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: "AIDSDON'T DIE OF IGNORANCE". Posters
were put up nationwide, telling the public that: "AIDS IS
NOT PREJUDICEDIT 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 and Body
Positive worked to influence both behaviour in the gay community
and policy itself. 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. It
was also shown that the vast majority of the country thought it
was right to run such a campaignin spite of fears that
the material used was too explicit and would cause offence.
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)
and similar reductions in other sexually transmitted infections
such as gonorrhoea.
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. Nothing
could be further from the truth. Thousands of people are still
being infected every year.
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,
with the cost to the health service approaching £1 billion
a year. The numbers
of those accessing care have trebled since 2000.
It remains one of the most serious public health issues confronting
the Government at the start of the 21st 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
improveddepending 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.
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.
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. Many feel
themselves isolated because of their condition,
and the issue of stigma has been constantly raised.
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.
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.
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. 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
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
HAUK 24 (NAM). Back
HAUK 72 (Virginia Berridge). Back
COI/Gallup survey, March 1987 Back
COI/Gallup survey, February 1987. Back
Sex Transm Inf 2001; 77: 242-247 Back
Health Protection Agency, Sexually transmitted infection data
tables, 2009: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1204619477126 Back
See, for example, Q 595 (Natika Halil, FPA). Back
See QQ 833-834 (Dr Valerie Delpech, HPA) and Q 837 (Professor
Noel Gill, HPA). Back
HAUK 68 (Health Protection Agency). Back
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
Health Protection Agency, HIV in the United Kingdom (2010 Report):
Health Protection Agency, United Kingdom; new HIV diagnoses data
to end of December 2010, Tables. No. 2, 2010. Back
See, for example, Q 501 (Dr Simon Barton), and QQ 275-276 (Dr
Ian Williams). Back
See, for example, Q 550 (Jim Jewers). Back
See, for example, HAUK 37 (Positively UK), HAUK 47 (National AIDS
Trust), HAUK 22 (Body and Soul). Back
Department of Health, Programme Budget 2009-10, op. cit.. Back
HAUK 97 (Health Protection Agency). Back
Gross expenditure on asthma was more than £1bn in 2009-10:
Department of Health, Programme Budget 2009-10, op. cit. Back