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The Earl of Dudley: My Lords, before my noble friend sits down, will she confirm that her speech and her references to methadone did not hint at an intention by the Government to restrict the prescription and controlled use of methadone as a heroin substitute?

Baroness Cumberlege: My Lords, we are trying to take it forward in these pilot areas so that we have firm evidence as to the impact that methadone can have in combating this problem.

3.48 p.m.

Baroness Jay of Paddington: My Lords, I am grateful to the Minister for introducing this debate on the Green Paper Tackling Drugs Together and, very

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importantly, for giving us the opportunity to discuss HIV and AIDS on World AIDS Day. December 1st has now become a traditional moment to reflect on the global pandemic and to look at the situation in Britain and our own strategies for prevention and care.

The World Health Organisation has today reminded us that in the past year more people have been infected with the HIV virus and more people have died than in any previous year. There are now 6,000 new infections every day. The World Health Organisation predicts that 40 million people will be HIV-positive by the end of the decade. Already 1 million children are infected, and by the year 2000 there will be 10 million so-called AIDS orphans.

Today, in Paris, there is a world summit of government Ministers--I understand that the British Government are represented by the right honourable Mrs. Bottomley, the Secretary of State for Health--which will sign a series of agreements to improve international co-operation on AIDS. One of those agreements is to make clean needles universally available to injecting drugs misusers. I suspect that, like all attempts at prevention, it is likely to be more vigorously pursued in the industrial world than in the poorer countries, where all resources, including for that kind of programme, are very scarce. On the agenda in Paris is an attempt to redress the balance of the resources for AIDS prevention, so that more money and more skills can be deployed in the countries of Africa, Asia and South America, where whole populations are now threatened.

On World AIDS Day we may indeed justifiably congratulate ourselves in Britain on our success in keeping levels of infection fairly low. Just over 22,000 HIV-positives are officially reported in this country compared with 10 million in sub-Saharan Africa. But, particularly today, we cannot ignore the global crisis and our responsibility to try to help. AIDS and the Family is today's international theme; the family of man is certainly facing a terrifying health threat, the scale of which is unique in modern history.

In this country the prevention strategies adopted in the mid-1980s have been relatively effective. Today, for example, there are more AIDS cases in Paris than in the whole of Britain. But, although the number of people infected in the past year through sexual intercourse has risen and the percentage of those infected heterosexually has now reached a substantial 28 per cent., and although drugs use is increasing, the number of infected drugs users seems to have stabilised. The continuing message about that, as the Minister has already emphasised, is that, although the overall picture is somewhat encouraging, we must continue to say, "No complacency". A successful prevention programme is not like a successful vaccine: one shot and it is all over. Health education and other measures must be constantly repeated, constantly reviewed and constantly renewed. It is in that context that Tackling Drugs Together has been generally, if not particularly enthusiastically, welcomed.

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Many of those working in the drugs field are pleased that the document recognises the value of a co-ordinated strategy and acknowledges the growing pressure on local communities by establishing drug action teams in every district health authority in England. The Minister outlined an extensive programme; but, as so often in health and social services, there is grave concern among those working in the field about the potential gap between a paper policy and practical reality. In other words, where are the resources to make it all work?

Yesterday we had a very interesting and rather disturbing debate, in which many noble Lords who are present today took part, about the funding crisis which already exists in community care. It seems that many of the proposals in the Green Paper on drugs will again fall on the overburdened local authorities. We know that ring-fenced money for HIV and AIDS is to be phased out. It is difficult to see from where the new money for new services and new programmes will come. Although the Minister's speech paid tribute to the voluntary sector, in this context it is unfortunate that the Green Paper pays scant attention to the role of the voluntary sector and volunteer action. Small community groups and national groups, such as the already mentioned Turning Point, have played a leading role in the fight against AIDS. They have the credibility and often the kind of information and support that is more acceptable to drugs misusers than is the statutory sector. It is vital that they are equal partners in any drugs strategy and any AIDS strategy and that they are properly resourced to do their own work.

There are also concerns about the proposals for general health promotion campaigns and education in schools. As your Lordships know, the Health Education Authority, which has done extraordinarily useful work in this area, remains under a very peculiar political cloud. Its future still seems very uncertain. It would be interesting to know whether the Department of Health, or even perhaps the Department for Education, now intends directly to manage some of those programmes. I am pleased that the Department for Education will offer new resources to schools through the GEST schools programme. But those programmes will have to be very sensitively introduced, particularly to those teachers who feel somewhat scarred and burned by all the furore in the past few years about sex education and the removal of HIV and AIDS from the national science curriculum.

Many teachers are now extremely wary of the whole area of personal and social education. The climate, which a few years ago produced helpful, open discussion in schools and clear direct information for pupils, has changed. It has changed because the policy messages from Ministers have frankly been inhibiting and regressive. Perhaps the climate has now changed again and perhaps the Green Paper signals another change. But any new initiatives which try to introduce new programmes on drugs and health will need very careful nurturing to be successfully launched.

I welcome this opportunity for a World AIDS Day debate. But frankly I am a little surprised that the Government have linked the introduction of the Green Paper to the issues of HIV and AIDS. I understand from

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the Minister's remarks that the noble Baroness, Lady Masham of Ilton, whose work in this field we all know and respect, may have been influential in this matter. But it seems to me that the Green Paper's dominant theme is much more concerned about law and order than about public health. That is perhaps not surprising when the Government spend twice as much on control and enforcement as they do on prevention and treatment.

My noble friend Lady Mallalieu will focus later in the debate on some of the specific enforcement issues. I would simply suggest that the overall law and order tone of parts of the Green Paper seems to distort some of the health objectives and may even work against some of the successful work on drugs that the Department of Health itself previously supported and promoted. Time and again, despite what the Minister said, the Green Paper underlines the ambition of total abstinence for drugs misusers. Nowhere in the Green Paper is harm reduction explored as a suitable goal. Yet, all the evidence suggests that it has been the effective programme of harm reduction, through needle exchanges, substitute prescribing and education on safer drug use and safer sex, that has produced the stable HIV infection rate of which we are now rightly proud. As we know, harm reduction methods are complicated and expensive, but they have been successful.

If now the loudest theme from central government is the notorious American "Just say no", local health and social services authorities, battling with severe financial problems already, may well be less enthusiastic about delivering balanced interventions that can help serious drug misusers achieve stability. As the Minister said, two years ago the Health of the Nation, as part of the general HIV and AIDS policy, set the very ambitious target of reducing injecting drug use by 50 per cent. by 1997 and a further 50 per cent. by the year 2000; in other words, wiping it out altogether by the end of the decade.

The Health of the Nation handbook on action for HIV and AIDS in sexual health set out in a very detailed and constructive way programmes for at least trying to achieve that very ambitious target. Most of the proposals included there were rooted in harm reduction and education. The action points contain every type of proposal, ranging from the national to the very local, and are based on the idea that it is not very difficult to achieve total abstinence for most drugs misusers. The same messages run through the latest report from the Advisory Council on the Misuse of Drugs (ACMD) working party on AIDS and drugs misuse.

The working party again pays tribute to the success of comprehensive harm reduction and suggests extensions, including, significantly, a great deal more outreach work. The Minister has already mentioned the oral methodone programme. Despite the intervention from her own Benches, I hope that the Government will not shy away from extending the programme of a structured strategy, about which the AIDS and Drugs Misuse Update says:

    "The benefits both in terms of individual and public health have now been clearly demonstrated"

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Both those documents--the AIDS and Drugs Misuse Update and The Health of the Nation handbook--seem to reaffirm the basic tenets of the drugs and AIDS programme in this country far more strongly than the new Green Paper does.

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