| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
The world is facing two major problems. I consider HIV/AIDS to be a major world problem. The other one is global warming, which is closely connected with population increase worldwide. It is no use our pretending that the two have no connection. If we are not allowed to use condoms or operate family planning, where are we going to end? I hope that some pressure will be applied to the Catholic Church to rethink the needs of everyone instead of just concentrating on a doctrine that is so out of date. The world is drowning in population. It is not as though we have a shortage of people, although, actually, Italy does: the Italian birth rate is 1.2 per couple. That is interesting because people there do what they want; they are not subject to doctrines. That is what happens in western countries because people can take their own decisions, but the poor have faith in their church and believe what they are told. That is where the Catholic Church needs to help—and to help the women particularly.
All the speakers today have touched on the stigma of HIV/AIDS. Nothing can really change unless people are able to say, “Yes, I am sick. Please see what’s wrong with me”. People get hidden in houses when health visitors come. In poor countries such as India, monogamous women who become infected by
3 Apr 2008 : Column 1164
So give a thought to women when thinking of HIV/AIDS and give a thought to the global situation. I know that we have 80,000 infected people in this country but I think that they are irresponsible. We need to be much more directive. Perhaps we need more education in schools; we have been ambivalent about these issues in schools and we need to be more proactive and more directive.
12.51 pm
Viscount Craigavon: My Lords, I would like mainly to focus on the issue of HIV prevention in the UK, and how that can be assisted.
I am grateful to the noble Lord, Lord May, for giving us this opportunity and for bringing the benefit of his intense and forensic analysis to this subject. His speech was a compelling tour de force and I hope he continues to harass both the Government and us on the subject. I apply the term tour de force also to the speech of the noble Lord, Lord Fowler, who continues to fire on all cylinders on the subject; we are grateful for that. Many of the issues I was going to raise have been covered in those two speeches, so mine will be quite brief. I also praise the noble Baroness, Lady Flather, for her characteristic forthrightness on the subject. We should all read her speech and take it in. I shall, however, concentrate on the UK.
We are fortunate to have from the Health Protection Agency the figures for 2007, which were published just last week. They were available in a very accessible form, a press release with an accompanying article and graphs. That is just the format needed to help people begin to grasp the current underlying picture and trends. I am grateful also for excellent, highly comprehensible briefing generally from the National Aids Trust.
With my interest in international development, specifically in the field of reproductive health, I have always been aware of the huge—usually horrific—shadow of HIV/AIDS in many parts of the world, particularly in Africa. I very much echo the way in which the noble Lord, Lord Fowler, characterises the shame we should feel over the 20 million or 25 million who have died, with this country and the western world generally ignoring it. The situation was given even more colour by the noble Baroness, Lady Flather.
I have for many years been a slightly detached member of the All-Party Group on AIDS—but I have not been a committee member, as the noble Lord, Lord May, may have implied. I get the impression that the subject seems rather to go in and out of fashion in this building according to what other winds may be blowing and the extent to which what one might call “occasional fatigue” on the HIV/AIDS issue has set in. But however imperfectly the All-Party Group on AIDS may struggle to draw the attention of Members of both Houses to this key subject, I commend the group for its valuable efforts and for what it has
3 Apr 2008 : Column 1165
The noble Lord, Lord May, mentioned the recent valuable POSTnote—an excellent document entitled HIV in the UK produced by the Parliamentary Office of Science and Technology, which Parliament has benefited from. It summarises, in the customary four-page format, all the current aspects of the subject, in a form which is digestible and authoritative and is exactly what Members of both Houses need. I hope that it can occasionally be updated.
The recent survey and report from the National Aids Trust, assisted by the Health Protection Agency, confirmed that there had been a real reduction in spend on HIV prevention over the past 10 years. It has occurred at a time when the number of those living with HIV has steadily increased. The conclusion was arrived at mainly by surveying primary care trusts where the real amount spent on HIV prevention is often not clear. This trend of relative under-spending continues, sometimes in areas with the greatest local need, areas which would benefit from tailored prevention services and whose attempts are failing.
I advocate more focus on prevention. In my experience, there is always a temptation in the international field to follow the immediate treatment needed by those who are visibly suffering, and sometimes to follow the blandishments of the drug companies. As in international areas, we should aim to have measurable targets for HIV prevention, both nationally and locally. One report refers to “aspirational” targets. I would prefer the aim to be more realistic.
If the Government could devote more funds to prevention, it should be clearly identifiable how the funds are to be spent and they should be ring-fenced. The noble Lord, Lord May, said that not all the money allocated has been spent on the intended purpose and that there was disproportionate spending on treatment. I agree with the noble Baroness, Lady Gould, that the elements should be treated in parallel.
I understand that there has been some success in improving access to HIV testing and take-up. As the noble Lord, Lord May, emphasised, there has been a welcome, though possibly slow, move towards opting out rather than opting in to testing. Ready access to diagnostic services is a key part of infection surveillance and we should be more proactive in this field. I recognise the sensitivities that will have to be overcome in achieving that.
A recent excellent, very human television programme gave us Stephen Fry’s take on HIV. It showed a testing centre in Middlesbrough, I believe, which had stripped away many of the disincentives to visiting such a place. It showed how a 15-minute test can be conducted in a most sympathetic way. It deserves praise for not being heavy-handed and for not browbeating the audience. It showed what happens in real life, and it let us judge how we and others might respond. It illustrated the
3 Apr 2008 : Column 1166
Slow progress is being made in this field in the UK, but in years to come we will be found to have not treated it with the seriousness and urgency it deserves.
12.58 pm
Baroness Barker: My Lords, I, too, congratulate the noble Lord, Lord May, on introducing the debate with such clarity and passion. I invite him to join my PowerPoint Liberation Front. There are days when I think I will scream if I see another bullet point. More to the point, PowerPoint stops people making the sorts of speeches that the noble Lord made, speeches which communicate and convey issues in a way that computers never can.
I thank all noble Lords who have taken part in the debate. Every noble Lord who spoke has approached the subject in a slightly different way and added something very important. I want to pick up one of the first things the noble Lord, Lord May, said—that we need longitudinal work to draw attention to what happens with HIV. One of the lessons I always draw from our frequent debates on the subject is the need for persistence and repetition: persistence in looking at the issue and repetition in raising it. That is what we are doing today.
In preparing for the debate, I was taken back to the late 1980s when the virus and the illnesses first emerged. I remember talking to a group of people who worked with and were users of an HIV service at that time. It was a time when people put a brave face on what was a devastating diagnosis. One of those to whom I spoke did an excellent job of putting on a brave face, but he said something terribly important. He said: “I know it sounds strange to say it, but I actually feel quite lucky that I live here. I live in a country where there is a National Health Service. The reason I feel lucky is not only that I know I will be treated but that, as we have a National Health Service and it can look at the incidence of the illness across the whole population, there must be hope that it will find a cure quicker than in other circumstances”. He was right. The National Health Service has a unique opportunity to study the virus and transmission, and to do research at a population and sub-population level. The noble Lord, Lord Fowler, was right that the great tragedy of the past 25 years is that we have wasted that unique opportunity to learn. We have failed to learn some very simple lessons.
I am one of the Front-Benchers in this place who frequently lay into the Government and castigate them for having too many targets and centralised policies. However, I agree with the noble Earl, Lord Howe, who often speaks on health, that public health is an exception to that. Public health targets and nationally determined programmes—which need not be the same all over the country—are a wise way in which to develop public health policy and to make use of the fact that we have a National Health Service.
3 Apr 2008 : Column 1167
Other noble Lords have quoted statistics from the survey which came out last week. There are just two on which I wish to focus: the fact that approximately one-third of all cases of HIV are undiagnosed, which is a very high comparative level; and the accompanying statistic that nearly 40 per cent of gay men in the UK have never had an HIV test. There are public health and clinical concerns about such a high level of undiagnosed people, because they are most at risk of transmitting HIV to others. They are far more at risk of doing so than are those in care. Good evidence suggests that people with an undiagnosed HIV infection are responsible for between one-third and one-half of all new HIV infections. I echo a point made by the noble Lord, Lord Fowler, and the noble Baroness, Lady Gould. We should have learned by now, 25 years later, that HIV testing has to occur in a number of different settings, some of which are not identified as having anything to do with HIV, so that a range of different people can be tested in a place where they feel comfortable.
In 2006, the Health Protection Agency produced an excellent report entitled A Complex Picture. It was a very good title because the situation is complex. The document set out how the surveillance systems established in the UK have served the population well during the past two decades. However, it also highlighted the rise in all STIs and drew to the attention of policymakers the key issue of cross-infection. When somebody has another sort of sexually transmitted infection, they are more at risk of developing HIV because they have a compromised immune system. That is part of the issue in Third World countries to which the noble Baroness, Lady Flather, drew our attention. The coincidence of HIV with other STIs makes managing people’s health more difficult. That is important. We have had debates in this House about the rise in the incidence of chlamydia, for example.
I contrast that with the findings of a survey on clinics carried out at the same time by my honourable friend in another place, Sandra Gidley. That showed that fewer than 33 per cent of clinics reached the target of giving appointments within 48 hours, with more than half of all patients having to wait more than seven days for a diagnosis. Many clinics were working with restricted opening hours, some to fewer than 20 hours a week. Many opened irregularly. That is not the way to enable and encourage people to come forward for testing. Other noble Lords are right that cuts to community, outreach and voluntary-sector sexual health services happened in 2006. Those happened because word came from the Department of Health that the overall NHS target was to meet its budget for that year. Therefore, in PCTs across the land, all sorts of other budgets, including for sexual health, were raided. It was a false economy.
A number of noble Lords have spoken about the work of the noble Lord, Lord Fowler. Although the noble Lord, Lord Newton, is rarely mentioned, he was similarly important in that work back in 1986. I do not know whether noble Lords know it, but the noble Lords, Lord Fowler and Lord Newton, were responsible for one of the top 100 adverts of all time, and we all remember its importance.
3 Apr 2008 : Column 1168
Around about that time, I was engaged in some of the very first work in Europe on older people and HIV. We noted in statistics that more than 10 per cent of those who were infected were aged over 50, yet, at that time, for very understandable reasons, everything was targeted at young people. For older people who had become infected or who were their carers or relatives, nothing was being done. I remember going along with a colleague to talk to a bunch of older gay men one night in about 1992—so it was after that advert. We assumed that they would have a level of knowledge about infection and safe sex, but we were wrong. They wanted to hear some very basic messages about safe sex, the reason being that, although the gay community as a whole had been given an awful lot of information, it was inappropriate to them. They did not feel that they could go and get it; they did not feel that they could take it home; they did not feel that they could use it; and they missed out on those messages.
The noble Lord, Lord Fowler, said that we are stuck in that argument about global/population-level or targeted adverts. We need both. That is what we have learned in 20 years. We have learned more than anything else that health and information campaigns need to be repeated over and again. The one agency that can do that is government. It is the role of government to be there when everybody else has gone and to bang out those messages until they get right through to the population.
The noble Baroness, Lady Gould, raised the important issue of why HIV has been singled out as the only transmissible disease for which people have to pay for their care. The National Aids Trust, too, has raised it with us. I return to the fact that we have a National Health Service. I am one of the biggest defenders of the National Health Service; it is one of the things about this country of which I am most proud. I pay my taxes to fund the National Health Service, and do so not because I want to be treated—although I am—but because I want a National Health Service that will treat other people. I want a National Health Service that will ensure that the whole population enjoys good health. I want to see my taxes to the NHS going towards those interventions which are not popular and may be open to political criticism from time to time but which are fundamentally necessary to the health of the population.
I enjoyed greatly and agreed with almost all that the noble Baroness, Lady Flather, had to say—not quite all, but most of it. She reminded me that following the US mid-term elections, one of the first things to happen when the composition of the Congress and the Senate had changed was that the policy of the US Government towards funding only abstinence programmes was challenged. Given that the Bush era is coming to an end, given that change on the part of one of the biggest donors and players on the international scene, could the Minister tell us what the Government are doing to make sure that all the lost time which the noble Lord, Lord Fowler, talked about in international work on HIV is regained and that we move towards far more effective policies? Once again, I thank the noble Lord, Lord May, and I say to him, “Do not give up and do not let us give up”.
3 Apr 2008 : Column 1169
1.11 pm
Lord McColl of Dulwich: My Lords, I, too, thank the noble Lord, Lord May, for initiating this debate and for his brilliant speech. I am going to follow the example of the noble Viscount, Lord Craigavon, who did not repeat everything that has been said. All the statistics I was going to give have already been given so I will limit my remarks to a few things.
The director of the Health Protection Agency, commenting on the statistics in November 2007, said that the sooner HIV and other sexually transmitted illnesses are diagnosed and treated, the less likely they are to be passed on. That is certainly true, as the noble Lord, Lord May, said, but it is important that the diagnosis is given in the right and sensitive way, together with correct HIV prevention information and coupled with ongoing support and monitoring. There is, as has been mentioned by several speakers, considerable stigma attached to the diagnosis of HIV and AIDS, especially in many ethnic minority groups, which produces a great fear of disclosure to friends, family and community. Patients often present late, already with advanced HIV disease, because of this fear.
The free availability in the United Kingdom of highly active antiretroviral therapy—HAART—has made some people complacent about HIV transmission and there is now a misconception, as has been mentioned, that HIV can be easily treated. There is still no cure. Treatment is complex and it is given for life. The development of resistant and possible long-term side effects means that regular monitoring at HIV specialist clinics is essential. Many are now living with a much better life expectancy and with a good quality of life but there are still significant numbers with chronic and very complex HIV-related problems. For them, services are far from widely or easily accessible. An editorial in the journal AIDS published in 2007—vol. 21, 1965-66—regarding AIDS dementia commented that there is a common impression that HIV dementia is no longer important as we have these high-powered drugs. However, the prevalence of AIDS dementia has increased in spite of high-powered drugs and this widespread lack of awareness, even among clinicians, has to be remedied.
I need to declare an interest in that I have been associated with the first hospice for people dying of AIDS in Europe—namely the Mildmay centre in Tower Hamlets, which was established in 1985. We remain very grateful to a junior Minister of Health—one Kenneth Clarke. The matron, the chairman of the board of governors and the medical superintendent went to see him because the Mildmay had been closed, being surplus to requirement. These three ladies asked for the hospital back: “It is our hospital and you have taken it away”. Kenneth Clarke, in his usual jolly way, said: “Yes, of course you can have it, no problem at all, but you will never find any money to run it”. He has been a great supporter ever since and we have always been grateful to him. It is the only specialist centre in the UK to provide rehabilitation through in-patient and daycare services for patients with advanced AIDS dementia, together with other neuropsychological and complex HIV problems. Its
3 Apr 2008 : Column 1170
The Mildmay has extended its work with AIDS over the past 15 years into many countries in Africa. I shall never forget one day in the Mildmay centre in Uganda when we saw nearly 100 orphaned children, all with HIV and AIDS, 80 per cent of whom had TB and many other infections, including scabies. Scabies presents just a few spots on the body, but with their immune system destroyed, they are covered with scabies and suffer terribly. That, of course, can be treated.
I would like to draw attention to the plight of children with HIV and AIDS. Currently there are 2.5 million children with HIV in the world. Last year new infections amounted to nearly 500,000 and deaths among children amounted to 330,000. Only 15 per cent of the 780,000 children who are in need of treatment with these high-powered drugs are currently being treated in low- and middle-income countries. Children living with HIV are often neglected or ignored and are the last to access care and treatment. Quite rightly, many donor agencies have in the past two years or so included the development of services and support for orphans and vulnerable children in their agenda, especially since UNICEF and Save the Children called for more attention to the needs of the 15 million or so AIDS orphans in the world. The issue must be fully acknowledged and included in any national and international aid programmes and government policies and strategies and plans.
It is also important to be aware of the needs of the large number of children who are HIV positive and in need of comprehensive holistic medical care. Of those who access treatment, many are living into adolescence and early adulthood with all the challenges that that brings in terms of increasing sexual awareness and expression.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |