here - United Kingdom Parliament
here - United Kingdom Parliament here - United Kingdom Parliament
299WH 1 DECEMBER 2010 HIV 300WH HIV 2.30 pm Mr Edward Leigh (in the Chair): The sitting is resumed. Hon. Members: Hear, hear! David Cairns (Inverclyde) (Lab): That might be the best cheer I get all day. I welcome you to the Chair, Mr Leigh. It is a pleasure to serve under your chairmanship in this important debate. I also thank Mr Speaker for allowing this debate on HIV services in the UK to take place on world AIDS day. I have been in Parliament for nine years, but I am still ignorant about how debates are selected—whether there is a lottery or whether Mr Speaker has a say in the matter. If he does, I thank him; if it was a lottery, I thank the Fates for timetabling this debate on 1 December. I begin with a point of clarification. This is not for the benefit of hon. Members present in the Chamber, as they are well aware of the procedures of this place, but for those who are watching the debate on television or the internet, and those who will read the account of the debate in days to come. This debate will focus mainly on HIV in the UK, but that is not because we think that HIV outside the UK is not a problem, or because we are unaware of the scale of HIV in the developing world. Africa has 10% of the world’s population but 72% of the deaths from AIDS, and we are aware of that. However, parliamentary procedure means that different Departments respond to the debates on different days, and today it is the turn of the Department of Health, not the Department for International Development. Therefore, although an enormous number of points could be raised about the global AIDS epidemic, I will in the main restrict my comments to HIV in the UK. With your indulgence, Mr Leigh, I might also sneak in a few comments about the international scene; I alerted the Minister about that in advance. If colleagues are anxious to hear about the international aspects of the HIV epidemic, I should say that a world AIDS day reception will be held this evening at 7 pm in the CPA Room. You are invited, Mr Leigh, as are all hon. Members, friends and colleagues. Mr Gareth Thomas (Harrow West) (Lab/Co-op): My hon. Friend is performing a service by raising the issue of HIV/AIDS in the UK. Does he also recognise that many people, both inside and outside the country, want to know what the UK Government intend to do about the future funding of the Global Fund to Fight AIDS, Tuberculosis and Malaria? That body has an excellent record in getting drugs to people with TB, malaria and particularly AIDS, many of whom are still in desperate need. David Cairns: I am grateful to my hon. Friend, who was a distinguished and long-serving Minister at DFID. In a sense, it is a false dichotomy to say that there is an AIDS epidemic in the UK and an AIDS epidemic in Africa and never the twain shall meet. One of the largest at-risk populations in the UK is the African community––people who come from Africa and are HIV positive, or those who contract the disease in the UK within the African community. I will speak about that in a moment. My hon. Friend is correct to highlight the need to address the problem of the AIDS epidemic in Africa. Over the past few years, one of the most effective ways of doing that has been through the Global Fund to Fight AIDS, Tuberculosis and Malaria. The last Government had a good record in ensuring that the global fund was initiated, then adequately resourced. During the most recent meeting of the fund in October, high, medium and low targets were set for the level of replenishment. Unfortunately, the global community failed to hit the low target, let alone the medium or high targets. I understand why the Government do not come forward and state the exact figures for the replenishment of the fund. Through DFID, they are conducting a multilateral aid review, and until they decide their priorities, they cannot say how much will be made available for the global fund. Until we can provide a figure, I encourage Ministers to let the world know, at least with rhetoric, that we remain committed to the global fund. Much of the world looks to the UK for an international lead in tackling AIDS, and other countries will be looking to our figures for the replenishment of the global fund before making their commitments. The Government have an excellent opportunity to set a global lead. I was going to make those points about the international community at the end of my speech, but I have made them now. Let me return to matters for which the Minister is responsible—she will be pleased to hear that—rather than the rest of the world. I will make three points about how we should respond to the ongoing HIV epidemic in the UK and our public policy priorities. First, I will speak a little about prevention, secondly I will discuss testing and treatment and thirdly I will say something about care and support. Those three things do not exist in isolation; they are not, to use fabled management-speak, in “silos.” One point leads into another, but for the purposes of the debate I will say a little about each issue in turn. The backdrop to this debate is not only the ongoing financial constraints under which all Governments around the world are operating, but the NHS reconstruction and reconfiguration that the Government have embarked on, as well as the messages contained in the public health White Paper, launched yesterday by the Secretary of State. Because the national health service is undergoing a process of change and transition, there is some uncertainty. Until we get answers to some of the questions that we raise, that uncertainty will continue. As I pointed out in the main Chamber this afternoon, although the Minister’s responsibility on such matters is constrained to the NHS in England, the HIV virus does not respect geographical borders. It is incredibly important for the Government to work closely with the devolved Administrations in Edinburgh, Cardiff and Belfast to ensure a coherent, joined-up approach. That is the only way to tackle the virus in a way that will see a reduction in the number of people affected and reverse the rate of increase in new cases of the disease. Therefore, although I am addressing the NHS in England, the message must be heard by those who configure the NHS in the devolved Administrations. I was pleased to hear that the Secretary of State for Scotland will meet the Minister responsible for health in Scotland tomorrow, and will put that important issue on the agenda.
301WH HIV 1 DECEMBER 2010 HIV 302WH The first issue that I mentioned was prevention. In the early days of the epidemic, not much was known about the virus. There were no drugs and no effective treatment. Messaging was, by necessity, extensive and untargeted. Those of us old enough will remember the adverts with the collapsing tombstones and the gravelly voice telling us about the new virus—AIDS—and how dangerous it was. We remember the posters and the radio adverts, which were essentially blanket advertising for the whole UK. People debate the relative impact of those messages, but we remember that campaign many years after it happened, so it did have some impact. The situation of those who have HIV in the UK today means that that type of mass media advertising is not perhaps the best way of getting a message to those most at risk. That point was made in the foreword to the “Halve It” document, by Lord Fowler, about which I will speak shortly. Lord Fowler was a distinguished former Secretary of State for Health and Social Security, and he is remembered very fondly by people who work on behalf of and alongside those with HIV and AIDS for the forward-looking approach that he took. As he acknowledges, such mass communication messages are no longer relevant, and the campaign must be more targeted. Will the Minister tell us whether the Government’s strategies on sexual health and HIV propose to target messages on specific, at-risk communities, and particularly but not exclusively on younger gay men, for whom some of the safe sex messages may have been lost in time, and the African community? Those communities are not mutually exclusive, of course, but the messaging to each will have to be different. Particularly now that more heterosexual people are contracting the virus, many of whom are in the African community, there is a pressing need to develop messaging that speaks to that community and to its values and structures, whether through Church or faith networks or whatever, so that we can overcome some of the ignorance and stigma in the black African community in this country. I would be grateful for the Minister’s comments on what she proposes to do about that. Pauline Latham (Mid Derbyshire) (Con) rose— David Cairns: I am happy to give way to a vice-chair of the all-party group on HIV and AIDS. Pauline Latham: Does the hon. Gentleman accept that, in addition, white heterosexual people who perhaps have got divorced recently, after having had a monogamous relationship for many years, are now going out into the world of single dating and getting into a mess because they do not realise that HIV/AIDS is out there in the heterosexual community? Is that not an expanding area that we should also be targeting? David Cairns: The hon. Lady is right. I was saying that the messaging should not go exclusively to gay men and to people in the African community. There must be a message for everyone, but the messaging needs to be differentiated. There will need to be different messages to different people, within relative constraints. I hope that the Minister will deal with her point. There is concern. I am of the generation that came to maturity at the time when the AIDS epidemic—well, I might not have come to maturity yet; it is probably up for debate whether I have reached maturity. Mr Thomas: Don’t do yourself down. David Cairns: Yes, I am doing myself down here. I am of the generation that came to adulthood when the virus was making its first big impact, so those messages really stayed with me. I wonder whether that is the same today, particularly, although not exclusively, for young gay men of 17, 18 or 19. We cannot be squeamish about this issue. We must speak a language that they hear and will listen and respond to. I do not expect the Minister necessarily to go into that in detail today, but I want an assurance from her in that regard. I know, particularly given her former career, that she is not squeamish about these things, and we cannot be squeamish when people’s lives are at stake. Of course, one way to prevent the spread of the virus is to ensure that everyone who is HIV-positive knows that they are HIV-positive—knows their status—and is receiving the correct drug treatment. It is not widely appreciated that when someone who is HIV-positive is on the correct level of antiretroviral drug treatment, they become significantly less infectious. I had not appreciated that—I must confess that that was ignorance on my part—until fairly recently. It means that treatment for one person is prevention for another. When an individual is on ARVs and is less infectious, that helps to constrain the spread of the epidemic and when people know their HIV status, it alters their sexual practices. Most of the evidence and studies show that. The more people we can test and the more HIVpositive people who know their status and are receiving the right treatment, the more we will do to prevent the spread of the virus. Jenny Willott (Cardiff Central) (LD) rose— David Cairns: I am happy to give way to another vice-chair of the all-party group. Jenny Willott: I have just had a baby and I was tested automatically for HIV during my pregnancy. Does the hon. Gentleman agree that extending such automatic testing could play a valuable role in identifying cases very early so that people can receive the treatment that, as he said, will not only help them with their own medical needs, but prevent them from spreading the condition? David Cairns: The hon. Lady makes an excellent point. I think that it was my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), when he was Secretary of State for Health, who introduced automatic testing in pregnancy. If we look at the graph, we see that the tail-off is quite astonishing: once opt-out testing was introduced for pregnant women, the numbers of babies being born HIV-positive plummeted. Of course, the issue is not just about babies. Quite often when we are talking about the prevention of mother-to-child transmission, we focus on the baby, but a woman is involved as well. As the hon. Lady rightly says, if a woman’s own HIV-positive status has been diagnosed at the beginning of pregnancy, she can be put on the correct course of ARVs. That is why, in the northern world, mother-to-child transmission has been, if not completely eliminated, massively reduced— because not only ARVs but the correct education about
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299WH<br />
1 DECEMBER 2010 HIV<br />
300WH<br />
HIV<br />
2.30 pm<br />
Mr Edward Leigh (in the Chair): The sitting is resumed.<br />
Hon. Members: Hear, hear!<br />
David Cairns (Inverclyde) (Lab): That might be the<br />
best cheer I get all day. I welcome you to the Chair, Mr<br />
Leigh. It is a pleasure to serve under your chairmanship<br />
in this important debate. I also thank Mr Speaker for<br />
allowing this debate on HIV services in the UK to take<br />
place on world AIDS day. I have been in <strong>Parliament</strong> for<br />
nine years, but I am still ignorant about how debates are<br />
selected—whether t<strong>here</strong> is a lottery or whether Mr Speaker<br />
has a say in the matter. If he does, I thank him; if it was<br />
a lottery, I thank the Fates for timetabling this debate<br />
on 1 December.<br />
I begin with a point of clarification. This is not for<br />
the benefit of hon. Members present in the Chamber, as<br />
they are well aware of the procedures of this place, but<br />
for those who are watching the debate on television or<br />
the internet, and those who will read the account of the<br />
debate in days to come. This debate will focus mainly on<br />
HIV in the UK, but that is not because we think that<br />
HIV outside the UK is not a problem, or because we are<br />
unaware of the scale of HIV in the developing world.<br />
Africa has 10% of the world’s population but 72% of<br />
the deaths from AIDS, and we are aware of that.<br />
However, parliamentary procedure means that different<br />
Departments respond to the debates on different days,<br />
and today it is the turn of the Department of Health,<br />
not the Department for International Development.<br />
T<strong>here</strong>fore, although an enormous number of points<br />
could be raised about the global AIDS epidemic, I will<br />
in the main restrict my comments to HIV in the UK.<br />
With your indulgence, Mr Leigh, I might also sneak in a<br />
few comments about the international scene; I alerted<br />
the Minister about that in advance.<br />
If colleagues are anxious to hear about the international<br />
aspects of the HIV epidemic, I should say that a world<br />
AIDS day reception will be held this evening at 7 pm in<br />
the CPA Room. You are invited, Mr Leigh, as are all<br />
hon. Members, friends and colleagues.<br />
Mr Gareth Thomas (Harrow West) (Lab/Co-op): My<br />
hon. Friend is performing a service by raising the issue<br />
of HIV/AIDS in the UK. Does he also recognise that<br />
many people, both inside and outside the country, want<br />
to know what the UK Government intend to do about<br />
the future funding of the Global Fund to Fight AIDS,<br />
Tuberculosis and Malaria? That body has an excellent<br />
record in getting drugs to people with TB, malaria and<br />
particularly AIDS, many of whom are still in desperate<br />
need.<br />
David Cairns: I am grateful to my hon. Friend, who<br />
was a distinguished and long-serving Minister at DFID.<br />
In a sense, it is a false dichotomy to say that t<strong>here</strong> is an<br />
AIDS epidemic in the UK and an AIDS epidemic in<br />
Africa and never the twain shall meet. One of the<br />
largest at-risk populations in the UK is the African<br />
community––people who come from Africa and are<br />
HIV positive, or those who contract the disease in the<br />
UK within the African community. I will speak about<br />
that in a moment.<br />
My hon. Friend is correct to highlight the need to<br />
address the problem of the AIDS epidemic in Africa.<br />
Over the past few years, one of the most effective ways<br />
of doing that has been through the Global Fund to<br />
Fight AIDS, Tuberculosis and Malaria. The last<br />
Government had a good record in ensuring that the<br />
global fund was initiated, then adequately resourced.<br />
During the most recent meeting of the fund in October,<br />
high, medium and low targets were set for the level of<br />
replenishment. Unfortunately, the global community<br />
failed to hit the low target, let alone the medium or high<br />
targets.<br />
I understand why the Government do not come forward<br />
and state the exact figures for the replenishment of the<br />
fund. Through DFID, they are conducting a multilateral<br />
aid review, and until they decide their priorities, they<br />
cannot say how much will be made available for the<br />
global fund. Until we can provide a figure, I encourage<br />
Ministers to let the world know, at least with rhetoric,<br />
that we remain committed to the global fund.<br />
Much of the world looks to the UK for an international<br />
lead in tackling AIDS, and other countries will be<br />
looking to our figures for the replenishment of the<br />
global fund before making their commitments. The<br />
Government have an excellent opportunity to set a<br />
global lead. I was going to make those points about the<br />
international community at the end of my speech, but I<br />
have made them now.<br />
Let me return to matters for which the Minister is<br />
responsible—she will be pleased to hear that—rather<br />
than the rest of the world. I will make three points<br />
about how we should respond to the ongoing HIV<br />
epidemic in the UK and our public policy priorities.<br />
First, I will speak a little about prevention, secondly I<br />
will discuss testing and treatment and thirdly I will say<br />
something about care and support. Those three things<br />
do not exist in isolation; they are not, to use fabled<br />
management-speak, in “silos.” One point leads into<br />
another, but for the purposes of the debate I will say a<br />
little about each issue in turn.<br />
The backdrop to this debate is not only the ongoing<br />
financial constraints under which all Governments around<br />
the world are operating, but the NHS reconstruction<br />
and reconfiguration that the Government have embarked<br />
on, as well as the messages contained in the public<br />
health White Paper, launched yesterday by the Secretary<br />
of State. Because the national health service is undergoing<br />
a process of change and transition, t<strong>here</strong> is some uncertainty.<br />
Until we get answers to some of the questions that we<br />
raise, that uncertainty will continue.<br />
As I pointed out in the main Chamber this afternoon,<br />
although the Minister’s responsibility on such matters is<br />
constrained to the NHS in England, the HIV virus does<br />
not respect geographical borders. It is incredibly important<br />
for the Government to work closely with the devolved<br />
Administrations in Edinburgh, Cardiff and Belfast to<br />
ensure a co<strong>here</strong>nt, joined-up approach. That is the only<br />
way to tackle the virus in a way that will see a reduction<br />
in the number of people affected and reverse the rate of<br />
increase in new cases of the disease. T<strong>here</strong>fore, although<br />
I am addressing the NHS in England, the message must<br />
be heard by those who configure the NHS in the devolved<br />
Administrations. I was pleased to hear that the Secretary<br />
of State for Scotland will meet the Minister responsible<br />
for health in Scotland tomorrow, and will put that<br />
important issue on the agenda.