to control the impact of the disease.

I understand that the Soviet media have announced that 540,000 people in Leningrad have already been tested. No one can tell me that that was done on a voluntary basis. I suspect that it was enforced, and the betting is that the 540,000 were composed largely of men of military age, between 18 and 50.

We should also consider the air defence implications. The fourth international congress on AIDS in Stockholm presented a large number of papers. Abstract 8581 reported a deficiency in visuospatial processes among HIV-positive men, while abstract 8582 reported a deficiency in vigilance and verbal memory among HIV-positive men--as opposed to AIDS sufferers. Paper 8595 reported cognitive defects among United States air force HIV positives.

When someone is flying a combat aircraft, it takes only a small cognitive defect to create the potential for disaster. Flying such aircraft requires extreme precision and lightning reactions. Combat aircraft cost many millions of pounds ; an AIDS test costs about 50p. In a written answer, the Minister of State for the Armed Forces told me that he was very much aware of those abstracts, but did not intend to screen air force pilots. I hope that it will not take a future disaster to make him dispense with his reticence. Before the gutter press descends on me, may I say that those remarks have nothing to do with recent sad events.

The matters that I have discussed are covered by three, if not four, Ministries : there could be five if the Scottish Office were included. That shows, I think, that the disease is spreading its tentacles through every aspect of our daily lives. It emphasises the need for a strategic approach to the issue.

Professor Adler has called for a national commission to deal with the urgency of the disease. He has expressed his desperation about the lack of co-ordination of Government Departments. My hon. Friend the Member for Cheltenham suggested that a case can be made out for an AIDS Ministry. If we do not act now, future--perhaps

depleted--generations will criticise us. The whole history of plagues and epidemics suggests that extraordinary

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measures need to be taken. AIDS is no exception. We have a window of opportunity in which to act, but it is closing and soon it may be shut.

11.40 am

Mr. Archy Kirkwood (Roxburgh and Berwickshire) : I am privileged to be allowed to take part in the debate. I also had the privilege of taking part in the November 1986 debate.

The hon. Member for Warrington, South (Mr. Butler) made an interesting speech, and I agree with much of what he said. I agree that a national strategy is needed, but I became very nervous when he referred to testing. There are two ways in which to approach testing. One can oblige people to take tests or one can encourage them to take tests, as the Government have been doing. I prefer the latter course. I am not challenging the hon. Gentleman's good faith. We both wish to attain the same objective, but I counsel the Government to be cautious about taking up some of the hon. Gentleman's suggestions about testing.

The debate is timely. The fact that it is taking place now means that the Minister has had time to work himself into his new job. I underline what has already been said about the way in which he has responded to his responsibilities. I hope that he will continue to take the matter seriously. I hope also that the matter will not become a party political issue. There will always be differences of opinion about levels of expenditure, so I was nervous about the fact the the hon. Member for Peckham (Ms. Harman) strayed into the realms of party politics. The Minister will understand the spirit in which the comment is offered when I say that he does not have a reputation for not responding to provocation.

There is also a danger that the general public may become complacent. There is no complacency in hospital wards, research laboratories and hospices or in the counselling, advisory and voluntary organisations. I believe that there should be closer co-operation between the Government and the voluntary organisations. The hon. Member for Cheltenham (Mr. Irving) referred eloquently to the work being done by Lighthouse and other charities. It is difficult to overestimate the importance of the voluntary sector in the battle against controlling this disease. Hon. Members who take an interest in the voluntary organisations are filled with admiration not just for the work that they do and the way in which they do it but for the effectiveness of what they do. They are able--in a way that Ministers and Members of Parliament are never able to do--to warn those who are in the at-risk groups of the dangers and to suggest effective and acceptable preventive measures. They are talking on equal terms to the people whom they are seeking to help. No matter how well managed official bureaucracy may be, and no matter how well intentioned, the value of the counselling and advice given by the voluntary sector is much greater.

I give as one example of many the buddy system used by the Terrence Higgins Trust. It has provided nearly 250 buddies. It costs the trust £900 a year to finance them. They are on 24-hour call, they go out under any circumstances and they provide very effective help. There is no way in which to measure the value of the help that that organisation provides. We should recognise the quality, the quantity and the cost effectiveness of its work.

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The Government must also pay attention to important matters relating to the voluntary sector. The problem is not unique to the voluntary sector, but I understand that it is very difficult for voluntary bodies to plan sensibly over a two or three-year period and to set up difficult projects unless they know how much Government money they can expect to receive. The Treasury rules create difficulties, but attention needs to be given to that problem. I understand that the Department of Health expects voluntary organisations to make independent and separate applications to the different regional health authorities for central core funding for national activities. The £14 million that has been allocated to the regional health authorities is valuable assistance and will make a great contribution. Community-based initiatives are more effective because they are based in the community, but it is not sensible to expect organisations such as the Terrence Higgins Trust, Lighthouse, the Albany Trust and perhaps Streetwise to spend time, effort and resources on making individual applications to the regional health authorities for assistance. The national voluntary organisations should be allowed the privilege of making a once-and-for-all application. They should not have to run about the country trying to obtain core funding.

I was interested in what the Minister said about the Cox report. It is a valuable contribution to the debate. The recommendations are sensible and provide a basis on which to make plans. Does the Minister intend to use the Cox recommendations when planning financial increases? They are very substantial--38 per cent., 28 per cent. and 24 per cent. over the next three years. I know that the Minister has to fight his corner against the Treasury, but he said that he intends to use the Cox report as the basis for his Department's work. Does that extend to applying for additional finance?

There has been some difficulty over the advertising campaigns. I appreciate that it is not easy, particularly for a Conservative Government, to engage in some of these necessary advertising campaigns. Will the Minister consider involving the voluntary organisations in the planning of those campaigns? Their insight into the problem is special ; they live alongside the problems that are experienced by the at-risk groups. It would be foolish not to allow them to take part in the valuable work that is already being done by the Health and Education Authority on a consortium basis. That would make it easier for the Government because if there were controversies they could say that it is not just down to the Health Education Authority--it involves the voluntary groups also.

When I visited the Terrence Higgins Trust I was slightly disappointed to discover that it could not run its valuable telephone helpline service for 24 hours a day. When I made my last visit to its premises, it had just finished a pilot project and had found that the telephone helpline could provide a valuable service in the hours when it is now shut down. At present it is operational for only certain parts of the day. A strong case can be made about that, because the Terrence Higgins Trust did the most valuable initial work to assist the homosexual group when it started to suffer problems from AIDS. I was interested to find that the trust now assists a wide range of groups. When I was there the trust advised some people who were inquiring about whether the AIDS infection could be spread through the

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Church and its use of the common cup. The trust is making a valuable contribution through its helpline service to others as well as the homosexual interest group.

My next specific question for the Minister may be a little unfair so perhaps he will write to me about it. I am a little disturbed by the experience of the AIDS Health Education and Advice for the Deaf organisation. There seems to have been a bit of a bog-up somewhere in the bureaucracy. That organisation provides specific help on AIDS for those who are deaf. Its general secretary, Mr. Peter Jackson, was told just before Christmas that the core funding was being withdrawn. Will the Minister look at that matter and see what he can do to put it right?

I should like to spend the last few minutes of my speech dealing with Scotland because part of the focus of the debate has been the position north of the border. I pay tribute to the work done by the hon. Member for Edinburgh, East (Mr. Strang). His private Member's Bill was a valuable contribution. We now have the benefit of some of the reports made under that legislation. The hon. Gentleman has made a valuable contribution, but I would expect nothing else of him knowing how interested he is not just in his own constituency, but in the city of Edinburgh.

It is a stark fact that in 1983, when I was elected to this House, as far as we were aware no intravenous drug users in Edinburgh were infected. Now, 50 per cent. of intravenous drug users in the city of Edinburgh are infected. Those statistics frighten me to death. The hon. Member for Edinburgh, East referred to the remarks made on the radio this morning by Dr. George Bath that currently 1 per cent. of the 15 to 44 age group in that city is HIV-infected. That figure scares the pants off me. Some medical authorities have predicted that by the middle of the 1990s AIDS will be the biggest killer of young men in that age group in Edinburgh. We cannot ignore that. The hon. Member for Edinburgh, East also referred to the McClelland report. I know that this matter is not directly in the Minister's brief and fully understand why we do not have a Scottish Office Minister present although I am sure that the report of the debate will be studied in the Scottish Home and Health Dept. The McClelland report was left unattended for too long.

I was interested to see the report by Mrs. Runciman, who chairs the Advisory Committee on the Misuse of Drugs. The report says : "We are deeply concerned that many of the McClelland report's recommendations have not been acted upon and we consider that vital time has been lost in tackling the spread of HIV in Scotland. We emphasise that many drug misusers are mobile"--

that point was emphasised by the hon. Member for Peckham, and I agree with it-- "and that failure to curb the spread of HIV in Scotland will inevitably lead to the virus spreading more rapidly throughout the UK and beyond. HIV infection in Scottish drug misusers is not a problem for Scotland alone. it is a problem for the UK as a whole."

I agree that the response to the McClelland report has been too slow. To date, not enough of a lead has been given and until December there was a distinct lack of resources. Indeed, there is still a need for extra resources.

In our debate in November 1986 I called for condoms to be freely available in surgeries, clinics and at chemists. I intimated that I was deeply worried about the possibility

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