HIV Prevention

– in the House of Commons at 5:00 pm on 12th March 2015.

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Motion made, and Question proposed, That this House do now adjourn.—(Harriett Baldwin.)

Photo of Mike Freer Mike Freer Conservative, Finchley and Golders Green 5:01 pm, 12th March 2015

Thirty years ago we became aware of AIDS. The 1980s saw a ground-breaking public information campaign about AIDS. Leaflets to every household as well as television and radio all made us aware of the illness and the risks. The term “safe sex” and the knowledge of the need to use condoms became established and behaviours changed. I lived through that period and I remember the fear and the stigma. We have made progress in combating the stigma, and we have made progress in challenging the misconception that it is a gay disease. But it is worth reminding ourselves that in fact 55% of people living with HIV in the UK acquired the infection through heterosexual sex.

Having lived through those years and having lost too many friends to AIDS, it saddens me that we continue to have a problem with new HIV infections. Today, it is estimated that 108,000 people live with HIV in the United Kingdom. Today, the infection rate means that an additional 6,000 people a year are diagnosed. Ten years ago, the figure was 7,700 a year, so that reduction of more than 30% is welcome. But if we dig below that headline figure, there are some troubling trends. Among men who have sex with men—MSM—the rates are increasing, up 33% from 2,450 a year in 2004 to 3,250 a year in 2013. So while we are having success on many fronts, we still need to combat the rising levels of infections in those groups where infection rates are increasing.

I have already mentioned one group, MSM. Another group is black Africans. The rates per 1,000 head of population are similar. In the MSM cohort, it is 59 per 1,000, and for black Africans it is 56 per 1,000. I must stress that it would be wrong to stigmatise MSM or black Africans. The majority of both groups do not have HIV, but they are groups in which more work needs to be done, not least because it is thought that 25% are unaware of their HIV status and so are at risk of passing on the infection.

Some of the other issues we need to address are: aversion to safe sex; unwillingness to be open about male-to-male sexual partners; drug use, particularly what is known as chemsex; and a lack of knowledge about how HIV is transmitted and how to protect oneself. Therefore, the key issues appear to be prevention through education, prevention through intervention and medical intervention.

The obvious starting point is to educate when people are becoming sexually aware. I appreciate that that is not in my hon. Friend the Minister’s portfolio, but if we are to be innovative in tackling the problem we need to work across Government. Sex education in schools is always controversial, as Members who were present for the previous debate will have heard, but we have to accept that teenagers will have access to online pornography. Not only does the sexualisation of teenagers mean that they do not learn enough about loving relationships, but the imagery can undermine information on consent and on the health implications of behaviour.

Photo of Ben Bradshaw Ben Bradshaw Labour, Exeter

Is not the hon. Gentleman making a strong argument for mandatory personal sex and relationship education in schools, which is something the Opposition now support? Sadly, his party has not quite got there yet.

Photo of Mike Freer Mike Freer Conservative, Finchley and Golders Green

The right hon. Gentleman makes a good point. If he bears with me for just a minute, he might find that I am in agreement.

We have to accept that many teenagers will become sexually active, yet sex and relationship education—SRE—remains poor. The National Aids Trust recently published a report showing that in SRE there is little teaching about, among other things, same-sex awareness or HIV transmission. Teachers can be nervous of sex education full stop, let alone same-sex issues, sexual health or, in particular, HIV. That is compounded when schools struggle with homophobic bullying, which can contribute to teenagers feeling uncomfortable about seeking advice or information about their attractions or about having a safe sexual relationship when the time comes.

Photo of Nigel Evans Nigel Evans Conservative, Ribble Valley

Is my hon. Friend as alarmed as I am by recent newspaper reports that it appears an increasing number of youngsters are being bullied or harassed at school for being gay, and in some cases even being taunted by teachers? Surely there has to be a completely different attitude in the 21st century UK.

Photo of Mike Freer Mike Freer Conservative, Finchley and Golders Green

My hon. Friend makes a very good point, and I agree entirely. In the Department for Education—I apologise to my hon. Friend the Minister for straying away from health, but this is a cross-Government issue—work has been done to fund teacher training on dealing with homophobic bullying, but we need to go one step further and make it integral to teacher training, not an add-on paid for by schools and local education authorities. One of the problems is that if gay men or men who declare as MSM are bullied for showing any form of attraction to other men, for seeking advice or for showing that inclination in any shape or form, they will simply not seek that information. In school they may be afraid of being bullied, whether by other schoolchildren, teachers or other members of staff. They will close down and withdraw, and as a result they might make ill-informed decisions about their sex lives.

In my view, therefore, it is time for SRE to be made compulsory and inclusive. I appreciate that that is not the view of my colleagues in the Department for Education, but I think that they are wrong and that they need to reassess that. We are talking about people’s health and future relationships, so this is too important to get hung up about the ideology of compulsion.

There is also the issue of new technology. When I was at school, in the dim and distant past, sex education was skirted around and pupils, if they were lucky, were given a rather dusty old book with some rather dodgy drawings—clearly that did not teach me very much. Today, teenagers have access to technology. They are accessing sex differently, and accessing information differently, so we need to educate and inform differently. The increasing use of dating apps—I use the term loosely —means that increasing numbers of teenagers are finding sexual partners through their phones. Are colleagues in Government and in health authorities nimble enough in using that technology effectively to ensure that appropriate sexual health messages are there too? Are we constantly playing catch-up, or can we innovate too? How can we intervene differently to support those who are HIV-positive? I said that we need to start with education and that we need to use technology, but when people present as HIV-positive, how can we intervene differently?

It is true that new anti-retroviral drug treatments—ARVs—have transformed the lives of those who are HIV-positive, and they help most people to live near-normal lives, but it is still a life-changing diagnosis. ARVs have to be taken every day for the rest of the person’s life. Relationships can be harder to find and to maintain because potential partners often reject someone who is HIV-positive. Despite anti-discrimination laws, few employees volunteer their HIV-positive status. To my knowledge, only one Member in the history of this House has ever declared his HIV-positive status. That former Member is now in another place. People will not volunteer their HIV-positive status for fear of discrimination—not just overt discrimination but the subtle passing over for promotions or snide comments in the workplace. Then there is the fear of shunning or harassment by co-workers. Despite all the work over the years, some people still believe that HIV can be transmitted through saliva or through sharing crockery and cutlery— 30 years after a major education programme.

All these factors combine such that the human cost of HIV-positive status can be significant. Despite the medical breakthroughs and ARVs, the costs of depression, isolation and the fear of being open remain. We still have work to do to ensure that health education is provided in the workplace, and not just in health education teaching or clinics. The impact on mental health is often missed by health services and sexual health clinics. Sexual health clinics should be more about general well-being and not just sexual health. It should not just be about treating a symptom. If someone goes in with gonorrhoea and comes out with a pill, it is “Job done” for many clinics, but what if they are treating someone who is presenting as HIV-positive? What is the back-up? What about their mental health? Are we providing that total well-being package?

I mentioned chemsex, where men use drugs that enhance sexual performance combined with drugs such as crystal, methedrone or GHB. This can lead to reduced sexual inhibitions and so increased risk-taking. I understand that someone presenting at a sexual health clinic who has chemsex is more likely to have broad sexual issues, and the clinic will deal only with those issues, while the drug-related issues will often be subject to referral to a drug treatment facility. That is often a separate facility and the referral may take six, eight, 10 or 12 weeks, during which time the person who has been interested in seeking treatment falls through the cracks. The separation of treatments, particularly for those involved in chemsex, not only breaks the treatment plan but increases the chance that the patient will not take up the treatment referral, and so behaviours are not changed.

Only this week I had the chance to visit 56 Dean Street and Dean Street Express in Soho. They are absolutely stunning facilities that look nothing like what we imagine the NHS to look like. It was not clinical and there was no plastic seating—it looked for all the world like an attractive boutique hotel. Dean Street Express has harnessed technology. Rather than someone having to go into a clinic, stand at a counter and announce to the world why they are there, or having to sit in an open waiting room, with everyone looking sheepish because they may recognise somebody else, they can book in using technology. They can also swab themselves, and then use the technology. That is the way forward if we are to make the system friendly and receptive, to innovate and to make it worth while and easy for people to seek help and treatment. Most importantly, it provides help on total well-being, not just sexual health. In my view, the Department of Heath should look at rolling out that innovative technique.

I have mentioned the black African community. It is a difficult community to reach, and I do not have any answers, but we need to work harder to reach it, whatever the method—perhaps through its community groups or churches—both to educate and to support those who disclose themselves as MSM or those who are afraid of doing so for fear that their own community will reject them.

We have to accept that people will make poor choices and have unprotected sex, which leads me on to intervention. I pay tribute to the PROUD report. Its initial studies show that post-exposure prophylaxis and pre-exposure prophylaxis—treatments taken immediately after suspected exposure to HIV or as a preventive measure—work. The initial findings show that they are cost-effective approaches to the prevention of transmission, or at least to ensuring that infection rates drop dramatically.

I accept the fact that the use of PEP and PrEP has cost implications. I understand that PrEP costs up to £6,000 a year, but we should compare that with cost of treating someone who is HIV-positive. The lifetime cost of treatment for a person with HIV is between £250,000 and £330,000 a year, so a £6,000 investment could save between a quarter and a third of a million pounds a year.

I have outlined some of the human and financial reasons for understanding what is driving up infection rates, and the action we could take. That brings me to my last point, which is that we need to increase testing. We need to make it easier and less clinical so that people do not fear that it means always having to go into clinics. A clinic is not a friendly—to overuse the pun—environment.

If clinics are used, they should at least make routine tests for HIV across the board so that people who are HIV-positive can have early intervention. Early diagnosis and early treatment dramatically improve the lives of individuals and reduce transmission rates. Let us remember that 25% of those who are HIV-positive do not know it. Easier and faster testing will help to reduce the number of transmissions and new infections. That should include the roll-out of home testing, because it must be right to make testing accessible and easy.

We often shy away from talking about sex, and we certainly find it uncomfortable to learn about sexual practices outside our own experience. Yet if we are to tackle the issues, we have to deal with the problems that exist and with the world as it is, not as we might like it to be. That is why I call on my hon. Friend the Minister to explain how we can redouble our efforts to educate and innovate in HIV prevention.

Photo of Jane Ellison Jane Ellison The Parliamentary Under-Secretary of State for Health 5:18 pm, 12th March 2015

I congratulate my hon. Friend Mike Freer—my friend in every sense—on securing this debate on a very important subject. As he said, it is one that we perhaps do not discuss enough. I am delighted to have the opportunity to respond. I pay tribute to my hon. Friend for his long and distinguished record of campaigning in this area, and for the important work he has done in our party on equalities and in this Parliament in championing HIV prevention and other important matters.

Other distinguished colleagues are in the Chamber this evening. Mr Bradshaw, a former Health Minister, has done long and distinguished service in this field, and it is good to see him in his place. It is also good to see my hon. Friend Mr Evans in his place, and he highlighted the important issue of homophobic bullying in a telling intervention. I also wish to place on record my thanks to my hon. Friend Simon Kirby, who has done great work, with others, in lobbying Ministers extensively on the subject of HIV prevention.

Many good points have been made, and I will pass on the passionate views on sex and relationship education to my right hon. Friend the Secretary of State for Education. I am sure that she will want to be aware of those comments, but I shall not attempt to respond to them myself.

I am proud of the Government’s record on tackling HIV, including on prevention. In 2012-13, the Government spent an estimated £630 million on HIV treatment and care, which has been key in enabling people with HIV to live long and healthy lives. The success of that treatment is shown by that fact that 90% of those on treatment are virally suppressed, substantially increasing their lifespan and significantly reducing their risk of passing HIV to others. However, as my hon. Friend the Member for Finchley and Golders Green said, we need to do far more to stop people getting HIV in the first place.

On top of the money I have just mentioned, we have given local authorities a ring- fenced public health grant of £8.2 billion over three years and mandated the provision of sexual health services as part of that. We welcome the fact that new HIV diagnoses have fallen from 6,333 in 2010 to 6,000 in 2013, and the proportion of late diagnoses continues to decline—down to 42% in 2013 from 50% in 2010—but we have a lot more to do, and my hon. Friend outlined some of the concerns in his speech.

The Government have taken action beyond awareness-raising and testing, for example through lifting the ban on the sale of home testing kits. Reducing the number of HIV infections, especially in men who have sex with men—MSM—is important because we have seen a worrying trend in new infections. In 2013, there were an estimated 3,250 new diagnoses, the highest number ever reported. That really is a cause for concern and one of the reasons why it is good that we are debating the subject this evening. We also know that transmission is continuing among black African men and women who are acquiring their infection within the UK.

It is estimated that one in eight gay men in London are HIV positive, and while that might sound alarming, it also reflects the success of treatment and that more and more people are now living into old age with HIV. My hon. Friend rightly put a focus on being more innovative, and the importance of preventing the spread of HIV is one of the reasons why the Government have committed to protecting the HIV prevention budget—but I am clear that we need to be more ambitious and innovative. That is why we are redesigning our HIV prevention programme for England in 2015-16. I see this as a transitional year towards the updated long-term strategy for HIV prevention and sexual health promotion more widely. In future, this work will be led and managed by Public Health England, which is consistent with its wider work on health promotion and social marketing. I expect PHE to work closely with local authorities to promote the health of their populations.

One of the most exciting innovations to promote HIV testing is postal home sampling kits. Public Health England and local authorities will establish, for the first time, a national home sampling service. Through this, we will be able to deliver up to 50,000 home sampling kits in 2015-16, around three times as many as last year. That will augment the continued growth in HIV tests performed in genito-urinary medicine clinics—more than 1 million tests in 2013, which was 100,000 more than in 2010. People knowing their HIV status is important not only in getting treatment and allowing them to live a long and healthy life, but, critically, in preventing HIV from being passed to others. We now know that being on treatment substantially reduces the risk of passing on HIV. That testing is critical and a key component of our public health response to HIV.

We will continue to contract with the Terrence Higgins Trust in running public awareness campaigns. Changes to that contract have been made for 2015-16, but it is a respected charity in the field and its work remains an important strand of our HIV prevention programme. THT will have an increasing focus on digital platforms to meet the needs of the 21st century, including using Facebook and Twitter. The potential is huge. A single push on a phone app has consistently generated more than 1,000 postal test orders. In addition, those contacted through Facebook have turned out to be three times more likely to return a postal test than those contacted through any other route. Facebook is used by all age groups. It is therefore an important access point, particularly given the middle and older age profile of many of those diagnosed HIV positive.

THT will also continue to work with local partner organisations to talk to those at highest risk face to face, particularly those without access to the internet or to more traditional media. Those conversations include encouraging tests in GUM clinics, use of postal test kits and offering point of care tests in a diverse range of settings, including in churches and shops. That work is particularly important in reaching black African populations who are less likely to attend GUM clinics, but more likely to be diagnosed late.

Photo of Ben Bradshaw Ben Bradshaw Labour, Exeter

I thank the Minister for her kind comments about the Terrence Higgins Trust. I refer hon. Members to my declaration in the Register of Members’ Financial Interests—I am a trustee. Can she clarify whether she has announced specifically how the Government’s public health HIV prevention budget will be spent? If not, will she tell us when she expects to make that detailed announcement?

Photo of Jane Ellison Jane Ellison The Parliamentary Under-Secretary of State for Health

In about four paragraphs’ time, if the right hon. Gentleman will bear with me.

As I have said, I want to be more innovative in how we prevent the spread of HIV. I am pleased to announce tonight an innovation fund up to £500,000. We want to give grants of £50,000 to £100,000 to local organisations or groups of organisations, who want to work in new and innovative ways to tackle HIV. As of tomorrow, those who wish to apply can contact PHE and register their interest. PHE will work with chosen organisations to ensure the work they are doing is aligned with the work local authorities are doing to prevent HIV infections in their area. Applicants must seek endorsement from their relevant local authority before submitting a final application. The grant awards process will take place through late spring and early summer this year.

In addition, PHE has invested £150,000 in new innovative work on reducing late diagnosis of HIV, and the Elton John AIDS Foundation has generously matched funding. My hon. Friend the Member for Finchley and Golders Green mentioned the Dean Street Express model. We also think this is an excellent model. We support that approach and will promote it in other areas.

Turning to the long-term strategy, as I have said I want the HIV prevention programme in 2015-16 to be a transition towards our longer-term strategy for HIV prevention, and for sexual and reproductive health more widely. PHE has today initiated a process of engagement with stakeholders in this field to seek their views in drawing up the strategy from 2016-17 and beyond. That will set out the short and medium-term priorities for HIV prevention and sexual and reproductive health promotion. It also considers how all of this work needs to pull together and highlights the level of need that will need to be met in the future. As part of that engagement plan, PHE will meet key stakeholders in this field in the next Parliament to discuss its plans in more detail and be able to give them more information.

Turning to pre exposure prophylaxis, which my hon. Friend mentioned in his speech. The results of the PROUD research trial are very encouraging: 86% of the men, many of whom were at very high risk of acquiring HIV, remained HIV negative. Importantly, those taking PrEP in the trial did not have an increased rate of sexually transmitted infections. The PROUD research trial results are an important first step and the work continues. NHS England has set up an expert group to consider whether PrEP should be managed on the NHS and how this might be practically delivered.

Photo of Mike Freer Mike Freer Conservative, Finchley and Golders Green

I am grateful to the Minister for that announcement. Is she able to give us any indication of how quickly the expert panel will report?

Photo of Jane Ellison Jane Ellison The Parliamentary Under-Secretary of State for Health

I am sure we would all want the panel to do that work in a timely fashion. I am not able to provide a date tonight, but I will convey the sense of urgency here in the Chamber to NHS England.

Hon. Members made important points about stigma and discrimination. I can only support everything they said. There is some encouragement: in the latest Ipsos MORI poll in 2014, the National AIDS Trust reports that overall public support for people with HIV is higher than ever, with 79% agreeing that people with HIV deserve the same level of support and respect as people with cancer. That is up from 2010. There is room for improvement, however, and a need for engagement across the spectrum. The NHS, local authorities, the Government, community and faith groups, the media—everyone has a part to play in eliminating HIV-related stigma. I note the comments about the role of schools—I will convey them to my right hon. Friend the Secretary of State—and the intervention about homophobic bullying. The Government have invested money in tackling such bullying and take it extremely seriously. It remains a concern for all of us.

It is positive that the number of new HIV infections overall continues to fall, and I believe that the Government can be proud of their record in this area, but the rise in the number of new MSM infections and the high levels of late diagnosis among black African populations are of great concern. Today I have set out how we will be more bold and innovative with the HIV prevention programme, including through a new national home sampling programme—one of the first of its kind in the world—increased use of social and digital media platforms and the setting up of an innovation fund to trial new approaches. Importantly, we are working in partnership with local authorities in taking this work forward. I see this as a transition to a long-term plan for HIV prevention and sexual and reproductive health promotion, and it is our ambition to see infection rates falling, not rising, and late diagnosis becoming a much rarer event. I thank all right hon. and hon. Members for their contributions to this excellent debate.

Question put and agreed to.

House adjourned.