House of Lords - No vaccine, no cure: HIV and AIDS in the United Kingdom - Select Committee on HIV and AIDs in the United Kingdom

No vaccine, no cure: HIV and AIDS in the United Kingdom - Select Committee on HIV and AIDs in the United Kingdom Contents

No vaccine, no cure: HIV and AIDS in the United Kingdom

CHAPTER 1: An Introduction

1. Twenty-five years ago, a major campaign was launched to tackle HIV and AIDS in the United Kingdom. At the time there was no effective treatment for the disease; AIDS was usually a death sentence. It was already making devastating inroads in Africa and seriously affecting several cities in the United States, such as San Francisco and New York. The question for the Government was what measures could be taken to prevent the spread of the virus here. The decision taken was that the main measure should be public education, warning of the dangers and advising of the actions to take to avoid contracting the disease.

2. The result was one of the biggest public health campaigns ever seen. Leaflets were sent to 23 million homes under the banner: "AIDS—DON'T DIE OF IGNORANCE". Posters were put up nationwide, telling the public that: "AIDS IS NOT PREJUDICED—IT CAN KILL ANYONE". Under each was the additional message: "Gay or straight, male or female, anyone can get AIDS from sexual intercourse. So the more partners, the greater the risk. Protect yourself. Use a condom".

3. At the same time the BBC and Independent Television produced radio and television programmes of their own warning of the dangers; and newly formed organisations like the Terrence Higgins Trust[1] and Body Positive worked to influence both behaviour in the gay community[2] and policy itself.[3] Inside Government a special Cabinet committee was formed, which took a crucial decision to authorise the introduction of clean needle exchanges for drug users, with the aim of preventing a further source of transmission.

4. The net effect of these actions was that knowledge of the causes of HIV and AIDS vastly increased, with follow-up research showing that 98% of the public became aware of how HIV was transmitted.[4] It was also shown that the vast majority of the country thought it was right to run such a campaign—in spite of fears that the material used was too explicit and would cause offence.[5] The clean needle exchanges established their worth very early and have remained an instrument of policy ever since. Combined with awareness campaigns and behaviour change amongst the gay community, the result was a significant fall in HIV transmission among men who have sex with men (MSM)[6] and similar reductions in other sexually transmitted infections such as gonorrhoea.[7]

5. That was the position at the end of the 1980s, but what is the situation in the United Kingdom today? There has been no nationwide campaign on the same scale since and, perhaps because of this, there is a widespread assumption that the danger has gone away.[8] Nothing could be further from the truth. Thousands of people are still being infected every year.[9] The numbers of those diagnosed with HIV continues to grow relentlessly and next year it is estimated that there will be 100,000 people living with HIV in the United Kingdom[10], with the cost to the health service approaching £1 billion a year.[11] The numbers of those accessing care have trebled since 2000.[12] It remains one of the most serious public health issues confronting the Government at the start of the 21^st century.

6. The nature of the challenge, however, has changed profoundly in one respect. In the 1980s AIDS was untreatable and too often a death sentence. Thanks to the utterly beneficial development of antiretroviral drugs, progression from HIV to AIDS can now be significantly delayed and life expectancy significantly improved—depending upon how quickly the condition is detected. There have been almost 20,000 deaths from AIDS in the United Kingdom since the epidemic began, with the peak being reached in 1995 when more than 1,700 people lost their lives.[13] Thanks to the new drugs the number of deaths now run at around 500 a year, a number which has remained stable for the last decade.[14] HIV has been transformed into a serious long-term condition for those who are infected, with just as serious cost consequences for the health service.

7. One assumption is that because of these medical advances, acquiring HIV is consequence-free. This is not remotely the case. We have been struck by the evidence given to us of the serious medical and mental health problems that remain for many with HIV.[15] Many feel themselves isolated because of their condition[16], and the issue of stigma has been constantly raised.[17] The vast medical advances should not, therefore, breed a false sense of security. Patients can now live with HIV, but all those infected would prefer to be without a disease which can still cut short life and cast a shadow over their everyday living.

8. The cost of the epidemic continues to grow. Gross expenditure on HIV and AIDS increased by more than 50% in the four years between 2006/7 and 2009/10, rising from £500m to more than £760m.[18] If the 3,800 infections acquired in this country which were diagnosed in 2010 had been prevented, £1.2bn in direct lifetime healthcare costs would have been avoided.[19] These costs will only increase as the numbers of those living with HIV rise; increasing life expectancy means that treatment lasts for decades rather than years.

9. This is not a case for cutting back on treatment; it is a case for investing in prevention. HIV remains an entirely preventable condition, unlike other expensive conditions like asthma.[20] Investment in preventing future infections has the potential to ensure huge savings in future costs. We are concerned that successive governments have seemed unable to grasp this essential point. The result is that the number of new infections, which could have been prevented, have risen; and health service costs, which could have been avoided, have increased. HIV and AIDS has not been given the priority it deserves.

10. In their planned changes to the National Health Service the Government have proposed significant changes to how public health services are organised. This includes the creation of a dedicated public health body, Public Health England, with its own ring-fenced budget. These changes hold the potential for significant improvement. The acid test will be the response to the challenge of HIV and AIDS.

11. The Committee was appointed by the House of Lords on 20 December 2010 to consider "HIV and AIDS in the United Kingdom". The aim of this report is to examine progress made in tackling the domestic HIV epidemic over the past 25 years, and, where appropriate, to propose recommendations to move the situation forward.

12. Health is a devolved issue. This is most important in considering the potential impact, as we do, of proposed NHS and public health reforms. Many of those reforms extend only to England. It is therefore inevitable that many of our recommendations will not be applicable nationwide. However, where they are of more general relevance, we hope that the recommendations can be instructive throughout the United Kingdom.

13. We took evidence from a diverse range of witnesses between January and June 2011, including clinicians, vaccine researchers, prevention experts, people living with HIV and faith and community groups. This work has been supplemented by visits to HIV clinics and community centres in London, Brighton and Leeds, as well as a visit to Her Majesty's Prison Brixton. We have been assisted in our work by Professor Anne Johnson, Co-Director of the University College London Institute for Global Health. We would like to express our thanks for the support provided by Professor Johnson as Specialist Adviser to the Committee.

1 See Appendix 8 (Glossary) Back

2 HAUK 24 (NAM). Back

3 HAUK 72 (Virginia Berridge). Back

4 COI/Gallup survey, March 1987 Back

5 COI/Gallup survey, February 1987. Back

6 Sex Transm Inf 2001; 77: 242-247 Back

7 Health Protection Agency, Sexually transmitted infection data tables, 2009: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1204619477126 Back

8 See, for example, Q 595 (Natika Halil, FPA). Back

9 See QQ 833-834 (Dr Valerie Delpech, HPA) and Q 837 (Professor Noel Gill, HPA). Back

10 HAUK 68 (Health Protection Agency). Back

11 The cost of treatment and care was 762m in 2009-10, up from £500m in 2006-7: Department of Health, Programme Budget 2009-10: http://www.dh.gov.uk/en/managingyourorganisation/financeandplanning/programmebudgeting/DH_075743 Back

12 Health Protection Agency, HIV in the United Kingdom (2010 Report): http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287145367237 Back