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Science and Technology Committee
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Jamieson.]
Dr. Gavin Strang (Edinburgh, East and Musselburgh):
I am grateful for the opportunity to initiate this short debate on HIV and AIDS in the United Kingdom. HIV is the most important communicable disease in the UK. That is not my judgment, but that of the Public Health Laboratory Service Board. Since AIDS was first identified in the UK in 1981, a total of 32,200 HIV infections have been diagnosed. There have been 12,800 AIDS and HIV-related deaths, and more than 16,000 people are currently living with diagnosed HIV.
Thirteen years ago, I introduced the Bill that became the AIDS (Control) Act 1987. That Act requires health authorities to report annually about the disease--how many cases there are, and what the authorities are doing to help people with HIV-AIDS and to prevent the spread of HIV.
In introducing the Bill, I had three main objectives: first, to give us an understanding of the epidemic in each area of the United Kingdom; secondly, to tell us what health authorities and local authorities were doing on the ground, as a monitoring tool and in order that we could learn from best practice; and finally, to help ensure that there was a focus at national and local level on this terrible disease.
Much has changed since the Act went through Parliament. The profile of the disease is ever-changing. Sex between men remains the major route of transmission in the UK, but sex between men and women was the transmission route for more than a third of all newly diagnosed cases last year. The majority of those cases were acquired abroad, usually in sub-Saharan Africa.
One of the biggest successes has been in slowing the spread of HIV through intravenous drug use. Although that was once the major route of transmission in Scotland, the number of new cases of HIV transmitted by intravenous drug use has declined from 241 new diagnoses in 1986 to 25 last year. Such improvements can, however, be swiftly reversed, and indeed have been in other European countries.
There has also been tremendous progress in treatment for people with HIV and AIDS. For many years, AZT was the only drug licensed for use by people with HIV and AIDS. Now, there are several different classes of drugs that can be used in combination to prevent the onset of AIDS and to help prevent illness for people with AIDS.
These new treatments have brought their own challenges--challenges for individuals on tough drug regimes; challenges for our health services, which must cover the costs; and challenges for the significant proportion of those living with HIV who are unable to benefit from the new therapies. In addition, the success of the new treatments in prolonging life will result in significant rises in HIV prevalence, and increasing numbers of people undergoing long-term treatment.
Just as the profile of HIV-AIDs has changed, there is now a strong view among those working in the field that 12 years on, we would benefit from updating the workings
of the AIDS (Control) Act 1987. The all-party parliamentary group on AIDS concluded in its recent inquiry that the Act should be
I propose four changes to make the workings of the 1987 Act as relevant as possible to HIV-AIDs in the UK today. First, when the 1987 Act was going through Parliament, there were fears that people in low-prevalence areas might be identified by the press, and it was decided that where the number of cases was fewer than 10, an asterisk would be used instead.
However, the climate has changed, and it is felt that as long as confidentiality can be guaranteed, it would be useful to amend the 1987 Act to enable reports to publish the number of cases under 10, for epidemiological purposes, for the purpose of studying the allocation of resources between districts, and for the purpose of studying HIV-AIDS strategies among districts.
Secondly, the reports should include data for those resident in a health authority area, as well as those merely diagnosed or appearing for services in the area. I understand that a London local authority believed that it had just six people with HIV living in its area, but it commissioned research which revealed that 179 cases of HIV were readily identifiable as living within that authority's boundaries. The authority had been unaware of those additional people, as they had been travelling elsewhere for treatment.
Making available data by district of residence would help in compiling a more comprehensive picture of the changing nature of the disease in different areas. It would provide a more accurate basis for planning and monitoring prevention work and social service work, preventing health authorities and local authorities from having a false sense of security about the amount and type of work that they should have under way. Also, it would allow more meaningful scrutiny by interested parties of the work of local authorities and health authorities. Again, however, we must be able to guarantee confidentiality.
Thirdly, it is vital that the Government money provided to prevent the spread of HIV is spent effectively, but there are fears that HIV-AIDS funds are not being spent effectively on the people most at risk of getting HIV. It is the job of the AIDS (Control) Act reports to tell us what is being done, but there is concern that the Act and the Department of Health guidance do not do enough to ensure that health authorities account properly for their use of their HIV-AIDS funding, and that there is perhaps too much flexibility for health authorities to apply their own rules. The National AIDS Trust has said:
Regional AIDS (Control) Act reports have not been compiled since the regional health authorities were dissolved. The Department of Health receives 100 reports from the English health authorities, which is hardly a manageable number. That does not make it easy for the Department to make optimal use of the important information in them and the bigger picture does not emerge as a result.
I propose that regional AIDS (Control) Act reports should be prepared and collated annually by the national health service regional offices. We would also benefit greatly from an annual national report from the Department of Health. Such a report, perhaps from the Secretary of State, would give us an extremely valuable national overview of HIV-AIDS prevention, treatment and care work. I should add that that is a devolved matter, although surely the four nations of the United Kingdom should learn from one another.
The Government's decision to initiate a national HIV-AIDS strategy has been welcomed in every quarter, and I welcome the announcement of the steering group to take it forward. In her reply to my letter to my right hon. Friend the Secretary of State for Health setting out these proposals for changes to the AIDS (Control) Act, my right hon. Friend the Minister for Public Health suggested that they should be considered by the steering group. I am happy for it to do so and should be grateful if, in the meantime, my hon. Friend the Minister of State would share his preliminary views with us.
The apocalyptic predictions of the mid-1980s have not come true. When I introduced the AIDS (Control) Act, there was talk of the AIDS time bomb, Edinburgh was dubbed the AIDS capital of Europe and Government reports warned that Britain could have more than 30,000 AIDS cases by 1992. Compared with other European countries, the United Kingdom has done relatively well in dealing with the disease, but complacency about HIV would be a terrible mistake.
That Mrs. Jacqui Lait be discharged from the Science and Technology Committee, and Mr. Robert Jackson be added to the Committee.
That Mr. John Bercow be discharged from the Trade and Industry Committee, and Mr. Christopher Chope be added to the Committee.
That Sir Peter Lloyd be discharged from the Treasury Committee, and Mr. Michael Fallon be added to the Committee.--[Mr. McWilliam, on behalf of the Committee of Selection.]
1.24 am
"reformed into a more meaningful tool of accountability and audit, related to progress in implementing local strategies".
I hope that if my hon. Friend the Member for Walthamstow (Mr. Gerrard), who chairs the group, catches your eye, Mr. Deputy Speaker, and the Minister is willing, he will have a chance to take part in the debate.
"The returns made under the AIDS (Control) Act are not an effective tool to promote accountability at a local or national level."
It is important that health authorities show how their prevention spending reflects the local profile of the disease. I suggest that the Act should be amended to require the reports to show total expenditure on recognised epidemiological target groups. Those groups should be identified in the Department's guidance and should be mutually exclusive. I also propose that health
authorities should be required to give some evidence that what they are doing is based on good practice, setting out the evidence base on which they are acting.
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