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Mr. Deputy Speaker (Mr. Harold Walker) : Order. I can see five hon. Members who have been here for the whole, or a substantial part of the debate. I understand that the House would like to hear the Minister reply to some of the points that have been raised, so that gives us about 60 minutes before the Minister will seek to catch my eye. The arithmetic is obvious.
Mr. Alan W. Williams (Carmarthen) : I congratulate the Government on deciding to introduce routine anonymous testing. It is an important and courageous step, which has been advocated for several years.
It is important to establish the prevalence of HIV in this country. We know that there are about 10,000 cases, but some estimates are that the figure is nearer 50,000 and, possibly, 100,000. Anonymous testing will give us information about the regional breakdown of those figures, the age profile and the numbers of men and women infected. It is an important step and will mean that all the resources that are chanelled into public education and local authority support in this epidemic will be used more wisely. It is frightening when one realises the prevalence of the virus. In December, the Minister said that up to 25 per cent. of homosexual men in London have the virus. We have heard that half the drug addicts in Lothian region are HIV positive and that the virus has spread into the general population to the extent that 1 per cent. of men aged between 15 and 44 carry it.
The Cox report, which was commissioned by the Government, projects that there will be between 10,000 and 30,000 AIDS cases by 1992. That is up to 15 times the present level. It is significant that the estimate is that one third of those will be heterosexual. AIDS has broken into the heterosexual community and once there, its spread will know no bounds.
A news feature in the United States a couple of weeks ago found that, of a sample of 1,100 children, prostitutes and others who live on the streets of New York, 74 were HIV positive. That is 7 per cent. of the total. The Centre for Disease Control in the United States says that, by 1992, a total of 263,000 people in the United States will have died from AIDS. That is just three years away. Some 1.5 million people carry the virus in the United States. They will die of AIDS before the end of the century. We are talking of an epidemic of historic proportions.
I listened carefully to the hon. Member for Fulham (Mr. Carrington) when he spoke about Africa. It is estimated that 15, 20 or even 40 per cent. of the population there carry the virus. The problem is truly heterosexual there. Half the carriers are men and half are women, and most are of working age-- the population on which the economy depends. The hon. Gentleman speculated about whether some kind of human resistance might develop. I am pessimistic about that possibility. A study of prostitutes in a district of Nairobi found that 85 per cent. of the 1,000 people tested were HIV positive. In the light of such figures, it is clear that everybody is vulnerable. The World Health Organisation estimates that 400,000 people will die of AIDS this year and next, and that between 5 million and 10 million are already infected. We have already heard a wealth of statistics, but it is clear that AIDS is the greatest threat to human health this century. That is widely acknowledged to be the truth, so what are we doing about it?
Column 1147The only real hope--the only chink of light --must come from research work. I was a research scientist and have brothers who are medical researchers. One has been involved in AIDS research. I am, therefore, interested in the size of the Government's budget for research work on AIDS--£7 million this year for the Medical Research Council's directed programme.
AIDS is the greatest threat to human health this century, but how much are we spending on finding a solution? Only £7 million out of an NHS budget of £20 billion. It works out at 0.03 per cent. of our Health Service resources. Frankly, that figure is pitiful. During the summer, I wrote to the Minister's predecessor, asking for a much greater research effort. The answer was that the Medical Research Council was getting all the funds that it had asked for. I cannot believe that. However, if that is the case, the Government should be proactive and point out their concern to the Medical Research Council and the medical community, and ask the MRC to put much greater emphasis on AIDS research.
Next year, the budget will increase to £14 million. That is a doubling of the allocation, but it is only keeping pace with the spread of the disease. The figure for 1992-93 is £16 million. The figure is doubled for this 12 months, but it will be static after that.
Mr. Williams : I hope that the Minister will take up that point and give me an assurance that, in 1990-92, the budget will at least double every year, in step with the spread of the disease. The AIDS research budget in the United States is over $1 billion. We should compare our £7 million with the £600 million that is spent in the United States. Their research effort is literally one hundred times greater than ours. Our research effort needs to be stepped up tenfold immediately, and doubled every year in line with the spread of the disease. That is our only ultimate chance of finding a vaccine or improved drugs to slow the progress from HIV to AIDS.
Another main aspect is public education and the Government's efforts in that regard. Two years ago, leaflets were distributed, and there were television and newspaper advertising campaigns. It was on a far too small scale. It is not enough to hit people just once with the message. The message must nag people all the time. Until we find a cure--we may never do so--the only message that we can offer is that people must change their behaviour. For the next 10 years, it will come down to individual behaviour.
We have heard that the public education budget for local authorities is about £14 million. To the ordinary person, £14 million sounds like a lot of money, but when we divide it among our 650 constituencies it works out at £20,000 per constituency. That means that each constituency has the equivalent of one full-time worker trying to stop the greatest threat to human health this century. That is the extent of our defence--just one person per constituency trying to tell young and sexually active people to modify and control their behaviour. Again, it is a case of far too little. When the history of this chapter is written, it will be seen that, as with many environmental problems, our action was too little, too late. I end by quoting my right hon. Friend the Member for Chesterfield (Mr. Benn), who, in one of our parliamentary
Column 1148Labour party meetings, said as a throwaway remark that AIDS was a greater threat than the Red army. It is worth dwelling on that remark, because I am persuaded that it is true. Between now and the turn of the century far more British people will fall victim to AIDS than to the Red army. Our defence budget is £20 billion a year ; our research budget for AIDS is £7 million a year. I ask the Government again to start thinking hard about the scale of the problem--and in a proactive way. Politicians think in terms of economic growth of 2 or 3 per cent. a year ; if it is as high as 4 or 5 per cent., we lose control, as the Chancellor has done. Unfortunately, AIDS is growing by 100 per cent. a year and seems likely to continue to do so for several years. So we must think in those terms.
I ask the Government to devote 10 times as much money to research, to local authorities and to public education, and to remember the regrettable fact that the budget needs to double every year. 1.31 pm
Mr. Barry Field (Isle of Wight) : I look forward to welcoming my hon. and learned Friend the Minister on his first visit to my constituency in his new role. We shall show him many areas of health care on the island. One of the few that receives publicity is the fact that the Isle of Wight is a favourite holiday resort of haemophiliacs. We stock larger quantities of Factor 8 than do most district health authorities. The tragedy of tragedies in all this, as evidenced in this sensitive debate, is what happened to those who received infected donated blood and Factor 8.
The Isle of Wight is not a constituency primarily at risk from AIDS. Representing one of the largest and oldest populations in the country, I suggest that its incidence in our community is low. But we have three prisons, and I promised in my election manifesto that I would campaign for a change in the law to make screening for AIDS compulsory in our prisons. I could not possibly go as far as the hon. Member for Tooting (Mr. Cox) went ; he said that no one who seemed to be suffering from AIDS should have to stay in prison any longer. I included the promise in my manifesto not by way of censure but as a helpful contribution to the psychology and running of our prisons. I pray in aid the report of Her Majesty's chief inspector of prisons on Her Majesty's prison, Parkhurst. It is the only national prison surgical unit in the United Kingdom and receives prisoners needing surgery and treatment from all over the country. The report is dated 30 November 1988, and paragraph 3158 reads :
"We recommend that all inmates undergoing surgery should have routine blood assessments for Hepatitis B and HIV. Apart from emergencies, surgery should not be undertaken unless the inmate consented. Failure to observe this in the private hospital sector has already led to successful litigation."
I suggest to my hon. and learned Friend the Minister that that is a clear indication, from the highest level within the prison service, that there are misgivings about the fact that prisoners are not currently being tested for AIDS.
There was a recent tragic case on the island when a person died in Parkhurst prison. I know that it will come as no surprise that the individual was known to be a male prostitute, who was probably HIV positive, but during his time in the prison he would not allow a blood sample to be taken. As a result of his death, which occurred, sad to say, by hanging, it came to light that the Home Office's principal forensic science laboratory at Aldermaston does not have a policy for dealing with HIV positive specimens
Column 1149which are sent to it. I consider that that is a major omission in the campaign against AIDS and must raise some serious issues about undetected homicide. Of course, death in custody is a serious issue and we should always be sensitive in establishing its cause. My hon. and learned Friend may tell me that these matters are not for him and his Department. I understand that the island's pathologist declined to carry out a post-mortem and that the director of the forensic science laboratory, Mr. Neylan, entered into quite considerable correspondence with the island's coroner. Mr. Neylan stated that whether samples sent to the laboratory would be analysed depended on a system of volunteers to carry out such work. To say the least, that is an extraordinary state of affairs. However, I take Mr. Neylan's point that, in having to deal with these samples, the individual staff are put at considerable risk over a much longer period than perhaps would normally be the case. It was summed up very well by the coroner when he said :
"My personal view of these matters is that it cannot be right to put a life at risk merely to discover why another life has expired." That is probably a wise comment.
My hon. and learned Friend may suggest that these matters are not for him, but I draw his attention to one particular point. His Ministerial colleagues have a duty to discharge their
responsibilities for the collection of information for the Office of Population Censuses and Surveys, and those duties include the registration of deaths and the analysis of the causes. I wonder how the Department can be discharging that duty if the principal authority required to look into the forensic medicine side of pathology is unable to deal regularly with the samples that are sent to it.
As I have said, my call for compulsory testing for AIDS in prisons was not a matter of censure. There are two separate categories of prisons. On the one hand, there is the high security prison, where the prisoner faces a long sentence with no chance of remission or returning to life in the normal world outside, and where feelings and tension can run high from time to time. On the other, there is the low security prison where there is a vast turnover of inmates, who include a high proportion of drug addicts and male prostitutes. I sincerely believe that the psychological regime in our prisons would be considerably improved if there were a system of compulsory testing of prisoners for AIDS. In the tragic case to which I alluded, the coroner and the staff of the forensic science laboratory would have been in a better position to make a decision had they been able to refer to records, which had been available since the man first entered prison. For that reason I included in my manifesto the commitment for such testing, and I shall continue to campaign for it.
Mr. Harry Cohen (Leyton) : I welcome the debate and I am pleased that the Government have responded favourably by calling it. I requested this debate on 1 December, AIDS Awareness Day. The Government missed the opportunity to use the House on that day to raise the profile of the problems of AIDS, but they have rectified that mistake today.
Column 1150AIDS is a massive problem, and it will be the single biggest health problem that we face at the turn of the century. Many constructive speeches have been made today and, in common with other hon. Members, I acknowledge that the Government are trying to grope towards tackling some of the difficulties. There are, however, serious gaps in our response to AIDS.
My borough faces a problem because there are no genito-urinary clinics in Waltham Forest. The Minister has already referred to their importance. Because of the lack of such clinics, the number of people in Waltham Forest suffering from AIDS, or, more importantly, those who are HIV positive, is unknown. Because of the absence of those clinics, people are denied the confidentiality and anonymity that they desire before they take such a test. It also means that other sexually-transmitted diseases--for example, venereal disease--are not treated adequately.
Such a clinic is needed because it addresses individuals' fears and helps to allay them. There has been much pressure from the local authority and the community health council to establish a clinic in the borough. The district health authority has responded by saying that it has put in a bid to the North East Thames regional health authority for a clinic. I suspect, however, that the district health authority is using that bid as an excuse for lack of action. We are still awaiting a response from the regional health authority, but we have been waiting a long time. I hope that the Minister will pick up this point and tell the region to get on and supply that clinic. Such clinics are vital, not just to my borough, but to many others. Testing for AIDS is available in my borough if it is requested by a general practitioner. Many people, however, do not want their GP to know and are worried if their GP finds out that they might be at risk. They cannot ask for an anonymous test because that facility is unavailable.
Waltham Forest borough has appointed an AIDS counsellor who can arrange for such a test. That person also provides counselling before and after the test, which is good. I suspect, however, that that counselling is not widely known about. The borough also employs a co-ordinator who gets the various council departments--housing, social services and environmental health--to work together. He has tried to chivvy up the district health authority. He also has an important training role.
Each AIDS case is expensive. I am told that in my borough the cost is £5,000 per case, and that excludes hospital costs, the costs of the AIDS counsellor and co-ordinator and of training. That is just the basic social services costs. I understand that the national figure is about £27,000. Yet Waltham Forest receives £50,000 from the Government- -a small sum which is swallowed up in staffing and covers a bit of the training costs.
The Minister referred to a circular that he has issued and I was notified of the draft
"Social Services Specific Grant for services for people with AIDS and related expenditure, Financial Year 1989-90".
I understand that the Government are to provide £7 million to cover anticipated expenditure of £10 million. The remaining £3 million, which the councils must find for themselves, will be subject to all the restrictions of rate support grant cuts and penalties. That is a serious imposition on many London boroughs which are already suffering from problems.
What is worse, I understand that that £7 million will be allocated between two different categories, A and B.
Column 1151Waltham Forest is left out of both categories and so is not eligible. That is most unfair and brings me back to the problem that we do not have a clinic. We cannot collect proper figures, so the Government have not included us in either category and we cannot get the money. I understand that some county councils which have reported fewer cases than Waltham Forest are in category B.
My borough is similar to many boroughs in category A, let alone category B. For example, Westminster and Hammersmith and Fulham are both in category A. Waltham Forest is also similar to Brent, Ealing, Haringey, Lewisham, and Southwark, which are in category B. As a result, whatever the council spends to deal with the problem will be subject to rate support cuts and penalties. Then the Prime Minister, Ministers at the Department of Health and the ranks of the Tory party will say that we are overspenders. I ask the Minister to consider that local aspect and to review the position.
Many hon. Members have talked about the spread of HIV and AIDS in prison, and rightly so because it spreads from prisons into society. It is a scandal that the Home Office has adopted such a blinkered approach to the problem. Sir Donald Acheson, the Government's chief medical officer, is reported as having said at a world conference on 22 February 1988 :
"the possible spread of the virus within prisons and after the prisoner was released must be faced."
But apparently the Home Office does not feel that it must face the problem seriously.
We all know that transmission in prisons is mainly by drug misuse and shared needles and by sex with an infected person. A recent report stated that more than 4,000 prisoners who have been released are dependent on drugs, but recognised that the figure could be three times higher than that as many drug users are not in contact with the prison doctor. In 1987, the last year for which I have figures, syringes were found at 13 different prison establishments. In a reply to me, the Home Office stated that the needles were not normally tested for HIV. The Home Office does not want to know. Why not? Why were those needles not tested? The Home Office does not want to know the extent of the problem.
Prison authorities themselves use drugs extensively, often for control and restraint as well as for purely medical purposes. Those syringes could also escape into the prison community. The incidence of unofficial usage must also be recognised. A long-running experiment, carefully controlled and monitored, should be carried out, with clean needles being supplied to avoid shared use. Together with that, prisoners who want to get off drugs should be given counselling. The Home Office has shirked its duty in that respect. The same applies to sexual transmission of AIDS. We all know that sexual activity occurs in prisons, whatever the rules say. Again, however, the Home Office turns a blind eye to the reality. Condoms are not supplied : they are regarded as contraband. But, as has been said, Spain, Bologna in Italy and New York all supply condoms in their prisons. That surely is a basic, first-step precaution against the spread of AIDS. A similar move in British gaols could be facilitated if, as is done in Spain and Italy, conjugal visits in private were allowed.
I think that the Home Office will eventually pay for its negligence. Sooner or later--if it has not happened already--a prisoner will catch AIDS in prison, and it will be provable. The court will consider the question of blame.
Column 1152Suppose a prisoner is raped and then catches AIDS. Prison is supposed to be protective custody, yet the negligence of prison authorities will be the issue when the case comes to court. They may well be sued in such cases.
It is not merely a question of money. Society will pay, because the virus will spread from prisons into the community as a whole. The Department of Health should start exerting some muscle over the Home Office. And it is not just the Home Office : many other Departments seem to run the Department of Health ragged on the issue. The Ministry of Defence and the Foreign Office have a poor record on protection of the armed forces. It is a record of complacency. The Ministry of Defence has issued one poorly distributed leaflet to the armed forces. Some of our military personnel are posted in areas where HIV infection is widespread--as high as 70 per cent.- -and where prostitution is rife. As far as I am aware, the Foreign Office has made virtually no representations to Governments where those troops are posted--Governments that deliberately cater for prostitution for foreign troops. The Department of Health should demand that the Foreign Office and the Ministry of Defence fall into line with precautionary measures.
The business travelling public are also at risk. While the Department of Trade and Industry can find £50 million for one privatisation project, it has done nothing to warn travelling business men about AIDS. The Department of the Environment keeps cutting local authorities' rate support grant, and that means cuts in care, including AIDS community care. Again the Department of Health has remained silent.
The hon. Member for Fulham (Mr. Carrington) made an excellent speech about Africa, where AIDS is wiping out communities. We live in a small world ; that could affect this country. What are the Government doing about the debt problem? The World Bank has reported that, although the Third world paid the First world £43 billion net, because of compound interest it ended up £39 billion more in debt at the end of the year than it had been at the beginning. When countries are shackled like that, how can they tackle their enormous AIDS problem? The Department of Health has made no contribution towards solving it. For all its good efforts, and despite the fact that tentatively it is going in the right direction, the Department of Health is a wimp in its battles with other Departments. It should do something about it.
Sex education in schools should be compulsory so that the lives of our children can be protected. Serious consideration also needs to be given to the introduction of anti-discrimination laws over employment. The Government ought to establish a special insurance fund so that those who contract the HIV virus have access to mortgages. They have a right to be part of the home-owning democracy. They should not be prevented from owning their own homes because of insurance problems.
Community care, above all, is vital. It is right that people should be treated in their own homes. Treatment, however, involves back-up support-- almost daily visits from health and social workers and home helps, as well as counselling for families and lovers. It is impossible to provide that support on current funding levels. The Government's dogmatic antipathy to local authorities, particularly Labour authorities that are doing their best to tackle the problem, is retrograde and adds to the problem, and AIDS victims suffer as a result.
Column 1153There is still a great deal that a responsible Government ought to do to counter the terrible spread of AIDS. If action is not taken, a large proportion of our young people will be wiped out.
Mr. Robert Key (Salisbury) : I can think of no area of public policy in respect of which any Government have reordered their priorities as swiftly as have this Government in the face of AIDS. There is a long way to go, but the Government have provided finance swiftly and have set in train a remarkable amount of research. I have recently visited the poorest parts of Africa, as well as Latin America and Canada--always in connection with development, family planning or AIDS. I have reached two conclusions. The first is that the Government are handling the problem better than any other Government, particularly in helping people to cope with AIDS and in the effectiveness of their public education programme. Money has always been available. The problem has usually been a lack of people to use it. As our ability to use that money improves, more money must be forthcoming and I have no doubt that it will be made available. Secondly, neither this country nor any other can afford to be xenophobic. AIDS is a pandemic problem. Its significance cannot be overstated. Politicians tend to hyperbole, but the danger on this occasion is that politicians throughout the world will not speak out. That danger is relevant to closed political systems, such as those in the Soviet Union and in China, where there have recently been unpleasant manifestations of xenophobia over overseas students. The danger is not limited to developing countries with fragile democratic or other systems. It is a feature of the most sophisticated democracies, such as Canada. On a recent visit I was shocked to discover that there are still states in Canada that do not allow AIDS education to be provided in their schools. As a nation that still operates a comparatively open door immigration policy, Canada must face up to the prejudices about immigrants and all foreigners, because of the heightened fear of AIDS. However, it would be an error in Canada, in the United Kingdom or anywhere else to single out immigrants or overseas students. Statistically, their impact is vastly smaller than that of the millions of people who flood into and out of our airports, whether on business or on holiday. Can anyone seriously suggest that in current circumstances every one of those international travellers should be AIDS tested, with all the attendant problems, including the insurance implications?
The pandemic is in its early stages and no one is certain of the number of AIDS cases. The World Health Organisation estimates that there are more than 250,000 AIDS cases, but between 5 million and 10 million people worldwide are probably infected by the virus. Within the next five years, about 1 million new AIDS cases can be expected. The global situation will become much worse before it can be brought under control.
In its most recent publication the Panos Institute stated : "In both its potential for destruction and the dilemmas it poses the HIV pandemic is in a league of its own."
Column 1154There is no virus vaccine and the quarantine techniques that were used for controlling smallpox, which was eradicated in 1977, is of no use with AIDS because the incubation period is too long.
Poverty is probably the most important co-factor influencing the spread of the AIDS virus. Africa in particular has been afflicted simultaneously by HIV infection and unprecedented economic deterioration. With per capita income lower than in 1980, and a fall of 4 per cent. since 1986, the continent's debt is now three times greater than its export earnings, with no effective relief in sight. The falling prices for African exports have cost African countries nearly $50 billion since 1986.
According to leading British epidemiologists, between 11 and 20 per cent. of the general population of countries such as Kenya, Tanzania, Zambia, and Angola and Somalia are HIV positive. Uganda has the highest reported HIV seroprevalence in Africa, reaching 80 per cent. in high risk groups, including prostitutes, blood recipients, patients with sexually transmitted diseases, the visitors of prostitutes, and partners of any of the above, between 61 and 90 per cent. of such people are HIV positive in Zaire, Uganda, Kenya, Ruanda, and Burundi.
The computer modelling carried out by Professor Roy Anderson of Imperial college and his colleagues suggests that under certain conditions, over a period of decades, AIDS has greater potential to depress population growth rates in developing countries, especially in sub-Saharan Africa and South America than smallpox and bubonic plague in the past.
Therefore, the AIDS pandemic will mean that, even more than in our own country, there will be a huge reduction in the number of young economically productive men and women. That will have considerable economic and social effects on societies that already suffer mass poverty and death from hunger or from simple diseases related to undernourishment. In addition, the present period between infection and the development of AIDS--thought to be eight to nine years--will be reduced in developing countries where people are exposed more frequently to, and to a larger range of, infectious agents than are those in the developed world.
Experts argue that the focus on the number of AIDS cases rather than on the entire spectrum of HIV infection has distorted our understanding of the size of the epidemic. The collection of accurate data has been hindered by political and social sensitivities in developing countries, as well as by under-recognition,
under-diagnosis and under-reporting. Experts say that although AIDS is unlikely to affect the ratio of dependants to non-dependants in such societies, the high predicted mortality of AIDS, which requires repeated hospitalisation, perhaps over a period of years, and which is thought to enhance morbidity due to other infections such as TB, will be devastating to already overloaded health care systems in poor countries.
It is impossible to imagine how such health care systems will cope. There is no vaccine in sight and the only hope for arresting the further spread of HIV is the development and forceful application of education programmes that are aimed at changing behaviour. So what are we doing about that in Britain? We are supporting a programme of research into the socio-economic aspects of AIDS. One study will investigate the future demographic and economic impact of the disease. Three others will
Column 1155contribute to a better understanding of the social contexts which affect the transmission of the virus and the way in which communities cope with the consequences.
First, there is a project at Imperial college, London on the "Analyses of the Demographic and Economic Impact of AIDS on Developing Countries."
It started in August 1987 and will be completed in July 1990. Another project on
"Community Coping Mechanisms in Circumstances of Exceptional Demographic Change."
is being carried out by the University of East Anglia. That started in November 1988 and will finish in February 1990. There are a further two projects on key issues in prevention. The first, "A Review of Sources on Social Behaviour in Sub-Sahara Africa" is being carried out by the Sussex university starting in October 1988 and finishing in March this year. Finally a very interesting study on
"Traditional Health Practitioners and the Spread of the HIV Virus in Sub- Saharan Africa"
is being carried out at Swansea university. That started in July last year and will finish in June this year. That is particularly interesting, because it will assess the methods used by traditional healers in providing health care services in terms of the transmission of the virus and in combating the spread of the disease. Traditional healers may be able to play an important role in campaigns to counter HIV transmission.
The Government have a very good record. The United Kingdom is the largest donor to the World Health Organisation global programme, providing £7.75 million. In addition, we are supporting national AIDS pro- grammes. The United Kingdom contributes to the International Planned Parenthood Federation. Some £1.6 million goes towards helping its public education material. I have seen that operating in Nigeria and the Gambia. It is remarkable to see how effectively one can communicate in such countries and communities, and I commend the IPPF on its work. We also support the European Community AIDS programmes, and our health assistance programme of more than £40 million a year is designed to strengthen developing countries' health services in dealing with the disease.
We simply do not know what will be the economic impact in sub-Saharan Africa, but the United Kingdom has commissioned research which is so important. I listened with interest to what my hon. Friend the Member for Fulham (Mr. Carrington) said about that. Two types of cost will be involved --the direct cost for prevention and patient care, and the indirect costs due to lost output. That is particularly difficult to quantify because we do not know the extent of the epidemic or its effect. Populations may alter significantly, but we do not yet know what will happen. The balance between economically active adults and the dependent young and old may not change because the number of deaths from AIDS among young children may be greater than we first thought and the balance may be relatively undisturbed.
There is much work to be done bilaterally. The Overseas Development Administration is concentrating bilateral assistance on three to five-year, medium-term national AIDS control plans in priority countries and £5.63 million has been pledged in support of programmes
Column 1156in Uganda, Kenya, Tanzania, Zambia, Zimbabwe. Our support is channelled through the World Health Organisation.
Many people are anxious that the money should be spent in the right way. I believe that it is. In the absence of a cure or vaccine, priority must be given to education and information. However, other priorities that the Government are addressing include protecting blood supplies, laboratory diagnosis, training and surveillance of the progress of AIDS. The Government also offer training on social aspects to developing countries in the form of a one-year post-graduate course leading to a PhD which will equip a person to return and work on the social impact of AIDS in his own country. It is surprising and unfortunate that very few candidates have come forward.
One of the most cynical proposals that I have heard is that we should reduce our overseas aid programme because the AIDS pandemic will eliminate the need for supporting overpopulation. But Malthus was always wrong and AIDS is not a Malthusian crisis. We should reject such arguments and I am very glad that this Government do so ; the modest growth in the overseas aid budget next year underlines their commitment.
Above all we must continue to support family planning which brings enormous benefits to mothers and children particularly in developing countries. The idea of a spaced family in a healthy community is good for the menfolk too. I thank the condom manufacturers and pharmaceutical companies for their responsible attitude to the pandemic. I am sure that they have all contributed in their various ways. London International, the makers of Durex, gave substantial sponsorship to the world AIDS conference in this country last year and, together with Roche provided very helpful assistance to the all-party parliamentary group on AIDS.
Without a doubt the United Kingdom is the world leader in recognising and acting on the international dimension of AIDS and I congratulate the Government on that. I have a constituency interest because a great deal of AIDS work is conducted at the public health laboratory service at Porton Down and at its sister establishment in the Gambia. Also, after 40 years the common cold research unit at Salisbury is to shut down. It is a victim not of failure, but of its own success in pioneering work on virology. It is ironic that its distinguished staff, led by its internationally respected director, is putting behind it the impossible quest for a cold cure, but finds itself at the frontiers of knowledge about viruses with a crucial contribution to make in conquering the AIDS virus. The Medical Research Council and the Health Education Authority have also made remarkable efforts to combat AIDS.
This country led the world in public education through media campaigns and direct mail shots. Valuable innovative programmes are now being developed all over the world including in the developing countries. We should not be afraid to learn from them. In particular, there is a remarkable project in Jamaica which has successfully used calypso songs in its education. Of course education need not be drudgery.
Sexual taboos, customs and perceptions do not differ only between races, religions and cultures. Can any hon. Member deny that there are differences of attitude between a Londoner and a Glaswegian, a Yorkshireman and a Welshman, an Ulsterman and a man of Kent? The Government have already announced plans to encourage
Column 1157local initiatives, but it would make good sense to develop far more public education resources at health authority level. Our district medical officers of health have already shown how they can respond positively. Doctor Armand-Smith of the Salisbury health authority has taken a national lead in many ways in developing local networks. It is important that we all realise that AIDS is not a bleeding hearts issue. It is one of the toughest problems of the age. It knows no boundaries, but it still rates a low political and parliamentary priority. I noted that none of the hon. Members leading campaigns for or against amending the abortion legislation have been present in the Chamber today. This time next week the Chamber will be packed and the public will be queuing to get into the Public Gallery. Hon. Members will be bombarded with letters and will be lobbied mercilessly by people who feel passionately about abortion. If I am forced to abandon my constituency duties next week, I shall probably be here to vote down a business motion which I consider entirely inappropriate to furthering the cause of the preservation of life and I speak as a moderate supporter of the Bill to amend the abortion legislation. What a contrast next week's debate will be to today's debate, which is also about the preservation of life.
Mr. Toby Jessel (Twickenham) : I am very grateful to my hon. Friend the Member for Salisbury (Mr. Key), who has a specialist knowledge of this matter, which he has studied in great depth, for speeding his delivery to allow me to speak for a few moments.
AIDS is becoming a massive threat to life. At its present rate of increase, the number of cases is doubling every 14 months. As a cause of death in Britain, in 1991 it will overtake all other infectious diseases put together , in 1992 it will overtake road accidents, in 1993 it will overtake diabetes, in 1994 bronchitis and in 1995 pneumonia. At the present rate of increase, at some time in the first five years of the next century, it will even overtake cancer as a cause of death, but most of the deceased will be young.
The Minister reminded us earlier that, although AIDS has so far affected mainly homosexuals and drug addicts in Britain, that is not so in Africa. In France, and Belgium the rate of heterosexual infection is twice as great as in the United Kingdom. During last night's Adjournment debate my hon. Friend the Member for Streatham (Sir W. Shelton) spoke of prostitutes in Streatham who are infected with AIDS. All this tends to bear out the fact that the spread of this horrible disease between men and women is increasing. I congratulate the Minister on the action that has been taken so far, in particular his announcement today. However, we must be more rigorous in finding out who is infected and then curtail their infection of others, whether by persuasion or compulsion. That is much more important than upholding traditional medical ethics, politeness or not hurting people's feelings. We should be motivated by compassion and we should show great compassion and care for those who are ill and soon to die. However, it is at least as important to show compassion to those who may catch the disease as to those who already have it because there are more of them and the disease is incurable.
Column 1158In relation to AIDS, preventive medicine must be paramount. Blood tests for HIV infection should be stepped up. The Government should draw up a list of priorities. They could start with blood tests on anyone needing an operation on anyone entering hospital as a casualty and on anyone having their blood examined by a doctor for any purpose, including general medical check-ups. When anyone shows up as HIV positive or infected by AIDS after a random check, that information should be passed on. Those categories could later be extended. Testing for AIDS, which is currently anonymous, should not be so. Doctors should be notified as to which of their patients have the disease and they should officially notify the relevant patients. It should be made a criminal offence for anyone who is knowingly HIV positive or who has AIDS to have sexual intercourse with anyone other than a person who is similarly infected. That may sound tough, but it has the sole object of controlling the spread of this appalling plague.
Mr. Mellor : I apologise for the delay in my rising to my feet, but I thought that my hon. Friend the Member for Twickenham (Mr. Jessel) was merely moving on to his next point. I am grateful to him for sitting down and giving me time to reply.
I hope that this debate has given those hon. Members who are most concerned about the issue the opportunity to state their views. I have a formidable list of points that have been made, only some of which, alas, I shall be able to deal with in the remaining time. I am grateful to the hon. Member for Peckham (Ms. Harman) for giving up her right to reply.
Mr. Mellor : In that case, I plead guilty to an excess of chivalry. I am grateful to you, Mr. Deputy Speaker, for your firm and guiding hand on our deliberations. I have the right to speak a second time, though some hon. Members might have wished it otherwise.
I shall deal with some of the points raised and I shall write to the hon. Members concerned about any significant points with which I do not have time to deal. If any hon. Members are still worried that points might remain unanswered, they should let me know.
This has been an enjoyable debate. All hon. Members appreciate the significance of the problem and most were kind enough to suggest, as is only fair, that the Government have made a serious and sustained effort to come to grips with it. Everyone, including myself, has said that more needs to be done. The worst possible case for a Minister in an issue such as this is to be defensive about what has been achieved and what remains to be achieved. We have sought to improve facilities and to gear ourselves up to action in line with the growth of the problem. We have, for example, doubled the resources specifically aimed at AIDS, although that underestimates the full extent of activity.
Year after year, as the problem grows, far more resources will have to be devoted to AIDS. I say to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) that one of the key points is to have the best possible data with which we can go to the Treasury about
Column 1159resources for the Health Service, for example, and social services in the community. We accept the Cox report as the planning base and we shall rely each year on information for determining what more needs to be done. Data is a management tool and we intend to use it as such.
I enjoyed much of the speech made by the hon. Member for Carmarthen (Mr. Williams). We shall not take the view that the notional budget for the Medical Research Council for 1992 is the final figure. Such matters are kept continually under review and I can assure him that if people from such bodies come forward with credible research proposals there is no question of our saying, "Sorry, that is important work but we don't have the money to do it". Our commitment to AIDS research is such that such valuable work as can be done in this country is being done.
I can agree with much of what was said by the hon. Member for Peckham. However, I must say again, en passant, that these debates--and I hope that there will be more of them--would be better if she could purge what she said of one or two points that strike me as being geared more to twisting a knife in the innards of the Government than to shedding light on the topic. We have enough issues on which to be partisan without having to include this one. I endorse what was said by the hon. Member for Edinburgh, East (Mr. Strang). Hon. Members should not be partisan, but the Government must not describe every call for improvements or every suggestion of underfunding as partisan. The hon. Lady should reflect on the fact that, although she spoke of the Government feeding a witch hunt on AIDS, no one else has associated themselves with that comment and there is no question of it being true.
I can join the hon. Lady in identifying certain priorities. I, too, deplore the inaccurate press article that she mentioned. I agree that it is important to have proper education about a healthy lifestyle--which must include knowledge about AIDS--in schools. Although that decision lies primarily with the boards of governors, we are doing everything in our power, through the distribution of information packs, the Health Education Authority and the provision of an expert co-ordinator in every education authority, to ensure that the information is put across.
The hon. Lady referred to section 28. Whatever controversy remains on it, the hon. Lady must know that an amendment was accepted to ensure that anything done in schools for the purposes of treating or preventing the spread of disease was not stopped and AIDS was one of the prominent reasons why that was done. The hon. Lady asked about the £131 million. Yes, that is fresh money over and above the amount that the National Health Service asked for specifically, justified to the Treasury and would have received on the basis of the growing threat of AIDS. It would be unacceptable to expect district and regional health authorities--given, especially, how disproportionately the burden falls on certain authorities, as my hon. Friend the Member for Fulham (Mr. Carrington) made clear--to pick up the burden without additional, specified funding. We have put in a bid and obtained for next year double the amount spent this year and we are allocating it as fairly as we can.
The hon. Member for Peckham raised the question of fairness of allocation. This year, the health boards in Scotland have received what they asked for and we know that the provision for England will be doubled, as I said to the hon. Member for Edinburgh, East. No regional health