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28 Nov 2007 : Column 129WH—continued
There has, however, been a welcome focus on GUM clinics in recent years. A target was set for March 2008 that all patients should be offered an appointment within 48 hours of contacting a GUM service, and by August this year 86 per cent. of patients in England were being offered an appointment within 48 hours. I ask my right hon. Friend to consider retaining the target for a further three years, as it is vital that the progress in improving GUM services is sustained. Quite apart from the direct benefits of improved access, the target also serves to focus primary care trusts on sexual health—an area that we know might otherwise drop down the agenda.
In the early days, a positive HIV test was a death sentence. From the mid-1990s, however, the lives of people with HIV have been transformed by highly active antiretroviral therapy. An emerging issue in the past year or so has been whether financial constraints within the NHS have had an effect upon the availability of drugs. The organisations representing the main providers of sexual health and HIV services in England conduct an annual survey of primary care trusts and clinicians. In the 2006 survey, participants were asked whether their organisation had restricted prescribing of any specific HIV medications or tests because of cost. Of those that answered, 13 per cent. said that there had been restrictions, and 22 per cent. said that there had not been any yet, but that discussions had taken place. The authors conclude that that represented a significant move towards drug rationing within HIV services, and was of serious concern. I would be grateful for any insight that my right hon. Friend has on those findings.
Of course, not everybody in the UK is allowed free treatment. People who are not recognised as being entitled to be in this country do not have the right to ongoing treatment on the NHS. That includes people who have been refused asylum but who are allowed to stay because they cannot return to their own country. The Terence Higgins Trust and the National AIDS Trust each report that pregnant women with HIV have been refused free treatment to prevent transmission to their unborn baby. People with TB or other sexually transmitted infections receive free treatment, but if they also have HIV they can be billed for their HIV treatment. The Terence Higgins Trust reports that people have consequently walked out in the middle of their TB treatment, creating a public health risk.
My right hon. Friend will be aware of the recommendation from the Joint Committee on Human Rights that HIV be included with all other sexually transmitted infections that are exempt from charging. I support that call. Quite apart from the compelling humanitarian argument, it seems likely that the costs of allowing those people HIV treatment is unlikely substantially to exceed the cost of treating them on an emergency basis, as we do now when they succumb to HIV-related illnesses. The Government are conducting a review of foreign nationals' access to the NHS, and I urge them to consider allowing such people access to HIV treatment.
The approach of World AIDS day makes this an opportune time to discuss HIV and AIDS-related matters. The independent advisory group is leading a review into the Government's current strategy on sexual health and HIV, and there is widespread support for the view that once the review is published Ministers should go ahead
and consult on a new strategy. I am grateful to have had the opportunity to put to my right hon. Friend some of the issues concerning HIV and AIDS in the UK today, and very much look forward to hearing her thoughts on those important questions.
4.57 pm
The Minister of State, Department of Health (Dawn Primarolo): I start by expressing my gratitude to my right hon. Friend the Member for Edinburgh, East (Dr. Strang) for initiating this important debate, and I pay tribute to his continuing interest in HIV both nationally and internationally. He mentioned his sponsorship of the private Member’s Bill that went on to become law as the AIDS (Control) Act 1987. That set out reporting and monitoring requirements for the NHS at a time when there were no effective treatments, and when today’s detailed surveillance and monitoring were in their infancy.
Let me address the points that my right hon. Friend made on that Act. With his extensive knowledge, he will recognise that the understanding of HIV is now much greater than when he introduced the Bill that led to that Act, which was at a time when the nature of HIV transmission routes was unclear. In prevention, we now focus on the particular sections of our community that are most at risk: gay men and African communities—the groups most at risk of sexual transmission of HIV.
My right hon. Friend referred also to the investments that have been made in relation to HIV and AIDS and sexually transmitted infections. He will realise that in the early days, the mass advertising that was necessary—both on television and in leaflets—was far more expensive. We now have very focused delivery of treatments. He also mentioned ring-fencing. He has followed the subject closely, so he will know that funds that were previously ring-fenced for prevention are now in the baseline for the national health service, and have been since 2002. Later in my remarks, I shall indicate the huge benefits that that has provided.
I am sure that my right hon. Friend would agree that it is important that World AIDS day, in three days’ time, gives us an opportunity to take stock of achievements, while recognising that we need to do more, as he rightly said. Last week, two major HIV reports were published: one is from the UN on the global picture and the other is the Health Protection Agency’s 2006 annual report on HIV and other sexually transmitted infections. Both make sobering reading. Despite global estimates having been revised downwards, the UNAIDS figures are still shocking, with 33.2 million people estimated to be living with HIV in 2007, 2.5 million new HIV diagnoses and 2.1 million deaths.
However, if we examine the situation in the UK, we have reason to be proud of our successes during the very long period for which my right hon. Friend has been following this issue. Deaths among HIV-infected persons fell from 749 in 1997 to 497 in 2006. That is a direct result of ART—antiretroviral therapy. AIDS diagnoses dropped from 1,080 in 1997 to 666 in 2006. Introducing routine HIV screening for all pregnant women has been a success. Today, 90 per cent. of HIV-infected women, up from 70 per cent. in 1999, are diagnosed before delivery, enabling treatment to be given to prevent HIV transmission to the child.
The offer and acceptance of HIV testing in sexual health clinics is now much more widespread. In all United Kingdom genito-urinary medicine clinics, voluntary confidential testing for HIV among men who have sex with men increased from 61 per cent. in 2001 to 85 per cent. in 2006. In heterosexuals, take-up increased from 41 per cent. in 2001 to 72 per cent. in 2006.
The huge success in screening people and therefore in identifying those at risk is the start of the answer to the question that my right hon. Friend posed about the information that it is now necessary to collect to inform treatment. I want to come on to that. Clearly, improving access to GUM clinics has been a top priority for the national health service. In September, 88 per cent. of patients were offered an appointment to be seen within 48 hours, up from 45 per cent. in May 2005. There is clear evidence that early access to services facilitates quicker diagnosis of infections, including HIV, and can break the cycle of onward transmission.
My right hon. Friend touched on the need to ensure proper education and access to counselling in our education system, including schools. He may have touched on the Ofsted report published in January 2005. The Department continues to provide funding for teachers and community nurses, who contribute to the provision of advice and support for our young people. We are developing specialist teams to improve their ability to ensure that such advice is clearly provided, but I recognise my right hon. Friend’s point that it is important to do more and, working with the Department for Children, Schools and Families, we are ensuring that that collaboration takes place.
As my right hon. Friend said, however, we still face significant challenges. I want to deal with those and some of the other points that he raised. Last Friday, the Health Protection Agency published “Testing Times”, its HIV and sexually transmitted infection report for 2006. It reported that although overall, the number of new HIV diagnoses appeared to be stabilising, they were still increasing in gay men. They remain the group most at risk of HIV transmission in the UK. Once all the reports for 2006 are received, the HPA expects a figure of 2,700 for new diagnoses among gay men in 2006.
To take forward the work on prevention and promotion of information that my right hon. Friend clearly identified as very important, we have to understand to whom exactly we are directing our messages and support. Our response involves looking specifically, although not exclusively, at the groups at highest risk; we are recognising the higher-risk groups. Those are gay men and African communities, who continue to bear the brunt of HIV in the UK and remain the focus of our national health promotion work. During the past two years, we have strengthened our national response by investing an additional £2 million in work by the Terrence Higgins Trust and the African HIV Policy Network. For African communities, we are working on interventions to increase awareness of the benefits of HIV testing and the importance of using condoms. We are working to achieve consensus on prevention priorities, as well as strengthening the evidence base for HIV health promotion in African communities in England.
My right hon. Friend recognises that, through that work, we are trying to ensure that we are using our resources to maximum effect to get information to those who need it. He will appreciate that the issue that
we are still seeking to address in particular is late diagnosis. I am referring to people who either are unaware of their infection or are not coming forward for testing. However, we have made considerable progress on testing and we need to continue to invest in that.
My right hon. Friend touched on the question of automatic entitlement to free HIV treatment in the UK. HIV treatment is not included in the list of treatments exempt from charges under regulations. As he knows, people who are illegally here have no automatic right to free HIV treatment, but I am sure that he would acknowledge that that does not include asylum seekers, who do receive NHS services, including HIV treatment, without charge, and that treatment is not withdrawn from people whose asylum applications subsequently fail. They will continue to receive that treatment. Guidance on charging provides a number of safeguards specifically for maternity services and immediately necessary treatment, which is always based on clinical decisions. I am aware of the reports to which my right hon. Friend referred. There are difficult issues in this area, but I am sure that he would agree that all those who are ordinarily resident in the UK are entitled to access the treatment.
In conclusion, the action to prevent and address HIV in the UK continues to be a priority for the Department of Health. We have very good treatment outcomes for HIV and some of our health promotion work has been used as a model in other countries. However, we recognise the continuing challenges posed by HIV and sexual health. We are determined to continue to focus and prioritise the resources on that important matter. We are working with the expert advisory group on AIDS and the independent advisory group on sexual health and AIDS. As my right hon. Friend rightly said, we are undertaking a review of our strategies in consultation with others to ensure that we continue to take forward those measures.
We have made a great deal of progress since my right hon. Friend introduced his Bill. We are much clearer about the treatments that are available, about ensuring that we get advice through to the right people and about supporting those people. There is more to do, but as we approach World AIDS day we can be satisfied with the progress that we have made. I hope that my right hon. Friend agrees with that conclusion.
Adjourned accordingly at eleven minutes past Five o’clock.
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