| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
During the celebrations last year to mark the bicentenary of the abolition of slavery, attention was rightly drawn to the existence throughout the world, including the United Kingdom, of a form of slavery more prevalent now than it was 200 years ago. Human trafficking is responsible for the spreading of HIV/AIDS and many other sexually transmitted diseases. It is reckoned that 80 per cent of women in United Kingdom brothels have been trafficked. Therefore most of the activity in these places is rape. As Her Majesty’s Government have insisted that all public places, including churches, display “No Smoking” notices, should they not find a similar way to warn customers in brothels that they may run the risk of being charged with rape? The amendment tabled by the noble Lord, Lord Anderson of Swansea, to the Criminal Justice and Immigration Bill a few weeks ago to make all purchasers of prostitution services liable for prosecution would certainly go some way to reducing the spread of all sexually transmitted
3 Apr 2008 : Column 1171
A recent “Panorama” programme drew attention to the appalling fact that 5,000 children are being trafficked into the United Kingdom and having unprotected sex. This is not only rape but a sure way of spreading disease, including AIDS. Lyndon Whitehouse, a former detective sergeant in Wolverhampton, said in the documentary that this activity is occurring in all major cities, but only two police forces have dedicated teams to deal with this scourge. He was involved in a pilot project that successfully dealt with the problem in Wolverhampton and secured 35 convictions, but the lessons learnt have not been implemented elsewhere. Apparently there are targets for reducing gun crime and burglary, but no targets for child prostitution reduction. Children are much more frightened of the pimps than they are of the law, and the violence that they suffer is terrible. One girl had boiling water held above her throat; another had her tongue nailed to a table. Will the Minister look into the reason why this successful Wolverhampton project has not been repeated elsewhere?
Care and prevention programmes really must go hand in hand, as the availability of good medical care and treatment encourages people to come forward for testing. Both HIV positive and negative individuals can then be taught about good prevention, with an emphasis on a balanced ABC approach—abstain, be faithful, use condoms—the successful programme in Uganda that resulted in a reduction in the incidence of AIDS from 31 per cent to 5 per cent in pregnant women. We do not know how far one can extrapolate that to the rest of the population, but the noble Baroness, Lady Royall, has confirmed that the Government support this ABC philosophy.
HIV infection is as least as devastating to the individual as a diagnosis of cancer, and although there is a cure for some cancers, there is no cure for HIV infection. So much more remains to be done.
1.24 pm
Baroness Thornton: My Lords, I am most grateful to the noble Lord, Lord May, for leading this important debate today. As several noble Lords have said, it has been a fascinating debate, which has embraced a wide range of issues in a sensitive and informative manner. The noble Lord has such an outstanding reputation in this area that it is a privilege to be in a position to respond to the debate.
Thanks in part to the contribution and leadership of the noble Lord, Lord Fowler, in the 1980s, to which noble Lords referred, and to his early action in introducing needle exchange schemes and other preventive measures, we in the UK have not experienced the rates of HIV seen in many other European countries. I hope that I can convince him that the Government’s policy has not failed and, indeed, that sexual health, including HIV, continues to be a priority for the Department of Health and the NHS. We are well aware of the challenges
3 Apr 2008 : Column 1172
Last week, the HPA published on its website its provisional HIV data for the UK for 2007, which were based on reports received up to the end of December. The HPA estimates that there were 6,840 new HIV cases in 2007, which is lower than the figures for 2005 and 2006. We welcome this modest downward trend. Gay men continue to be the group that is most at risk of HIV transmission in the UK, as outlined by the noble Lord, Lord May, and others. The HPA estimated that there were 2,630 diagnoses in 2007, which is similar to the 2,640 diagnoses in 2006. Gay men’s increased risk of HIV is the reason why the Department of Health continues to prioritise them as a population group that requires focused and targeted HIV health promotion programmes. Like many other European countries, the UK is not immune from the global epidemic, and since 1999 an increasing number of infections have been acquired in high HIV-prevalence countries, mainly in Africa, from people who migrate to the UK, although the latest HPA estimates indicate that the numbers are declining, having been stable for a number of years.
Published in 2001, our national strategy for sexual health and HIV sets out the Government’s response to the challenges presented by increasing sexual ill health, the changing HIV epidemic and the need to modernise and improve sexual health services. Four of the five aims address HIV, and include work on stigma and social care, to which I shall return later. The strategy has been effective in driving our national response and driving change. The noble Lord, Lord Fowler, and the noble Baroness, Lady Barker, mentioned ease of access to sexual health clinics, which has been improved by reducing waiting times. The latest data for January 2008 show that 96 per cent of patients were offered an appointment within 48 hours, which is up from only 45 per cent in May 2005.
We have also increased dramatically the offer and uptake of voluntary and confidential HIV testing in sexual health or GUM clinics. Among gay men, this has increased to 85 per cent in 2006, from 61 per cent in 2001, and among heterosexuals to 72 per cent, from 41 per cent in 2001. This builds on excellent progress in diagnosing HIV in pregnancy and offering interventions that prevent-mother-to child HIV transmission. Today, the HPA estimates that at least 90 per cent of HIV- infected pregnant women are diagnosed before delivery, which is an increase from about 70 per cent in 1999.
On the last World AIDS Day on 1 December, we announced a major increase—20 per cent over three years, or £17.6 million—in the AIDS support grant paid to local authorities, recognising the often complex social care packages required especially for women, children and families. I very much welcome the review of the strategy which the Independent Advisory Group on Sexual Health and HIV is conducting. The IAG was established by the Department of Health to monitor progress on the implementation of the strategy. It is currently finalising the review and will present its report to the Department of Health shortly. I pay tribute to the work of my noble friend Lady Gould in
3 Apr 2008 : Column 1173
HIV prevention and care promotion are key elements of our response to HIV. We know from the data, as outlined by the noble Lord, Lord May, with significantly more eloquence than me, that gay men and African communities continue to bear the brunt of HIV in the UK, which is why they remain the focus for our national health promotion work. Over the past two years we have strengthened this work by investing an additional £2 million in the work delivered by the Terrence Higgins Trust and the African HIV Policy Network. This is in addition to the sustained investment we have provided over the past 10 years or so.
New work for gay men includes work with men who use recreational drugs, owners of social venues—in other words, sex-on-the-premises venues—gay men with diagnosed HIV, and work to increase and improve the evidence base for gay men with HIV. The Department of Health has commissioned Sigma Research to do a retrospective analysis of the data amassed in the past 10 years of the Gay Men’s Sex Survey. We are keen for this work to look at trends and changes over time and drill down to the subpopulations of gay men at increased risk of HIV. In the early summer of 2008 we will make the findings, including regional and local information, accessible to NHS commissioners, who will then have up-to-date information to support their provision of local services.
For African communities we are working on interventions to increase awareness of the benefits of HIV testing and the importance of using condoms. Last week, at its national conference, the African HIV Policy Network launched a new campaign, funded by the Department of Health, called “Do it right” which addresses gender issues and how they impact on prevention, an issue mentioned by several noble Lords. We are also working to achieve consensus on prevention priorities as well as strengthening the evidence base for HIV health promotion in African communities in England. This is a challenge. It certainly cuts across a variety of issues to do with culture, migration, the movement of populations and, indeed, the place of women. We are also supporting innovative work in supporting faith leaders and communities to engage in HIV prevention and social care. Later this year the African HIV Policy Network will publish the outcome of this in the form of a toolkit and supporting materials.
I turn briefly to some of the issues raised by the noble Lord, Lord May, and other noble Lords. On the screening of migrants for HIV, the current routine screening of migrants involves screening for TB in those from high-incidence countries. TB has been targeted as a serious airborne infection. Over time, around 10 per cent of those in close contact with a person with infectious TB can expect to become infected. Screening for other infections is being kept under review. However, HIV and hepatitis do not pose the same risk and screening for them might be discriminatory and stigmatising. As the noble Lord said, testing should be opt-out, not opt-in. That poses some very difficult issues for us. We are considering
3 Apr 2008 : Column 1174
The noble Lord, Lord May, the noble Baroness, Lady Gould, and other noble Lords raised the issue of counselling and HIV testing. Moving from pre-test HIV counselling to pre-test discussion, unless a person asks for, or needs, counselling, aims to make HIV testing more routine and more normal, especially in more mainstream healthcare settings, including primary care and hospital settings. If a person seeks, or a clinician feels, that there is a need for, counselling, it is available following a positive test result. This approach has been supported for some time by the British HIV Association, the British Association for Sexual Health and HIV and others, including HIV voluntary sector organisations.
The noble Lord, Lord May, the noble Baroness, Lady Gould, and other noble Lords raised the issue of educating people. For the past 10 years, and in line with the epidemiology, which identifies the groups most at risk of HIV in the UK, our prevention and HIV health promotion has focused on gay men, or men who have sex with men, and people from, or with close links to, high-prevalence countries overseas, especially in Africa. This targeted approach is supported by the Health Protection Agency and organisations such as the Terrence Higgins Trust.
The noble Lord, Lord May, raised the issue of the money that is not being spent by PCTs on sexual health. The noble Lord, Lord Fowler, also raised this issue. Ultimately, funding arrangements are a matter for the NHS and the primary care trusts, which must be free to prioritise their local funding in accordance with local needs. However, we recognise the need for improvement in this area, which is why we produced the national strategy for sexual health in 2001, and why sexual health is a key element in the public health White Paper. It has been a priority for the NHS, over the past two years, to take action on reducing waiting times in GUM and chlamydia screening. The 2008-09 NHS operating framework and the national planning guidance confirm that sexual health will continue to be a priority for the NHS. Our targeted HIV work is additional to our new sexual health campaign, Condom Essential Wear, launched in November 2006, which tackles the five major acute sexually transmitted infections, as well as HIV. Evaluation is showing high levels of awareness.
I turn to the important area of HIV stigma and discrimination, touched on by the noble Baronesses, Lady Gould, and Lady Flather, the noble Lord, Lord McColl, and others. The national strategy for sexual health and HIV recognised the importance of tackling this, since it can have negative health and other outcomes for people with, or affected by, HIV. Last May the Department of Health published Tackling Stigma, setting out action on HIV stigma. This includes Department of Health funding for three new projects over the next two years. These are:
3 Apr 2008 : Column 1175
In the UK we provide some of the best quality HIV treatment and care in the world, underpinned by strong clinical guidelines and standards, and supported by excellent surveillance. AIDS diagnoses and deaths have fallen markedly following the introduction of anti-retroviral therapies in the mid-1990s, and have remained relatively constant in recent years. Deaths among HIV-infected persons fell from 749 in 1997 to an estimated 540 in 2007. AIDS diagnoses dropped from 1,083 in 1997 to an estimated 750 in 2007.
Despite these successes, we certainly are not complacent about the challenges that we face. I have mentioned the impact of stigma, which we never underestimate. Our other challenges include the persistently high numbers of HIV transmission among gay men in the UK; increasing rates of STIs; the evidence we see of the late diagnosis of HIV; and the proportion of those with HIV who remain unaware of their diagnoses. One of the challenges for gay men’s health promoters is how to keep fresh and relevant the long-standing health promotion messages for those gay men exposed to them since the 1980s, while addressing the needs of those who have become sexually active in an age of effective HIV treatments and more risk-taking behaviour generally. It is therefore essential that our national work, delivered by the Terrence Higgins Trust and its partners, gets the balance right.
We need to recognise, too, that for all groups, changing behaviour is not an area where government action alone is sufficient. We need to work with the NHS, the voluntary and commercial sectors, and individuals to promote a sustained and focused effort to improve sexual health. Action on sexual health is required through the joint Department of Health and DCSF PSA on teenage pregnancy. The target for improving access, and the inclusion of sexual health in new priority indicators, as well as detailed monitoring and reporting by the HPA of HIV have all helped to prioritise local action on sexual health and, importantly, focus action on improving sexual health outcomes, rather than focusing solely on inputs. The new NHS operating framework and national planning guidance identifies action on sexual health for 2008-09 focusing on chlamydia screening. I understand that the review of the strategy will also recommend some suggested performance indicators for HIV, sexual and reproductive health.
I now turn briefly to some of the points raised by noble Lords during the debate. I promise that I will write to reply to those that I do not deal with. The noble Baronesses, Lady Gould and Lady Barker, asked about late diagnosis of HIV. It is not clear why some groups, particularly Africans, delay testing or choose not to test. We can speculate about what those
3 Apr 2008 : Column 1176
On the issue of social care, which was mentioned by the noble Baroness, Lady Gould, and other noble Lords, over the past two years we have invested an additional £2 million, as I already said. That is an additional £2 million to our national HIV health promotion programme for gay men and African communities, the groups most at risk. We published an action plan on HIV-related stigma and funded new work, and last December announced the additional funding.
The noble Baroness, Lady Gould, and the noble Lord, Lord Fowler, mentioned the needle exchange schemes. In recognition of the importance of harm reduction services in preventing blood-borne virus transmission among infected drug users, the Department of Health published only in the past year an action plan to address that.
The noble Baronesses, Lady Barker, Lady Gould and Lady Masham, and the noble Lord, Lord Fowler, all mentioned, as did others, the issue of asylum seekers. The NHS is first and foremost designed for people living legally in the United Kingdom. We believe that the majority of people with HIV are living here legally and are entitled to receive free of charge the excellent NHS treatment for HIV. Asylum seekers are entitled to full NHS care without charge, including for HIV services. Those asylum seekers whose application and any appeal subsequently fails and who have started treatment continue to receive free NHS treatment while they remain in the UK. Following publication of the Home Office strategy Enforcing the Rules: A New Strategy to Ensure and Enforce Compliance with our Immigration Laws, the Department of Health and the Home Office are jointly reviewing the rules on access to the NHS by foreign nationals. That includes treatment for HIV.
The noble Lord, Lord Fowler, raised the issue of education in schools. Action to improve PSHE includes funding a training programme for teachers and community nurses who input into that programme, providing guidance to schools to help them better assess what pupils learn, provide support for PSHE teachers and share best practice.
I now turn to issues raised by the noble Lord, Lord Fowler, the noble Baroness, Lady Flather, and the noble Viscount, Lord Craigavon, about our international contribution. DfID provides substantial support through country programmes, multinational organisations and Global Partnerships. Under Global Partnerships, DfID is a key donor to the global fund to fight AIDS, TB and malaria, pledging £1 billion for 2008-15, which is an unprecedented contribution. DfID supports the Stop TB Partnership—nearly £9 million. We are funding programmes throughout the world to help reduce AIDS and address the issues of sexual health.
I am not able to deal with all the issues raised, but I should like to make one point to the noble Baroness,
3 Apr 2008 : Column 1177
I very much welcome this debate and the attention that it has given to HIV. We have seen tremendous progress, particularly on treatment issues, but we are well aware of the continuing challenges around the world. I thank all noble Lords, particularly the noble Lord, Lord May, for their fascinating contributions.
1.45 pm
Lord May of Oxford: My Lords, noble Lords who were here earlier will be reassured to discover that I have only three bits of paper in my hand, although if they could see the first bit of paper they would perhaps be less reassured. I want to thank all those who have spoken in the debate, which, it is fair to say, has been one of very high quality.
I began by saying that I find it rather surprising that this remarkable upsurge in the incidence of HIV in the UK has not received more attention. The noble Viscount, Lord Craigavon, pointed out that the issue is not fashionable. I hope that this debate, among other things, might help make it a bit more fashionable. We were reminded by several noble Lords that there are currently between 70,000 and 85,000 people—the numbers are uncertain, as I emphasised earlier—living with HIV in this country. We can keep them alive, but there is no cure and no vaccine, and I am shamelessly going to digress and mount a hobby horse for an instant.
The molecular biology that describes in molecular detail how individual strains of HIV virus interact with individual immune system cells in the human body is beyond imagination. That descriptive material has enabled us to design drugs that suppress viral replication and keep people alive. I would be willing to bet that probably nine out of 10 of the frontier researchers—the UK plays a disproportionately important role in research into the molecular cellular biology of this problem—never consciously reflect that we still have no agreed explanation of how HIV actually ends up causing AIDS. Personally, I do not believe that we will have one until we have a better understanding of the complex, non-linear dynamical system that is an invasive viral agent and the immune system. The immune system itself—questions of allergy—are still open because we have no agreed explanation of how it works. The immune system is not coded in the DNA. It is self-assembled in the first few years of life, reaches a level of complexity, and turns off. That is not understood in fundamental terms. It is described brilliantly, but we are still Tycho
3 Apr 2008 : Column 1178
An immunology text of today looks like an ecology text of the 1960s—the description is important and it is practically applicable, but it lacks an understanding of many of the complicated dynamical workings that knit communities together. Today, an ecology text has that analytic component. Immunology texts are still descriptive. Twenty years from now they will be different and that difference, I believe, is a prerequisite to having a cure or a vaccine.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |