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I want to concentrate on the national position. That is not because the international position is unimportant—on the contrary; it is a matter of shame that we in the West should have stood by while 20 million or 25 million people have died from AIDS. It remains a matter of shame that men, women and children are still dying on that scale, despite the fact that medicines exist and are available to save their lives. It is a matter of shame not just for Governments but for the churches that have argued against one of the few effective preventive measures—the use of condoms—which in this context could prevent deaths in a major way. I still find it extraordinary that, for example, the Roman Catholic Church can do so much fantastic work dealing with the casualties of AIDS, as I saw in New York, but so little work preventing those casualties. I do not think that history will deal kindly with its policy.
The reason that I shall concentrate on the national position is in a sense related to the international position and the loss of life in sub-Saharan Africa in particular. As we do not face a problem on the same scale, there seems to be a tendency to ignore what is happening inside the United Kingdom; to be, as the noble Baroness, Lady Gould said, complacent about the position here. There is absolutely no justification for such complacency. The figures published by the Health Protection Agency last Friday contain little for our comfort: 7,000 new HIV diagnoses in 2007; more than 80,000 people now living with HIV in this country; the annual number of newly diagnosed people has increased by 182 per cent since 1997; and new diagnoses among gay men are at their highest level since records began, despite all the warnings given about unprotected sex. The cost to the National Health Service is estimated at somewhere between £400 million and half a billion pounds per year. If we add in the cost of the other sexually transmitted diseases—the number of which, as the noble Lord, Lord May, mentioned, has also increased over the past 10 years—the overall cost is massive.
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By the Government’s own measure of what they wished to achieve, the current position amounts to a failure. The Government’s policy in The National Strategy for Sexual Health and HIV, which was published in 2001, took four years to produce. One of the key targets was a 25 per cent decrease in newly acquired HIV infections by 2007. As we can all see, it has not happened. There has been a failure of public health policy. There has certainly been a failure to meet the financial needs. Most of all, however, there has been a failure of will, a failure of commitment. To be blunt—and this is not remotely a party political subject—Ministers have successively failed to meet the challenge of HIV in this country. Unless we recognise that, we are not going to achieve any change and nothing is going to improve.
It is always tempting to sweep the issue of HIV/AIDS under the carpet. It is not a popular subject with the public, as any of us who have been involved in the area know only too well. It is probably the least popular cause for voluntary giving in the whole country. It leads to potential embarrassment for politicians who have to go into the area. It almost certainly leads to controversy with the media and the press. It brings no particular penalty if it is ignored. It is an area that is surrounded by prejudice and discrimination. As the noble Lord, Lord May, said, it is an illness that stigmatises.
Despite all that, I should hope, like the noble Lord, Lord May, that we can as a nation give HIV/AIDS a greater priority than we have managed over the past decade. I think that we should ask why the policy has failed as it has. One reason is the current orthodoxy in the health service that everything should be devolved. In so many areas that view is exactly right; in an organisation as massive as the National Health Service, good management means that power should be devolved downwards. But it should not be an inflexible rule. The Department of Health still has a direct responsibility in some areas. One of those areas is public health, certainly when we are dealing with a subject that is as difficult and sensitive as HIV/AIDS.
The Government’s White Paper Choosing Healthis an example of what can go wrong. The Government pledged £300 million to sexual health, much of which was to be allocated—devolved—to the primary care trusts. Ministers took credit for doing so and said that the money had been spent. Unfortunately the money had not been spent. As a survey by the independent advisory group made clear, only 30 of 191 primary care trusts had spent all their allocation for the purpose for which it had been allocated. Primary care trusts had the option to spend it on other things and they used that option, despite the fact that the Government had earmarked the money for HIV/AIDS.
Perhaps I may give another example, from my own experience. Most of those who remember our campaign of 1986-87 remember the public education, television adverts, icebergs, tombstones and leaflets sent to every home—and I would defend every one of those—but we also took one important additional step: we took the decision to supply free clean needles for drug users. It led to a permanent improvement in
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If we are serious about tackling HIV we cannot devolve everything down to the PCTs. We should understand that the centre, the Department of Health, has a crucial role and we should go back to ring-fencing some of the resources intended for tackling it.
We should also avoid taking action that appears discriminatory and counterproductive if the aim is to prevent the onward transmission of HIV. Like the noble Lord, Lord May, and the noble Baroness, Lady Gould, I am puzzled by the Government’s HIV policy in relation to the charging regulations introduced in April 2004. I do not think that there is any evidence that HIV tourism is occurring in this country. I do not see why HIV should be the only exception to the general policy. It also does not make sense in terms of cost. It means that people will become vastly ill and then have to go to Accident and Emergency for treatment. It also increases the risk of onward transmission of the HIV infection. So I add to the two previous speakers’ calls for the Minister to make clear the Government’s aim.
The Government have a direct responsibility in tackling HIV/AIDS, and I believe that there are three urgent priorities. First, testing must be improved and increased. About 25,000 of the 80,000 people living with HIV are unaware of their infection. That is obviously bad for them, because they do not get access as quickly as they might to treatment, but it is also bad for others, because onward transmission continues. Improved testing entails faster access for those wanting tests at clinics. We need more opt-out testing—there is no question about that—and we need testing outside the traditional clinic setting. I am a trustee of the Terrence Higgins Trust, which has done some pioneering work in offering testing at university campuses and in community centres. That has been valuable and successful.
Secondly, priority needs to be given to making much more progress in sex and relationship education. At present, we have a patchwork of provision between schools: some are good and some are frankly inadequate. I do not dispute that there is a complex challenge for schools here, particularly because they are already pressed by a tight timetable. I do not dispute that it means better training than we have now; but if more can be done, there are substantial advantages for young people, and there is the prospect that better education will help understanding and reduce the stigma surrounding HIV/AIDS.
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The third priority is public education itself. The truth is that public understanding of HIV and its consequences has lessened over the past 10 years; we have gone backwards, not forwards. Fewer people understand how HIV is transmitted. Almost a fifth of the population are not concerned about HIV because they believe that there is an easy treatment available for it. More and more people are ignoring the advice always to use a condom with a new partner.
At the time of the 1986 campaign, we said, “There is no vaccine and there is no cure”. That remains the position today. There is no cure. We now have drugs that preserve and prolong life, but it is a lifelong condition, taking with it a risk and a range of disadvantages with the disease itself. On the progress of the vaccine, the latest news is anything but encouraging. No one believes that we are on the verge of a breakthrough. That is not a reason for abandoning all research, but it is a further reason for underlining the importance of public education.
We need to put much more effort, imagination and commitment into public education. We have heard pledges from the Government before that serious money will be spent in this area, but they have not been followed through. Instead, we have had a debate, which has now lasted for a decade, on whether there should be a general campaign on HIV and sexual disease or a targeted campaign. The blunt truth is that we have had neither of those campaigns. At times, we have gone back to the old, tired debate about whether, if we advertise, we introduce people to areas about which they know nothing.
I would say only that when we held our campaign, we received very few complaints. Young people and parents valued the advice and, what is more, they acted on it. The advice came with the authority of the Department of Health, which was a fantastic advantage. It is utterly absurd that, at a time when modern communications allow us to get messages directly through to the public better than ever before, we are all but ignoring that course. We need to tell people, young people, about the dangers of HIV/AIDS, for unless we do, the figures will continue to rise. The tragedy is that it is not inevitable that the figures rise year by year, as they have done, but if we are to prevent that happening, the Government have to take a clear lead. I regret to say that this, at present, they are failing to do.
12.29 pm
Baroness Masham of Ilton: My Lords, I thank my noble friend Lord May of Oxford for this very timely debate. The Times on Saturday last week stated that HIV infection is continuing to grow, according to figures from the Health Protection Agency, and gay men are being urged to practise safe sex and have an annual HIV test in an attempt to halt the rise in infections in the UK. That is supported by the Terrence Higgins Trust, which stated:
“But the fact remains that gay men are still at highest risk of HIV infection in the UK. For those numbers to come down, we need to step up resources for targeted HIV prevention programmes”.
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I have been a member of the All-Party Parliamentary Group on AIDS since its inception in 1985 or 1986, when HIV began to present as something to be aware of globally. When the noble Lord, Lord Fowler, was a Minister, he promoted a hard-hitting publicity campaign, which made the public realise that HIV/AIDS was a new danger that could kill. I remember the advertisements to this day. To have an impact now is more difficult. With new drugs keeping HIV at bay and people keeping in better health and living longer, it does not seem so important to be careful. Some people even think that HIV is no longer a problem. That is very dangerous. There is an ever-increasing danger of multiresistance to drugs. There is a need for ongoing publicity so that people at risk realise that there are still dangers around. Campaigns need to be updated from time to time.
Human immunodeficiency virus attacks and destroys the body’s natural defence mechanisms, exposing it to certain infections. HIV can be found in blood, the rectal mucosa, semen and seminal fluids, vaginal fluids and breast milk. The amount of virus present in these tissues is enough to infect a person. While HIV can also be found in sweat and saliva, the amount is too small for an infection to happen. The destruction of a person’s immune system makes them more susceptible to other illnesses, especially infections such as tuberculosis, pneumonia and cancers, many of which are not so dangerous a threat to a healthy person. When the immune system has reached a certain low level of CD4 cells, or when some of the associated infections have happened, AIDS—acquired immunodeficiency syndrome—has developed. This is a condition that needs specialist experts to care for patients.
In 2006, there were an estimated 73,000 people aged 15 to 59 living with HIV in the UK. While London remains the main focus of care for people living with HIV, with nearly 24,000 residents accessing HIV-related care, the largest proportional increase was seen in Yorkshire and the Humber, where 2,475 people were accessing treatment in 2006—a 21 per cent increase.
The Royal College of Nursing, with a membership of nearly 400,000, launched its Think Positive campaign in 2007. I was pleased to be able to attend the launch at Cavendish Square. The campaign was introduced in response to the growing need for nurses working outside HIV and sexual health services to be familiar with the changing needs of people living with HIV and to ensure that they practise and communicate sensitively. The Royal College of Nursing is encouraging a change in attitude that will end the stigma that continues to surround HIV/AIDS. HIV/AIDS is not only a sexual health issue but a chronic long-term condition with which people are now living into their 50s and 60s. The Royal College of Nursing would like to see an updated strategy that takes into account the wider needs of people living with HIV. Perhaps this could be included in the Health and Social Care Bill.
The Government and the NHS must end the existing postcode lottery for HIV care and ensure that everyone has fair and equal access to high-quality treatment, care and support wherever they live. I hope that all people living with any long-term condition would also have that. Trusts should be encouraged to assess, monitor and forecast the needs of people
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As more people with HIV are living longer, there is a greater need to increase the number of specialist nurses working in HIV care to provide the high-quality care and expert support that they need. Sexual health and HIV services were particularly badly affected by financial deficits in the NHS, with many specialist nursing posts remaining unfilled. The Royal College of Nursing would like to see training extended to nurses working in primary care so that they can offer HIV testing to their local communities.
Last week I was interested to see a Telehealth Solutions system for monitoring people living with HIV/AIDS. Telehealth Solutions has developed the “pocket pod”, which is specially designed for people taking combination therapies. It is set by a GP to remind patients of what drugs to take and at what time and when to take viral load tests and to monitor vital signs such as temperature, blood pressure and weight. In the event of abnormal responses, an alert system is incorporated through SMS and e-mail services. This ensures prompt responses to adverse events. I am told that the pocket pod provides an essential and cost-effective tool in managing HIV/AIDS treatment, prolonging life and relieving the pressure on the NHS and patients. It should be investigated and assessed.
Some months ago, when the noble Baroness, Lady Royall of Blaisdon, was a Whip in the Department of Health, we visited the Mildmay Hospital in Tower Hamlets, which I have known for many years. There is still considerable stigma attached to a diagnosis of HIV/AIDS, as has been said, especially in many ethnic-minority groups. There is much fear of disclosure to friends, family or church because of this stigma, and patients often present late with an already advanced HIV disease because of this fear. Many people now have much better life expectancy and a good quality of life, but there are still significant numbers for whom services are far from widely or easily accessible.
The Mildmay is the only specialist centre in the UK that provides rehabilitation through in-patient and daycare services for patients with advanced HIV dementia, neuropsychological and other complex HIV-related problems. Its essential and unique services are under threat because of funding issues. As the only such hospital in the country, it is important that it is funded and enabled to continue to provide these services, while teaching and demonstrating to others how to apply its approach.
I end by asking a question that concerns the National Aids Trust: why has HIV/AIDS been singled out, in a most discriminatory way, from all other serious communicable diseases, including TB and all other sexually transmitted infections? Treatment is always provided free of charge irrespective of residency status, but HIV is explicitly excluded from this provision, so that refused asylum seekers and undocumented migrants are required to pay for secondary care. The result is that they are unable to pay if diagnosed with HIV. In almost all cases they
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Britain has been generous to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Many other European countries should do likewise. I therefore hope that the Government will pursue this through the European committees.
12.40 pm
Baroness Flather: My Lords, I must confess that when I put my name down for this debate I expected to hear what have already been referred to as the usual suspects, but it has not been like that at all. I thank the noble Lord, Lord May, for educating me to a great extent, the noble Baroness, Lady Gould, who added to that, and my noble friend Lord Fowler. It has been an amazing combination of speakers—certainly not the usual suspects or the type of debate that we could expect on a subject about which people feel that they have talked a lot. This is where the House of Lords shows its competence; you see people who know what they are talking about. But now your Lordships are going to hear from someone who does not know very much about HIV/AIDS.
I am a latecomer to this subject. I started taking an interest because I am deeply concerned about the situation of the poorest women in Africa and the Indian subcontinent. One cannot look at the situation of these women without focusing on HIV/AIDS. A DfID document says that, in 2007, 22.5 million were living with HIV in sub-Saharan Africa. Around 1.7 million were newly infected and 1.6 million had died, making AIDS the leading cause of death.
In sub-Saharan Africa, the HIV/AIDS epidemic is increasingly feminised. That is very frightening. It is not only in that region; look at South Africa, where AIDS is also increasing. The incidence of rape is unbelievable. In sub-Saharan Africa even little baby girls and old women get raped, and not just by strangers; it is people in the family, their priests, their doctors, their teachers. The lives that these females have to put up with—you cannot say “women” because they are also children—are unbelievable. That alone is terrifying.
UNAIDS has now said that 70 per cent of the world’s infected are women. Women have no way of protecting themselves. We have to take that important point into account. My noble friend Lord Fowler touched on the Catholic Church’s doctrine. The Catholic Church is breaching the most basic human rights of women all over the world. Condoms are the only way by which a woman can be protected from infection. If the church were to say, “Use condoms”, I think that we would see an instantaneous change.
I do not know whether noble Lords have learnt about PEPFAR, the President’s Emergency Plan for AIDS Relief, which devotes many billions of dollars to AIDS relief in Africa. I heard on the World Service, to my shock and horror, that it is being administered in Africa by the Catholic churches. We need to ask them whether they are allowing the use of condoms. If they are not, there is no point in the
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I have also been shocked by the issue of the arrival of microbicides, which is supposedly around the corner. The National AIDS Trust says that microbicides will come online in two or three years, the Bill & Melinda Gates Foundation says that we are 60 per cent there and the International Partnership for Microbicides tries to fudge the issue by saying two to three years. These “two years” and “three years” have been said for at least three years already. There is no breakthrough. At present, the only way a woman can be protected is by the use of a condom; there is no other way.
DfID is investing a huge sum on trials in Africa. I have had a long talk with Professor Jonathan Weber, who is involved in those trials, and there has been nothing so far that gives any hope for a quick breakthrough. Conducting trials in Africa or India is also extremely difficult, because the women are not used to such things. They have to be monitored and looked after very rigidly, which is not an easy task.
I say again that I have come to HIV/AIDS through the needs of women, which are so unbelievably overlooked, especially in places such as Africa and south Asia. Women are not important; if one woman dies, you get another one. They have very little value. That is what we need to change. We need to start thinking about how women’s lives can be improved. They have no power to force their partners to use condoms. I can speak for India: you have to go quite a way up the social ladder before you find a woman who can ask her husband, or whomever, to use a condom. It is a serious issue.
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