House of Commons Hansard Debates for 13 Jan 1989

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of the spread of AIDS through the intravenous route into the drug-using community in Glasgow. I note that the incidence of AIDS among intravenous drug users in Glasgow is only 34.7 per cent., compared to Edinburgh's 60 per cent. However, I believe that the figures for Glasgow are understated because when I ask the people working in this area there, they say that street conventional wisdom in Glasgow is, "Don't go anywhere near any survey. Don't get tested. Don't do anything. Stay out of the road of the official bureaucracy." That is one of the biggest problems with the intravenous drug transmission route. The lifestyle of some 80 or 90 per cent. of drug addicts does not take them anywhere near a Government Minister or a television set. Some of them cannot even read. If they can read they are often in such a state of intoxication that they cannot comprehend the message. There is a massive problem in trying to connect with those people. It would be difficult for anyone, but I wonder whether the problem is receiving enough consideration.

Returning to the role of the voluntary sector, I do not think that there is any alternative to trying to get folk who understand what is going on in the streets, under the bridges and in back closes in Glasgow to do the necessary work. In my view, that is the only way to make any real impact on the problem.

As for Edinburgh, two things strike me more than anything else. First it is unbelievable that Edinburgh does not have a proper drugs dependency unit. I do not understand why the Scottish Office does not attend to that as a matter of desperate urgency. It may well be a party political matter, but I make the recommendation as positively and urgently as I can. Secondly, Edinburgh must have a more effective needle and syringe exchange system in the near future. I do not consider that it is effective at the moment and the Scottish Office should attend to that.

The hon. Member for Cheltenham (Mr. Irving) has said everything there is to say about prisons. He has a proud record of arguing the case for action. I do not believe that we know what the dickens is going on in prisons. The spread of the virus in prisons is a unique situation. The spread of the risk depends upon the prevalence of the infection and that depends on the prevalence of activity. It is a desperate situation and again it is a gateway to the heterosexual population and that is very worrying. I believe that the voluntary organisations should be allowed to help. I understand that there are difficulties about that. At the moment voluntary organisations are technically banned from counselling and providing training in prisons. I know that the AIDS packs have been given to prison officers and I welcome that, but I do not understand how prison officers, in the context of the relationship between prisoners and prison officers, can easily make a connection that makes any sense whatsoever.

The Home Office should consider ways of introducing help through the voluntary sector. The Terrence Higgins Trust, the buddy system and the whole works should be turned on the prison system in an attempt to stem the infection.

In conclusion, I acknowledge that the issue presents unique problems for any Government because it is multi-disciplinary. As has been said, it involves various Government Departments and is, therefore, difficult to tackle. By its very nature, the campaign seeks to initiate changes in people's sexual and other personal behaviour and habits and that makes it a difficult problem for the

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Government. It is uniquely difficult because it is a uniquely difficult medical condition to treat. I do not think that enough is being done. Every case that can be prevented will save future personal misery as well as future public expenditure. Nothing is more important than preventing the spread of the disease and we must apply more resources and engage in a more effective partnership with the voluntary sector to prevent the spread of such a dreadful disease getting further out of hand.

11.58 am

Mr. Tim Rathbone (Lewes) : My hon. Friend the Minister of State, Department of Health started this debate in a sensible and low key way, and I believe that the debate has lengthened its stride after each successive speech. That must be one of the most important elements of the debate. The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) drew attention to the dramatic threat of AIDS in this country and in the world as a whole.

The truth about AIDS is that anyone can become infected by HIV through blood contact or inheritance. I do not believe that inheritance has been mentioned in the debate so far. Everyone must be wary about that. Tests for HIV are very easy to carry out, but they test for infection only at the time of the test. If the virus is dormant in the body, it can become evident at any time. A negative test result does not guarantee absence of infection or give any idea of the risk of infection in future.

There is no cure for AIDS and no proven treatment for someone infected with HIV. There is considerable risk that a baby of an infected woman will become infected by AIDS. However, in spite of all that, attitudes to AIDS are extremely worrying and we should all welcome this debate on that score, because if nothing else happens--and I hope that much will happen--there should at least be greater awareness in the country about the threat of AIDS. The fear about AIDS seems to be a mixture of a fear of the unknown, the incurable and the unlikely. There is also complacency in the belief that other people will catch it. They are usually identified as the immoral, those who behave promiscuously, black people--because of their supposed links with the spread of AIDS in Africa--homosexuals, drug misusers, and particularly homosexual drug misusers. It may be too easy for many people to blame those groups of people and their behaviour while avoiding questions about their own behaviour. Because of that, the infection has continued to spread among drug addicts in Scotland and in England and also among the heterosexual population. I believe that there are still 14 Government-backed needle exchange schemes under which injecting drug misusers can bring in old needles and exchange them for new ones. I understand that by October last year 18,000 had used that service. However, too few of those people continue to use it. At the end of last year the statistics showed a 34 per cent. drop out rate after the initial visit and 53 per cent. after two visits. Perhaps the Minister has more up- to-date and better figures. Perhaps they are better than those I have quoted, but I have a feeling that if they are up-to-date they will show an even worse picture. I wonder whether health authority schemes based on the Government's scheme have been any more effective.

The hon. Member for Roxburgh and Berwickshire referred to the report of the Advisory Council on the

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Misuse of Drugs which was extremely important. Ruth Runciman and her colleagues should be congratulated on the report. However, the Government's first reaction to it cannot be described as anything but bland. That was corrected somewhat in the more considered reactions towards the end of last year. I welcome the Government's confirmation of the report's categorical statement that prevention of drug misuse is now more important than ever. That cannot be stated too emphatically because of the horrors of drug misuse and the links between drug misuse and the spread of HIV. I pay due deference to the activities of the all-party drug misuse group, of which I am proud to be chairman. I pay tribute to the terrific work performed by my hon. Friend the Member for Bolton, West (Mr. Sackville) in the committee until he was elevated to grander and more powerful things. I do that because he is bidden to silence now.

I also want to congratulate the Government on what they are doing under the guidance of the inter-departmental ministerial group with regard to drug misuse and its connection with HIV. I particularly endorse the conclusion in its report, which was repeated by the Government, that effective and extensive education programmes are the most important influence on reducing the chances of people trying drugs and reducing the risk of the spread of AIDS.

The threat of AIDS overtakes even the miseries and threats of drug misuse. I am concerned that the Government have damned the advisory council's report with too faint praise and have shown too little willingness to embrace more wholeheartedly the report's recommendations to minimise HIV risk behaviour, despite the Government's more considered reactions that I mentioned earlier. The day has now passed for the preparation of services "as necessary"--as the Government's reaction said--to reduce the risk of AIDS associated drug misuse. The report reads :

"In all areas, substantial further expansion of drug misuse services will be necessary if services are to reach more drug misusers, and play an effective role in curbing the spread of HIV." That means we should have more community-based services, more hospital-based services, more generic services and, above all, a better understanding of the problem among general practitioners. They should provide better services immediately and the Government must provide funding for that and for their education. This is a question of life and death for an increasing number of British people. Some hon. Members have mentioned the special problems in Scotland and in prison. They require special and urgent attention and must not be pushed aside. The problems are serious in themselves and also pose a threat to the rest of the country as people move from Scotland and as prisoners return to life in the community at the end of their sentence. The problems of drug misuse show no signs of diminishing and deserve our continued positive attention.

The question of funding must be raised in this context. I shall give three small illustrations of the way in which the shortage of funds can affect work at the grass roots. First, I spoke yesterday to the London Lighthouse, which is run by the Terrence Higgins Trust. It has 28 or 30 beds available but, unfortunately, it is using only 18. That is

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because of a combination of the lack of pounds available to maintain the beds and the lack of trained nurses available to man the London Lighthouse.

Secondly, before coming to the debate I and my colleagues who share constituencies covered by the Eastbourne health authority attended a meeting with the regional chairman of the South East Thames health authority to inquire of him why his health authority has to carry out its work, including that involving drug misuse and the treatment of HIV, when it is funded to the extent of only 85 per cent. of the resource allocation working party's recommendation. That is the dramatic figure that a well- run, extremely efficient and thoughtful health authority has to work to because of a lack of Government funding for the region.

Even though the Government made £3 million available to regional health authorities last September to prevent the spread of AIDS among drug misusers and to help them make services better known and more widely available, it was not possible for the Government to help fund the East Sussex drug advisory council's trend monitoring unit--which is unique in Britain--largely because the 1983 drugs initiative fund had already been used up. The strategic approach mentioned by many other hon. Members is necessary.

There is a tradition of commitment to intersectoral co-operation within Brighton health district on drug misuse, AIDS and HIV infection. The co- operation between statutory and voluntary agencies has developed well. That is just as well because, in East Sussex, there is a significant drugs problem. East Sussex, tragically, has one of the highest notification rates per million of population in England, after London, Manchester and Liverpool. Many clients are poly-abusers of heroin, amphetamines, cannabis, minor tranquillisers, alcohol and cocaine, and for that reason, the drug advice and information service was set up in Brighton, funded by the Brighton health authority. It has been found that the awareness of the risks of HIV infection among drug users is extremely high. It was highest at the time of the Government's previous media campaign, but seems to have declined since, although such campaigns seem unlikely to change people's behaviour for any time. That was illustrated by the study on the illicit use of drugs in Portsmouth and Havant which was published last year. The drug advice and information service produced an excellent leaflet on AIDS and drug users which has been distributed among voluntary organisations and general practitioners, as well as through Department of Health channels. It is also of note that the drug dependency unit in Brighton has appointed a full-time member of staff to work specifically on preventing the spread of HIV infection among drug users.

East Sussex has also taken advantage of the educational support grant initiative to appoint a co-ordinator for drugs education in primary and secondary schools, further education establishments and youth services, although, as was said earlier, it is not so much the appointment that is important but the way in which it leads to more pupils acquiring a greater understanding of the issue.

I hope that I have given the House an insight into how one small area of the country, which faces a dramatic drugs problem, is dealing with the joint problem of drugs and AIDS.

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I hope that what I have said will give greater encouragement to the Minister and the Government to take an even more imaginative strategic approach. Preventing drug misuse or achieving abstinence, where prevention has failed, remains the primary goal. However, HIV infection has given far more importance to the intermediate goals of attracting drug users into services and helping them to change their high risk behaviour. That is the crux of the matter, as the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said in the Scottish context. If we do that successfully, we shall prevent the rapid spread of HIV among drug users and, ultimately, among non-drug users, but additional resources for the expansion of services must be provided. The only choice is whether to spend money now on curbing the spread of infection, not only through health care but through education, social services, housing and voluntary organisations, to which the hon. Member for Roxburgh and Berwickshire and my hon. Friend the Member for Cheltenham (Mr. Irving) drew particular attention, or to spend vastly more in a few years' time on the care of people with AIDS.

I welcome profusely what the Government are doing but humbly and hopefully ask the Government to do more. If the Minister pursues the problem of AIDS with the vigour with which he pursued the problem of drugs when he was a Minister of State at the Home Office, I and other hon. Members will not plead in vain.

12.14 pm

Mr. Chris Smith (Islington, South and Finsbury) : I thank the Government for making this debate possible. I give them considerable credit for much of what they have done in response to the problem of AIDS. The British Government have been considerably ahead of many other Governments in this respect. That does not mean, however, that they are perfect, and I hope to draw attention to some areas in which improvements can be made. A good start has been made and the Government deserve credit for that.

I cannot stress too strongly how important a fair, sensitive and sympathetic understanding of AIDS and HIV infection is. Too often, the advent of this tragically life-threatening disease has been used as an excuse in the tabloid press and by some irresponsible commentators for prejudice, intolerance and abuse. Many of those who face the onslaught of the disease or the virus which gives rise to it find that they are fighting not just their potential illness but discrimination and harassment. They need care and help but often find themselves at the receiving end of blame.

We need a cure for two diseases--for HIV and for the bigotry to which it sometimes gives rise. A number of my constituents--some of my friends--are touched by the disease. Many are living with extraordinary courage with the day-to-day facts of AIDS. Some face opportunistic infections and illnesses which are painful in the extreme. All are living, struggling human beings, citizens who deserve the understanding, sympathy and help of the House and the Government.

What should the policy response to AIDS be? I shall outline four categories of concern--first, public health education ; secondly, health care and social support for

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those who are affected ; thirdly, medical research to combat the virus ; and, fourthly, tackling the discrimination to which AIDS has given rise.

The Government deserve the greatest praise in regard to public health education. They rightly identified very early on that it is the principal weapon in our armoury against the spread of HIV. I have some criticism to make of some of the advertising material, especially that in the early days, which seemed to generate more fear than enlightenment, but there has been a considerable improvement. I might question the recent decision of the Health Education Authority not to use television advertising or hoardings in its latest campaigns. Restricting advertising activity principally to newspapers does not, I suspect, reach the major audiences who need to be reached. I hope that the HEA will review that decision in the not-too-distant future.

The greatest possible credit must be given to people who work in hospitals which are most affected by the AIDS epidemic. They provide the highest possible quality health care to people affected by the disease.

The Government have set aside funds for the AIDS problem. I was pleased to hear the Chancellor of the Exchequer announce in his Autumn Statement the increased funding that he is allocating for AIDS in the coming financial year. However, two questions remain, and I hope that the Government will begin to address them. First, for example, is the only currently prescribable drug that has been shown to have particular effect against the HIV virus, AZT--nowadays known as zidovudine--available to everyone who can benefit from it? I suspect that, currently, the answer is yes. However, if studies that are currently being undertaken in the United States reveal within the near future that AZT can be especially effective when given to those who have not yet developed AIDS symptoms but are HIV positive and that early use of AZT can be considerably more effective than late use, I hope that the Government will ensure that AZT is available for use by patients who require it.

At the same time, perhaps the Government could take up with Burroughs Wellcome the cost of AZT. Pharmaceutical companies' pricing policy for drugs that can be used to tackle the HIV virus is extremely important. As drugs become more widely used and more effective, pricing and cost to the National Health Service will be extremely important.

Another health care question is whether prophylaxis against certain opportunistic infections, and especially against pneumocystis, which is the most deadly of the opportunistic infections that can affect AIDS sufferers, is available.

It is difficult to overestimate the importance of medical research. Successful research carried out now can save hundreds of millions of pounds in long-term patient care. Sadly, a cure for AIDS will amost certainly be a long time coming. In the meantime, all indications are that, within a relatively short period, it will be possible to produce anti-viral therapies and drugs that can at least slow down or, in some cases, halt the progress of the virus in an infected person. The development of such drugs is crucial. The use of drugs for early intervention, at the first moment that infection is known, to try to slow the latency period between infection with the HIV virus and the development of the constellation of infections that are known as AIDS is extremely important. I hope that the Government will direct more of their research effort to early intervention.

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I have some questions about the wisdom of the decision by the Medical Research Council to devote so much of its directed programme effort to the search for a vaccine. I suspect that a vaccine will be a long time coming, and will be found only after we have some more successful drug therapies to counter the activity of the virus. The priority should be to tackle early intervention rather than to develop a vaccine. That does not mean that we should drop all efforts in search of the vaccine, but perhaps the priority of the MRC-directed programme has been wrongly focussed in that respect. The other issue connected with research and the use of early intervention drugs is the availability of successful therapies for patients who need them. Much work is being done on a number of possibly hopeful products in the United States. Two of the especially hopeful ones are drugs known as DDI and soluble CD4. There is some sign that such drugs can be more effective than AZT. They are already under preliminary patient trials in the United States. Those trials must be done ; we must know more about the side effects and be careful about how such drugs are tested and produced. But if they are clearly shown to be effective, it is important that they be rapidly and readily made available for people infected with HIV in Britain. I hope that the Government will ensure that the time between the identification of a useful product and its provision for patients who need it is as short as possible.

Discrimination is the fourth subject that must be dealt with. The insurance industry practises a certain amount of it. Admittedly the industry has a major problem with people who are already HIV positive. We must accept that. An assessment of the risk of mortality will clearly be affected if people are in this position ; it is beginning to cause considerable difficulties with access to housing and mortgage finance. That aspect needs careful consideration in the context of housing policy over the next few months.

However, we must take issue with the insurance industry on a number of points. First, the predictions that the industry makes about the spread of the HIV infection go wildly beyond those made by Professor Cox. We must ask the actuaries precisely where they get their information and ideas about future spread from. It is on that information that they base much of their premium accounting, and I do not think they have got it right.

We must also tackle the insurance industry about its treatment of the groups in society who have become known as high risks. The message that we need to give the industry is that, with HIV, it is not membership of a high -risk group that matters as much as high-risk behaviour. The difficulties that young single men experience in obtaining life insurance stem from a misconception on the part of the insurance companies about the nature of the virus and the ways in which it is spread. The questions that are frequently asked on insurance application forms about whether applicants have sought counselling for AIDS or have been tested for it, and the deductions made by the insurance companies based on their answers, are particularly dangerous. They act as a deterrent for those who should be going to get tested. This will become especially important if, in the near future, it becomes obvious that a product such as AZT can be especially effective in the early stages of infection. It will then be especially important for people to come forward and identify themselves for testing at the earliest possible opportunity. If insurance companies' deterrent actions make it difficult for an applicant to receive insurance cover

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if he answers yes to the question whether he has been tested, it will be difficult to persuade people to come forward for testing. That is a basic and simple point and I hope that insurance companies will begin to take it on board.

The secondary area of discrimination which is of great concern is employment. We know of a number of cases where an employee has been dismissed because he is HIV positive. Although some progress has been made in industrial tribunals on the question of unfair dismissal, the problem remains. A number of people have been dismissed, ostensibly for other reasons but in reality because they have been found to be HIV positive. There should be no excuse for an employer to take such action, where the medical circumstances of the person concerned are simply that he is positive, and is still perfectly able to carry on his work without any danger to his fellow employees or to the general public.

In some ways even worse than the relatively small number of cases of dismissal are the requirements that are now being made by a number of firms and organisations for applicants for jobs to take HIV tests before they can be considered for employment. I fear that a number of firms are especially bad in that respect. Texaco is the most obvious. It requires potential employees to take HIV tests, despite the fact that there is no medical reason why an employee of Texaco, who registers as HIV positive, may not be able to provide years of extremely valuable and useful work to that employer. British Airways, too, requires a similar test on its employees. The same used to apply to Dan-Air, which some years ago decided to employ only female cabin staff on its aircraft. I am pleased to say that Dan-Air was taken to the Equal Opportunities Commission because of that decision and, after a thorough and extensive investigation, a finding was made against it. Dan-Air advanced as its reason for taking that decision its concern about HIV infection among men. The Equal Opportunities Commission made its finding and Dan-Air, I am pleased to say, abandoned its policy.

I hope that other employers who are undertaking similar activities will rethink their employment practice. One of the most worrying examples of such employers is the Metropolitan police. A potential recruit to the Metropolitan police must fill in a questionnaire which contains the question that appears on insurance forms about whether one has ever been tested or counselled in relations to HIV or AIDS. That is not good enough. I am afraid that the answers that I have received so far from the Home Secretary to my questions about that practice have been unsatisfactory.

Many states in the United States have implemented

anti-discrimination legislation which makes it unlawful for an employer to discriminate against someone because of his HIV status. It would be useful if we could ensure that such legislation was put on to our statute book. I hope that the Government may give some consideration to that in the coming parliamentary Session. We need to co-ordinate our activity over a wide range of concerns affected by the threat posed by AIDS and HIV. We must consider public education, the care and the social support available to those who are infected and the crucial question of the research that has been done and

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how it has been put into practical effect. We need to ensure that discrimination does not take place arising out of the tragedy of AIDS.

The Government have made a good start on many of those aspects of the problem, but there is much more that must be done, and I hope that the Government will take further steps in many of the areas that I have outlined, because, hundreds of thousands of lives depend on it.

12.35 pm

Mr. Roger Sims (Chislehurst) : The hon. Member for Islington, South and Finsbury (Mr. Smith) made an interesting and well-informed speech. I hope to make an equally worthwhile contribution to the debate and, perhaps, to touch upon some of the points that he raised.

Society falls into four categories in the context of today's debate. First, there are those who, alas, are suffering from AIDS or the HIV virus. Secondly, there are the doctors, nurses and all those engaged in the care and treatment of and research into AIDS. They are familiar with AIDS. Thirdly, there is a number of people, such as Members of this House, medical journalists and a relatively small proportion of the community who are not professionally qualified, who have sought to inform themselves as much as possible about the nature of this dreadful disease.

Fourthly, there is the vast majority of the population, our constituents, who, I am afraid, despite the best efforts of the Government and the health education agencies, have only the sketchiest knowledge of what it is all about. They do not profess to understand AIDS fully, nor do they appreciate its extent. In fact, they do not realise the implications of it. If today's debate will do something to dispel a little of that ignorance, it will be time well spent. There is a real danger, as my hon. and learned Friend the Minister has already said, that AIDS will just come to be accepted as part of everyday life.

If public knowledge about this matter is sketchy, it is also fair to say that about us. We know how many people have AIDS and how many people have died from it. We know that, at the end of last year, there were 1,982 cases of AIDS, half of whom had died of the disease. There are about 9,603 known cases of HIV, but that does not mean that that represents the total figure. We do not know how many people are HIV positive, but the estimate is about 50,000. The comparable figure in the United States is between 1 million and 1.5 million people. It is also estimated that, in this country and the United States, up to 90 per cent. of those people will, during the course of the next decade, develop fully blown AIDS.

We must grasp the implications of this new phenomenon. For a start, new and extremely expensive forms of care are required. The Government have allocated a further £130 million over the course of the next three years to cover the cost of extra nursing care, but will that be enough? It is a substantial figure, but, frankly, we do not know whether it will be adequate. All care will not be in hospital. In this morning's debate several hon. Members have referred to the need for community care and how important it is. It is relevant to know what the Government's reaction will be to the Griffiths report. Perhaps all one can say on that is, how long, oh Lord, how long? We are to have a review of the National Health Service, and I hope that at the same time we shall have a response to Griffiths and be shown how we shall proceed.

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We know that hospices and the hospice care movement, which has become increasingly important for caring for what might be described as the conventionally dying, will almost certainly need to expand substantially to cope with AIDS victims. The Government have allocated £7 million for local institutions and voluntary bodies which, as several hon. Members have said, are so important in this context. Will that be anything like enough for the role that will face the hospice care movement?

We have heard figures of the likely number of AIDS patients and there are varying estimates of the cost of hospital treatment. Hospital treatment alone probably costs about £25,000 per patient, excluding all the ancillary expenses. It is not difficult to begin to estimate what the cost of AIDS will be to the country simply in terms of £sd. The costs could be astronomical and could seriously affect the whole development of the NHS, the plans for which we look forward to hearing shortly.

Furthermore, at a time when the proportion of people in their late teens and early twenties is diminishing, an increasing number of them will be unavailable for the work force because they will be dying of AIDS. My hon. Friend the Member for Warrington, South (Mr. Butler) spoke of the implications of that for the armed forces. Let us remember that, while the NHS and the independent sector of medicine will be faced with a diminishing pool from which to draw nursing recruits, an increasing number of those nurses will have to devote their skills to caring for AIDS patients at the expense of their other duties.

There are at least three steps that the Government must take. First, they must undertake research into treatment and cure, and that is exactly what they are doing to the tune of some £31 million. The Medical Research Council is directing a comprehensive programme, and I am not sure that I agree that it is for us to be telling it in which direction its research should go. It is satisfactory that research is going on and that sums are available for it. Recently I was talking to a researcher in this area who told me of a conference that he had attended, at the end of which a representative of the MRC asked any researcher who had a project on AIDS to tell the council what it was and the council would fund it. That paints a rather different picture of medical and other research from what we are often led to believe.

Secondly, the Government must encourage local initiatives for the care and treatment of AIDS patients. We have heard how sparse they are, and obviously they will be needed increasingly. Some voluntary organisations are particularly well equipped and experienced to provide that care.

Thirdly, the Government need to mount campaigns of education and information aimed particularly at preventing people from getting AIDS and, again, the Government are doing just that. But it is proving extremely difficult and it is a sensitive and complex area for advertisements and promotions. I am sure that initially the Government wished to aim at the whole population to try to explain the problem. In doing so they perhaps shocked people because they had to use, on radio and television and in the press, language which had not previously been used in polite circles--I put it no higher than that--and it upset many. But I am sure that it was right to do that to ensure that people were aware of the problem.

Now, rightly, campaigns are being aimed at the most vulnerable groups by way of posters, newspaper advertisements, leaflets, television and so on. The trouble

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is that, as my hon. Friend the Member for Cheltenham (Mr. Irving) has said, we need only tell people that eggs are likely to give them salmonella for everyone to understand. Everyone has had stomach trouble after eating food of one sort or another, and that is the kind of issue that the media are happy to grasp the opportunity to publicise. But how can we explain in simple terms what is meant by HIV, ARC and AIDS, when the symptoms are not specific and such symptoms as are present may be symptoms of something quite different? People may be suffering from HIV with no symptoms whatever. How can we get the facts across to young, fit men and women who are enjoying life and, inevitably, experimenting?

The "Don't inject AIDS" campaign was a good one which seems to have got across, and the current poster aimed at drug users which we see in the Underground is very effective. I am not so sure about the double-page newspaper advertisement showing someone suffering from AIDS and suggesting that 30 others probably have the virus. I do not know whether either the presentation or the wording will be understood by those at whom the advertisement is aimed, if indeed they read it. It is not particularly eye- catching. It could also be misunderstood : it could be interpreted as meaning that one person in 30 with HIV may develop AIDS. But, as my hon. and learned Friend the Minister said, there are estimates of 80 per cent. and more. Perhaps the advertisement is not ideal.

I am not necessarily criticising the Health Education Authority, or advertising agencies if they are responsible. It was a worthwhile effort. I use that example simply to illustrate the problem of putting over the facts and figures about this complex matter. The dilemma is in deciding the style and content of the message that we are trying to put across. If we try to tell people what they should and should not do, we are likely to be criticised for preaching and moralising. If, on the other hand, we speak in vague terms, we shall be criticised for not being specific.

My hon. Friend the Member for Derbyshire, South (Mrs. Currie), the former Under-Secretary of State for Health who recently left office, was criticised occasionally for saying things like, "Don't sleep around", but that is the sort of direct language that is necessary. As with so many things that my hon. Friend said, at least it got people talking and thinking. Perhaps Ministers should not preach, if by that we mean referring to personal conduct based on religious principles ; people, after all, have differing religious principles. One might hope, however, that some of the religious leaders will occasionally do a bit of preaching about this, and particularly that the Church of England will take a lead from the Chief Rabbi. Is it so wrong to moralise? Surely to moralise is to lay down what is right and what is wrong. In many spheres that is a matter of personal judgment : what is right for one person may be wrong for another, not least in matters of sexual activity. Surely, however, it must be wrong to indulge in practices that not only put the person indulging in them at risk, with all the accompanying costs to the community, but put others at risk of a long and distressing illness and premature death. Part of our education programme ought to involve moralising in that sense.

In her admirable analysis entitled "The 20th Century Plague", Dr. Caroline Collier suggested that we should bring back into prominence two old- fashioned words--chastity and fidelity. The Health Education Authority might care to consider using those watchwords in future campaigns. This problem can be controlled not by

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Government but by the behaviour of individuals. When a problem of this kind arises, people tend to say, "They ought to do something about it. What are they doing?"--"they" being the Government. The Government are doing a great deal. I hope that this debate will provide further publicity for what they are doing.

At the end of the day, whether AIDS will be controlled or contained or whether it will become the worst epidemic that mankind has ever seen will depend not on Government or Parliament but on the extent to which individuals, especially those who are sexually active or who are in the habit of taking drugs, are prepared to adapt their lifestyle.

12.51 pm

Mr. Tom Cox (Tooting) : I, too, welcome this debate and I congratulate the Government on initiating it. It has been a constructive debate on one of the major issues facing this country. I intend to concentrate solely on those with AIDS who are sent to prison and on the kind of care that is given to them while they are inside.

The report of the Select Committee on Social Services "Problems associated with AIDS', illustrates how little is being done for those with AIDS who are serving prison sentences. Recommendation 40 says : "We reiterate our conviction that prisoners who are seriously ill should normally be in hospital, not in prison".

Hon. Members who have any experience of prisons will fully agree with that recommendation. Recommendation 41 says :

"If the Departments responsible for the prisons of this country have grasped the full implications that AIDS and HIV will have for the prison system, they have yet to show it."

Those are the Committee's comments, not mine.

We do not know how many prisoners are suffering from AIDS. How can the prison authorities find out? Some sufferers may say when they go into prison that they have AIDS, but others fear to do so. In some European countries, all prisoners are tested for AIDS on reception. Although it may not be a popular suggestion, we need to consider the introduction of a similar procedure. If we knew how many prisoners were suffering from AIDS, a prison department policy on reception and treatment would have to be introduced. Many prison inmates who suffer from AIDS are treated like the lepers of old. No one wants to know. They are put out of the way and out of sight. Although the rights of prisoners in general may be limited, if a prisoner has AIDS his rights are virtually non-existent. A prisoner suffering from AIDS is not always put into a prison hospital, and in any case the conditions of many prison hospitals are an utter disgrace in this day and age. However, having seen a prison in my constituency, I pay the warmest tribute to the way in which prison staff, who work under often the most appalling and inadequate conditions, deal with the normal complaints that they have to treat. However, the treatment that a person suffering from AIDS can look for in prison is virtually non-existent. I understand that only Brixton prison has some provision for AIDS sufferers. By "provision", I mean that Brixton prison hospital has two or possibly three beds where some kind of treatment can be given to a prisoner suffering from AIDS. The sad thing is that the authorities do not seem to have any idea of the numbers.

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The vast majority of prisoners suffering from AIDS are put into single cells, away from other inmates who may not wish to have anything to do with them. They have little or no association. They exercise and eat on their own and must use only their own utensils, because, as I shall show, the prison authorities have not yet started to understand them or to give the sympathetic consideration that should be given to anyone who is suffering from AIDS and is in prison. Although I am sure that there are some sympathetic prison hospital staff who would willingly try and who would like to give care to the people in their charge, that is not true of all prison staff. I am told that some prisons refuse to accept any inmate who is thought to have AIDS. I suppose that that is because of the fear of what AIDS may do to the people who are fortunate not to have the illness.

Paragraph 92 of the report of the Select Committee on Social Services leads one to ask what is happening. However, I must pay tribute to the Minister of State, Department of Health, as have other hon. Members, for the progressive thought that he and many of his colleagues in his Department have given to this matter. I know that he was once a Home Office Minister. Paragraph 92 states : "in our Report on the Prison Medical Service we discussed briefly the problem of AIDS in prison. Lord Glenarthur assured us last year, on behalf of the Home Office that there was absolutely no complacency' about AIDS It is therefore surprising to learn that the Home Office has decided to issue protective clothing to all prison establishments for the use of officers dealing with patients suffering from AIDS. Such a reaction appears to reflect apparent ignorance of the method of transmission of the AIDS virus and of the risks to officers when dealing with such inmates."

I accept that the Minister is a sympathetic person. He and I have often dealt with issues of mutual concern. Therefore, I beg him to find out after the debate--I realise that he cannot do so during it--whether that philosophy is still operating in the Home Office. I am sure that hon. Members on both sides of the House will agree that if that is its thinking, heaven help people suffering from AIDS who are sent to prison.

We have heard a great deal about the funding that is available throughout the country. What funding is available within the prison department? What funding is available for the current year, which one assumes will end in March? What funding is proposed for next year? I understand that there is a moratorium on all prison expenditure for the current financial year. If that is true, it appears that whatever money may have been spent, no additional money will be spend on helping people and prison officers working in our prisons and on people who have AIDS and are in prison.

I share the view that has been expressed in reports that inmates with AIDS should not be in prison but should be in outside hospitals. However, I understand that that would create problems. If someone is serving a long sentence it is difficult to find a hospital that will accept such a responsibility. Therefore, it is the responsibility of the Home Office to ensure that there are modern prison hospitals with all the modern facilities that are needed to treat the disease, where patients can be kept and not treated in the way that I have seen them treated in prison. I am not quoting from reports now. I have actually seen inmates being segregated, with all the problems that that creates.

Finally, if we examine this increasing problem, as other responsible bodies including the DHSS have, it becomes

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clear that there really is hope. As other hon. Members who have not made such extensive comments about the problems in prison have said, not only will action benefit inmates who have AIDS while in prison, but it will greatly benefit them and their families and friends when they eventually come out of prison and start life in the outside world.

1.3 pm

Mr. Matthew Carrington (Fulham) : This has been a serious but depressing debate. Perhaps the least depressing part of it was the comment of my hon. and learned Friend the Minister of State that if any projects are produced for assisting with solving the problem of AIDS, it is his job to find the resources to enable them to go ahead.

The problem of AIDS is made very depressing by what is apparent from the debate and from all the literature : there is no great understanding of the disease. There is no explanation of the difference between the transmission of the disease in Africa and in America and the significant differences between what is happening in Britain and what is happening in the United States and the rest of Europe.

My constituency is in the Riverside district of the North West Thames regional health authority. The Riverside district has some of the highest incidences of people with AIDS and people who are HIV positive. My constituency contains a large number of such people, probably because St. Stephen's hospital, which is about a quarter of a mile outside my constituency, has the Kobler unit for the treatment of AIDS patients. That is partly a reflection of the number of people in inner London who are in the groups which are vulnerable to becoming HIV positive, but it is also a reflection of the fact that people who have, or suspect that they may have, contracted HIV to come to London either to get treatment or to escape from their backgrounds or from a society which may be less tolerant of people with that disease than those in London. As a consequence, inner London areas are forced to accept the enormous responsibility of looking after people who suffer from HIV and AIDS. The social services, the Health Service and council housing departments have so far tackled that task to the best of their abilities with the support of the Government who have provided considerable financial resources.

The problems facing AIDS patients have been well rehearsed in the debate. An HIV patient suffers from isolation within the community, discrimination in housing--and probably in employment--and socially at the hands of erstwhile friends, colleagues, acquaintances and neighbours. HIV sufferers also have personal problems of isolation, uncertainty and fear about the future. There was a time when it was thought that someone who was HIV positive would not necessarily develop AIDS. Although the suggestion is that there is an 80 per cent. probability that HIV sufferers will develop full-blown AIDS, the reality is that illnesses among HIV positive patients are significant even before they develop full-blown AIDS and become recognised as AIDS statistics.

HIV sufferers place excessive demands on the social services, the Health Service and the voluntary services. That demand also falls on the rest of the community. We must all be able to understand and support them. We must also be able to help people who come into contact with

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HIV sufferers to understand the problems facing sufferers and the threat that they do or do not pose to people who come into contact with them.

The Government's advertising has concentrated quite rightly on the groups in the community who are at high risk of AIDS such as drug users and the gay community. However, the message has not been conveyed that AIDS is not just a disease of the gay community or drug users. It is a disease of the heterosexual community as well. It is only a matter of time before significant numbers of people acquire AIDS not by misusing drugs, or being part of the community which other parts of the community despise wrongly, perhaps, or through blood transfusions, but have simply acquired it by leading a normal life. That message must be put over.

One of the sad consequences of AIDS that I have witnessed in inner London is the upsurge in prejudice and physical reaction against the homosexual community. That is very worrying, but is perhaps always latent in the heterosexual community. However, that prejudice has been given a reason to come back into the open again in a very distressing way in inner London.

Ignorance about AIDS is not confined to the uneducated or ill-informed. I am afraid that from the stories that I have heard from the medical school in Charing Cross hospital, problems of ignorance arise among people in the medical profession. The amount of education needed and the necessity for change in attitudes is much more urgent than was first thought.

I am more concerned about the future services to be provided for people who are HIV positive than about those provided today. No one can predict how many patients there will be in the next 10, 15 or 50 years. It is impossible to foresee the course of the disease, the percentage of infection that will occur and whether ways of controlling the spread of infection or of curing people with certain strains of the infection will be found. I suspect that, on the present evidence, it may be optimistic to speculate that we will be able to cure all strains of AIDS and HIV infection, but over time we may be able to control them.

The number of infected people making demands on the inner London health services and the voluntary services is rising exponentially and rapidly to a point where, if action is not taken now to provide care within the community, it will be too late. We shall be forced to take rushed action when the problem causes severe social tensions within the community.

People who are HIV positive experience different problems from those with full-blown AIDS. They need to be able to live a normal life in the community. People with AIDS are likely to need much more nursing care and more attention from health professionals. People who are HIV positive face housing problems which must be met. That can be done partly through hostels and sheltered housing that will allow them to live within the community but be protected and provided with necessary counselling. Those problems must be addressed now. That is difficult when we cannot predict how many people will need the resources and what types of resources they will need. However, the evidence is such that we should be making much greater provision than is apparently being made, certainly in inner London.

Anonymous testing was mentioned earlier. I understand the civil liberties arguments and I substantially agree with them. I understand that the need for research-based understanding of the spread of the disease

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is overwhelming. However, I am concerned that if the testing is left on a purely voluntary basis, people who are HIV positive and who do not understand the risks of their condition may unwittingly infect other people.

AIDS is much more serious and presents a more serious prevention problem than many other diseases. A line can be drawn more effectively than it has been so far between the anonymity of testing and being able to help people who are unaware of their problem but who will need support and counselling. Such people could be tested when they attend for a blood test or visit a hospital for other medical reasons.

Even more serious than the domestic problems of AIDS is its international consequences particularly as it affects the less developed countries, notably in Africa.

The official statistics coming out of Africa significantly understate what seems to be the reality from and anecdotal evidence of people working in the communities of east and central Africa. It is likely that the communities there are suffering badly from an endemic version of AIDS which has spread through the hetrosexual community by normal sexual activity. It is not subject to the expectations that were originally formed about the way in which AIDS would be transmitted and it is, therefore, not subject to the normal preventitive measures that can be taken to stop its transmission. I have heard it said--I suspect that there may be an element of exaggeration--that officers of the World Health Organisation are deeply pessimistic about the future of central Africa. They believe, because of the way in which AIDS has become so well established in those communities, that unless a natural response is developed within the human body to the AIDS virus, AIDS is likely to create such devastation that those countries will find it difficult to exist much beyond the next 20 or 30 years. The problem is worldwide ; it is not a problem that Africa can face or address by itself. It is not merely a research problem but a sociological problem of the African villages and way of life.

The spread of AIDS is a problem in which we, through the Commonwealth, are almost uniquely able to assist. I know that a great deal has been done through various development agencies and the World Health Organisation, but part of the difficulty that is faced, especially through the WHO, is the reluctance of Governments in those countries seriously to address the problem and to acknowledge its extent. Our Government should be examining carefully ways in which to persuade those Governments to accept the assistance that we, Europe and the United States should be able to give them so that they can provide the sociological support necessary to overcome the problem. That effort should be increased even more, although I realise that the Government do a great deal at the moment and intend to continue to do so.

The research problems connected with AIDS are part and parcel of the effort required and research needs to be supported on a worldwide basis. Although this country's research effort is paramount, our co-operation with research in the United States and the WHO must be such that it will lead to the development of the cure for AIDS which we all desire.

Several Hon. Members rose --

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