World AIDS Day

– in the House of Commons at 12:41 pm on 1st December 2022.

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Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means) 12:41 pm, 1st December 2022

It is my honour and privilege to be in the Chair for at least the opening of this particular debate. I call Lloyd Russell-Moyle to move the motion.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown 12:42 pm, 1st December 2022

I beg to move,

That this House
has considered World AIDS Day.

I declare an interest as the vice-chair of the all-party parliamentary group on HIV and AIDS and honorary patron of the British HIV Association, and of course as someone who is personally affected by these issues.

I thank the Backbench Business Committee for granting this debate to mark World AIDS Day. Every year, on 1 December, the world commemorates World AIDS Day. People from around the world unite to show support for people living with and affected by HIV, and remember those who lost their lives to AIDS. At 5.30 pm, I, among the community in Brighton, will read out the names of all the people who have died of AIDS in Brighton in the 40 years since the first death, as we do every year. Vigils such as that will be happening up and down the country: in London, in Birmingham, in Manchester, in Oxford, and in other places.

This year’s theme is “equalise”. It is a recognition of the health inequalities that still affect far too many children, men that sleep with men, transgender people, drug users, sex workers and people in prison. Those are the populations most affected by HIV and AIDS in their respective countries; different countries might have different, more focused populations, but those are the groups. Fundamentally, however, the groups that are most at risk are people who are marginalised from healthcare, and that is what we need to equalise—that is what we need to sort out.

This year marks the 40th anniversary of the death of the former Hansard reporter Terry Higgins, who died of an AIDS-related illness on 4 July 1982, and the creation of the now well-known Terrence Higgins Trust. On behalf of the APPG, I thank the Terrence Higgins Trust, not only for the work it has done over the past 40 years but for the work it keeps doing, pushing for us to have no new transmissions of HIV by 2030. That seems a remarkable target, but it is within our reach; it will help the estimated 106,000 people living with HIV in England that we know of. The work of the Terrence Higgins Trust, along with the National AIDS Trust and others, continues to lead the way, and I am delighted that the two organisations are working closer together. I hope that collaboration continues.

Ahead of World AIDS Day in 2018, four years ago now, I spoke in this Chamber about my own diagnosis. I said then that World AIDS Day was

“deeply personal to me, because next year I will be marking an anniversary of my own”.—[Official Report, 29 November 2018; Vol. 650, c. 492.]

Now, of course, it is 14 years since I became HIV-positive. It has been a long journey, from fear to acceptance and to today, where I now play a role of advocacy, knowing that my treatment keeps me healthy and protects any partner that I might have, preventing me from passing on the disease. Since then, further developments have taken place in the fight against HIV/AIDS—many of them positive, but there have been some setbacks, which I wish to talk about in a bit.

We have, of course, a HIV action plan in England, setting clear goals and milestones for achieving our target. Similar plans are set to be launched in Scotland and Wales—we hope they will come quickly. Last year’s HIV action plan for England sets out how we will achieve an 80% reduction in HIV infections by 2025, building to the end of transmissions by 2030. First, that plan will prevent new infections by expanding and improving HIV prevention activities, investing £3.5 million in a national HIV prevention programme up to 2024, and ensure that PrEP—pre-exposure prophylaxis—is expanded to all key groups. Secondly, it will scale up HIV testing in high-risk populations where uptake is low, and ensure that new infections are identified rapidly, including through the expansion of opt-out testing in A&E departments in areas of very high prevalence of HIV. That testing will be backed by £20 million over the next three years.

Thirdly, the plan will ensure that, once diagnosed, people rapidly receive treatment. When I was first diagnosed, you waited until your CD4 count was below 200, which is when you can start to get infections and AIDS can start to be diagnosed. At that time, we did not know whether the drugs would cause continuing side effects; now, as soon as someone is diagnosed, they go on the drugs, because we know that they have very few side effects. Of course, each person has to get the combination that is right for them, because everyone reacts differently, but we have a good array of drugs with which to do that. That means that very quickly—within a matter of months—new people who are diagnosed can be undetectable, and can effectively go about their life without fear or favour. That is a remarkable change in those 14 years.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I congratulate the hon. Gentleman, and commend him for his stance and leadership in this House—and, indeed, outside of this House—when it comes to HIV/AIDS and how to live with it, as he does. In Northern Ireland, which he did not refer to, the Public Health Agency has responsibility for this area. Its hope and ambition is to reach the target of eliminating HIV transmission by 2030, and it seems confident that it can do so, because of the PrEP that he has referred to. It is good sometimes to mark and record the things that are going well.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown

It is remarkable. If we achieve that 2030 target in this country, and if we then achieve a roll-out of it globally—that is a lot of ifs—HIV will be the first disease that we have rolled back via treatment and prevention, rather than vaccines. It would be a world leader, and hopefully a pioneer in how we can treat and test other diseases, particularly with mass testing, which I will come on to in a second.

If all that happens, we will meet the 2030 target, but—as we always say—the Government need to do more. To start with, they need to expand opt-out testing. That has been trialled in areas with very high prevalence—that is, Brighton, London, Manchester and Blackpool. Not all of London was originally included in the opt-out testing, but it took the decision to expand that to all hospitals in London, sharing out the money. Remarkably, that has shown that, in non-high prevalence areas, the percentage of people coming back with an HIV-positive test is still significant. The argument, therefore, is to roll that out to all areas.

Over the past 12 months, we have seen real successes in opt-out testing in England. That happens when somebody is already having their blood taken in A&E and the vial is sent off for an additional test. We are testing for HIV and hepatitis B, unless someone opts out. No one is forced to do this, but I understand that very few people opt out.

The pilot’s results have been astonishing. In just three months, 102 people were newly identified, and 70 people were identified as having dropped out of treatment. If someone drops out of treatment, they are a risk not only to themselves, but to the wider community. Those people have been brought back into treatment and that has saved lives. The results are clear: opt-out testing is working.

On a side note, it is also possible to test for syphilis with the same vial. However, it was not possible to expand this to syphilis, because syphilis testing is paid for by local authorities, not by NHS England, and the local authorities were unable to identify where people were from, because hospitals are not coterminous with local authorities and it was too complicated. That seems ridiculous. We need the Government to sit down with local authorities or to provide for that through central funding. If we are taking the vial, we can run it through the same machine. If the only reason stopping us is bureaucratic, I do not see why we cannot do this. We should test people routinely for as many things as we can, if we know that it will help people’s lives. We know that there is a spike in syphilis in certain key populations.

If this vital programme is eventually expanded to all towns and cities with high prevalence, it will be a game- changer. Where London has expanded the programme, it has already been worthwhile financially in areas that do not have very high prevalence. The programme should also be expanded to sexual health clinics to ensure that everyone going to one is tested for HIV. This may be a surprise to many, but that is not always done routinely and it is not an opt-out system. Actually, an HIV test is becoming less, not more common, because more sexual health clinics are moving to online services. Online services have some great advantages, but one downside is that they require people to collect a vial of their blood, which often does not happen, or does not happen effectively, so HIV test rates are lower. We need to ensure that, when people attend a clinic, it is routine and there is an opt-out system. Some clinics do this already, but it is not universal.

I spoke about the HIV prevention drug, PrEP, in 2018. We have a come a long way since the PrEP impact trial. To remind colleagues, PrEP, which is a pill that people take daily, contains two of the three drugs that someone with HIV would have. In fact, I have now been reduced to two because the latest evidence shows that, when someone gets to “undetectable”, the drug load for people who have HIV can be reduced to, effectively, just the PrEP load. The drugs will not be exactly the same as I take for PrEP, but some people can maintain on those as well. So this is also about new interventions that can reduce the costs and the amount of drugs that we are providing.

PrEP prevents HIV and the pill is covered by NHS England, but thousands are still missing out. They are struggling to get PrEP appointments because of under-resourced sexual health services. That is laid bare in the latest report from the National AIDS Trust, the Terrence Higgins Trust, PrEPster, Sophia Forum and One Voice Network. Due to the fragmentation of services in England, the drug PrEP is paid for by NHS England. That is a real milestone for the NHS, and I congratulate the Government on getting that out eventually, after our interventions.

Anyone who is currently sexually active should be tested by sexual health services every three months, and anyone on PrEP should be tested every three months. In theory, therefore, there is no additional resource for sexual health services for someone on PrEP, because the only people on PrEP should be those who are sexually active, or drug-injecting users who should also be tested, and so on—we should not give it to people who do not need it. But our sexual health services in this country rely on balancing the budget through the fact that people do not attend as regularly as they should. Therefore, that limits the places for PrEP appointments and limits the people who can get access to the drug that the NHS is paying for, even though they are entitled to it and should be offered that level of service.

Awareness of PrEP is far too low and it cannot be given out by GPs, pharmacies, community or maternity services. That means that the burden is solely on local government-funded sexual health services. We all know what is happening with local government and probably do not need to go there today—that is a whole other debate.

If we are going to meet our 2030 target, it is vital that everyone who is at risk of acquiring HIV and who wishes to access PrEP can do so as a key tool in completely and effectively preventing new HIV transmissions when it is taken as directed. Over the past two years, the all-party group on HIV and AIDS has published three important reports. We published “Increasing and normalising HIV testing across the UK”—which I just touched on—and “Nothing about us without us”, which addresses the needs of black, Asian and minority ethnic communities in the UK. Those communities are some of the hardest-hit by HIV in this country and are the least likely to have HIV testing done routinely. The roll-out and trial of the saliva HIV testing, which the Terrence Higgins Trust did two years ago and last year, was particularly effective in those communities. It was seen as less invasive, more private, easier to get hold of and possible to do through online and postal services. The Government should consider whether that process should be normalised nationally or provided cheaply and accessibly.

Our other report, “HIV and Quality of Life—What do we mean? How do we achieve it?”, was published today, and my colleagues have been launching that in Brussels with our partners in Europe. Those reports have been made possible only through the evidence provided by the strong HIV sector that we have in the UK. Its continued insights and hard work are appreciated.

The latest data, however, is not quite as positive. There were 2,692 people diagnosed across England in 2021. That is up 0.7%, from 2,673 in 2020. Some might say that is a small amount but, in 2022, there was a fall of 0.2% and, in 2019, there was a fall of 33%. We are clearly plateauing and there is a danger that we are starting to get more diagnoses. That might be positive because we are delving down to the hardest-to-reach areas, but we need more evidence on why that has plateaued and why it is creeping up before we can be sure that that is something to celebrate, rather than to be worried about.

To keep on track, it is vital that we use every lever available to end HIV transmission and to ensure that we do not plateau, as the numbers show. As I said, we can end transmission by 2030 and I strongly believe that the UK will be one of the first countries to do so. We are a world leader. At the beginning of the week, I spoke to our London NHS colleagues, who said that it is the first time in their career that people have been phoning up from around the world to say, “How are you doing the opt-out testing? How are you doing the PrEP roll-out? We want to learn from you.” That is remarkable and we should be deeply proud of that. The head of UNAIDS came to London and Brighton and we showed her the HIV testing vending machines that we have in Brighton. She said, “I thought that I would never learn anything for the developing world from a rich country. I was here as a courtesy visit, but I have seen what you are doing and how we can roll that out to parts of Kenya and Uganda, and community settings around the world, with HIV testing vending machines that run using solar panels”.

Photo of Patrick Grady Patrick Grady Scottish National Party, Glasgow North

I congratulate the hon. Member on all his work on the issue. Global leadership is incredibly important. He might be coming on to this point, but does he share the disappointment felt by a lot of people in the sector and the wider international development sector—perhaps even the head of UNAIDS—about the cut in the UK Government’s funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria? That risks exactly the kind of backsliding that the hon. Member warns us about.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown

I agree exactly. I will come on to the Global Fund at the very end of my speech, but let me move on now to the picture globally, which I am afraid is totally different.

Back in 2018, I said that

“one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes.”—[Official Report, 29 November 2018; Vol. 650, c. 496.]

The situation globally has become bleaker. Last year, an adolescent girl or young woman was newly infected with HIV every two minutes. In the past year alone, 650,000 people have died of AIDS-related illnesses and 1.5 million people became infected with HIV. Only half of children living with HIV have access to life-saving medication. Inequality between children and adults in HIV treatment coverage is increasing rather than narrowing.

Why are people still dying unnecessarily of AIDS? Why are there so many new HIV infections year after year, globally? It is too easy to put the blame on current crises such as covid and war; the reality is that we were already off target before many of those crises hit. The lack of a comprehensive healthcare system, a lack of education and the growing influence of evangelical Christian churches in Africa—often American-backed—have led to an environment that is hostile to an effective HIV response.

Uganda was the first country to host the world AIDS summit—it was a revolutionary leader. The same President is in power now, but has completely rolled things back. When Uganda hosted the world AIDS conference almost 30 years ago, condoms were given to every delegate and given out into community settings. When I went to Uganda only a few years ago to visit aid projects that we were paying for, I sat at the back of a classroom with Stephen Twigg, the then Chair of the Select Committee on International Development. We heard a teacher tell children that they could prevent AIDS if they washed the toilet seat and observed “sex only after marriage”. I am afraid that things have gone backwards because of the influence of some malign groups. It is concerning.

One of the inequalities standing in the way of ending AIDS is access to education, particularly for young girls. Six in seven new HIV infections among adolescents in sub-Saharan Africa occur among girls who are outside formal education. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV by more than 50%. All children, including those who have dropped out because of covid and those who were out of school anyway, should get a complete secondary education, including comprehensive sex education.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

The hon. Gentleman makes such an important point. Does he agree that we cannot shy away from talking about sexual and reproductive health in the developing world, because that is the single most effective way to ensure that girls stay in school, stay not pregnant and stay free from diseases that will affect them in future? It is crucial that in our role as providers of international aid we do not step back from programmes that talk about contraception.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown

I totally agree. As dark forces around the world try, I am afraid, to withdraw money from programmes that talk in a rational and evidence-based way about sex and reproductive rights, we have a greater responsibility. We must step up, because if we do not, others will not. As the right hon. Lady points out, there are two sides to the coin: providing better sexual health education means that girls stay in school, and staying in school allows them to get better education about their health. Those are both positive things. Both issues need to be tackled together.

Another inequality standing in the way of ending AIDS is the inequality in the realisation of human rights. Some 68 countries still criminalise gay men. As well as contravening the human rights of LGBT+ people, laws that punish same-sex relations help to sustain stigma and discrimination. Such laws are barriers preventing people from seeking and receiving healthcare for fear of being punished or detained. Repealing them worldwide is vital to the task of working against AIDS.

Of the 68 countries that outlaw homosexuality, 36 are Commonwealth countries. The majority of Commonwealth countries are still upholding laws that we imposed and that never originated in the countries themselves. In fact, before British colonialism—British imperialism, I should say—many of those countries had better customs and practices around homosexuality than they do now. These customs and practices are not native to people’s home countries; they were imposed. They should be discarded with the shackles of imperialism, which we all now recognise was wrong. One in four men in Caribbean countries where homosexuality is criminalised have HIV. Globally, 60% of people with HIV live in Commonwealth countries. Collectively, we have a responsibility to tackle that in the Commonwealth. Barriers undermine the right to health: a right that all people should enjoy.

Beyond the human rights implications, the laws criminalising homosexuality also have an impact on public health. LGBT+ people end up not seeking health services for fear of being prosecuted. Those who do seek health services often have to lie about how they were infected. Astronomically high numbers of people with HIV in Russia say that they were infected because they were drug-injecting users; that is widely believed to be partly because of the attitude in Russia that it is better to be a drug-injecting user than an LGBTQ person. Without accurately knowing the source of infections, we cannot accurately run public health programmes to save people. Putting people undercover in the dark, hidden in corners, means that the virus lives on. That is a danger for us all.

In some countries, people living with HIV are at risk of being criminalised even when they take precautions with their sexual partners. That opens them up to blackmail and fraudulent claims from former partners. People with HIV in the UK are not immune to that either, as we have seen in some high-profile cases. We have known for at least 20 years that antiretroviral therapy reduces HIV transmission, and for the past few years we have known that it stops it completely, so there should be no doubt that a person with sustained undetectable levels of HIV in their blood cannot transmit HIV to their sexual partner, and laws should not punish them. However, under Canadian criminal law, for example, people living with HIV can be charged and prosecuted if they do not inform their partner about their HIV-positive status before having sex. The law does not follow the science, and it puts people at risk.

Laws requiring disclosure perpetuate the stigma against HIV-positive people. With the advent of PrEP and with “Undetectable = untransmittable”, the law should now reflect the fact that everyone has a role in protecting themselves against HIV and everyone must step up. The criminalisation of drug-injecting users and sex workers has an equally negative effect on HIV prevention and treatment, as I have outlined, in LGBT communities. In all these areas, a health and human rights-based approach must be taken if we truly want to see the end of HIV.

Beating pandemics is a political challenge. We can end HIV and AIDS by 2030 in this country, but only if we are bold in our actions and our investments. We need courageous leadership. We need people worldwide to insist that their leaders be courageous. That is why last month it was so disappointing not to see courageous leadership from this Government. The UK Government were the only donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria to cut their financial settlement—by £400 million. The fund asked donors to raise their pledges by 30% this year, and almost all the G7 nations—which are suffering economic problems that are, in many respects, similar to ours; as the Government often remind us, this is a global crisis, not a crisis of their own making, although in our view it is a bit of both—increased their amounts. For decades the UK was the leader in the global response to these infections and diseases, but that is no longer the case. When our allies met the fund’s request for a 30% increase, the UK went for a 30% cut from their 2019 pledge.

Photo of Anthony Mangnall Anthony Mangnall Conservative, Totnes

I thank the hon. Gentleman—my friend—for making this speech; he is an extraordinary advocate in this area. However, I want to put on record the fact that the UK is the third biggest funder of the Global Fund. We have, to date, contributed just under £4.5 billion.

The hon. Gentleman has said that we are leading the way in respect of our health and our treatment, and that other countries are following. This, too, is a commodity that can be traded and given to other countries. It is not always a question of the value of the money that we give, because we can trade skills, research and development as well. The hon. Gentleman knows where I stand on the development issue, but I think it is worth making that point.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown

The hon. Gentleman has been very good on development issues in the past, and I think he is right. He has also touched on the discussion about patents and patent waivers. There is a live discussion about how we can ensure that the poorest countries in the world can gain access to some of the frontline drugs. Long-lasting drugs are one of the latest innovations, with the possibility of either an injection or a set of, effectively, implants—I cannot think of the exact term off the top of my head—which would last for up to a month and a half. That is revolutionary, especially for those who have irregular access to health systems. The problem is that these are the most expensive drugs because of the way our patent system works; but they are also the most useful in the parts of the world that are hardest to reach. In the UK, most people have regular access to medical settings and can receive daily pill medication. The UK has not always been the very best when it comes to seeking patent waivers. We have done it in the case of many HIV drugs, but we should consider doing it more widely. That might be a good compromise, but we will then need to step it up.

The UK’s decision on the 30% cut is, in my view, a disastrous decision, which stems from the Conservatives’ 0.5% cap on international development. Rather than considering that amount to be a floor and saying that it is the bottom of our ambition, the Government have said that it is the top of our ambition. Moreover, as a result of their insistence on including the Homes for Ukraine scheme, whereby we are housing Ukrainian people here in the UK, in that 0.5% cap, money is flowing out of the international development Department. International development—internationally spent money—should be 0.5%; that would enable us to fulfil many of our commitments quite easily. The additional aid and charity that we provide should be celebrated, but it should not be detrimental to others. This cut will result in the preventable deaths of up to 1.5 million people, and risk over 34.5 million new transmissions of HIV, TB and malaria. It will no doubt harm our credibility, and I hope we will reverse it as soon as we can.

We in the APPG have the political will to meet the targets set by UNAIDS and the action plans for Wales, Scotland, England and, I was pleased to hear, Northern Ireland. We will continue to work with and challenge the Government in ensuring that they do the same, because it is time we stepped up and pushed for that final mile. When you are at the end of the race, you do not slow down; you speed up. This is a prize that we can win, so let us not allow it to slip through our hands. In the words of the former Prime Minister Boris Johnson, let us end the “dither and delay”. Let us end HIV/AIDS today.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee 1:14 pm, 1st December 2022

It is a pleasure to follow Lloyd Russell-Moyle, who speaks with such passion, knowledge and indeed experience. I vividly remember being in the Chamber four years ago when he spoke of his own diagnosis, and of how he had coped with the emotional stress and trauma and the physical challenges. Of course it is always a privilege to follow any Member who speaks with such a depth of knowledge.

I apologise for the fact that my speech will focus almost exclusively on women. As Chair of the Women and Equalities Committee, I am very conscious that some of the people who are diagnosed at the latest stage, and some of those who are afraid of going for a test, are women. It has always been a humbling experience for me, in my role as Chair of the Committee, to meet those women living with HIV who have spoken of the barriers that they felt prevented them from taking a test. That is why I commend the work done by organisations such as the Terrence Higgins Trust and, indeed, the all-party parliamentary group, which has always led the way in trying to break down the stigma associated with testing.

There should be no such stigma. After all, there has been no stigma attached to covid tests over the past two years; and making oneself aware of one’s own HIV status is actually one of the most empowering actions that an individual can take. That is why, as Chair of the Select Committee and indeed before that—I was about to say, “I have never been afraid”, but that is the wrong term to use. I have always been keen to ensure that I use my role to emphasise to others that it is perfectly okay to go and get a test, and it is also much easier to do so nowadays than it used to be.

I was going to say that I had never been afraid, but I vividly recall that Simon Kirby, the hon. Gentleman’s predecessor as Member of Parliament for Brighton, Kemptown, used to arrange in this place, every year, a testing session for Members. I remember Simon telling me, years ago, “Nokesy, you have to go along and get a test”, and I remember rolling my eyes and saying, “I don’t really fancy that.” I was rather terrified of the prospect of going. However, I also remember coming away after the test and thinking, “That was the right thing to do. I now know that I don’t have HIV, so I can relax about that, but I also know how important it is to talk about it.”

I remember, too, the grief that I was given on social media from the ill-educated, ignorant and—to be frank—bigoted people who used that as a stick with which to beat me: “Ooh—why did she need an HIV test?” Why did I need one? First, to know, and secondly, to be a voice for everyone else who felt anxious about getting an HIV test. I wanted to tell them, “There is nothing wrong with it; there is no stigma attached to it; you are doing it for your own wellbeing.” That is why I now act as a champion for all women, telling them how important it is to go and get a test.

The hon. Member for Brighton, Kemptown made a very important point—I dwelt on it a little when I was thinking about what I wanted to say—about the prevalence of online and postal tests. I think that they are great innovations. Earlier this year, however, I received a little package through the post with the message “Give HIV the finger”—which was a wonderful message, but it was hard to get the required amount of blood out of my finger, and I felt slightly concerned about whether it was enough. I thought, “Will this be effective? Who knows?” For me, much of that process was about being photographed proudly holding up the box, having taken an HIV test. However, another part of it was to do with the fact that we need these testing programmes to be effective, we need people to be confident enough to use them, and we need them to be available in all sorts of locations.

That brings me to my next point. We need people to be culturally competent and aware. We know from statistics that a third of the people living with HIV are women, and we know that 25% of the new diagnoses are in women, but we also know of the prevalence of HIV in black African communities. Covid taught us—and I am an absolute advocate of this—that we must learn the lessons of really difficult experiences. We learnt through covid about the importance of speaking to people in languages that they understand, in a way that they can relate to, on the media channels that they instinctively use. It is no good broadcasting our public health messages exclusively on the BBC; we have to find different channels in order to communicate with the audiences who are most at risk, where the prevalence is highest, and where people might not be engaging with the traditional forms of media that you and I, Madam Deputy Speaker, might use. That is a really important message that I would like to give to NHS England and the Department of Health and Social Care. We must keep up the pressure, and talk to communities in which there is high prevalence and where there might be barriers, cultural or otherwise, to getting a test.

I have an important wider point on research. It was crucial that a great deal of the research on HIV and AIDS be done on those who were most likely to be affected by them, so of course, a massive wealth of research has been done on men. I absolutely acknowledge that that was right, but there are knowledge gaps when it comes to women with HIV and which drugs might be most effective for them. There is certainly still a barrier to women accessing PrEP; that is borne out by the numbers. They are simply not using it. We have to understand why that is, and how effective that drug and indeed other HIV drugs may be on women. We have to make sure that the DHSC and NHS England not only have sufficient data, but disaggregate it, so that it can be broken down by gender and ethnicity. Often when I talk about health, I find myself complaining and browbeating others about the lack of data that is relevant exclusively to women, the lack of women coming forward in drug trials, and the lack of research done on women. Those things are true when it comes to HIV.

I turn to what we have been good at. The action plan for HIV talks about the successes on vertical transmission; a tiny number of children are now born with HIV in this country. A big part of that is down to opt-out testing of pregnant women; the take-up has been absolutely enormous. The figures show the result: of the 60 people diagnosed in 2019 who acquired HIV through vertical transmission, only five were born in the UK. That is a huge step forward, and we have done brilliantly on vertical transmission, but it is crucial that we never let up on that, and that we get the message out that effective drugs taken during pregnancy can prevent HIV transmission to a baby. The mother has to be mindful of risks to do with the method of birth, be that natural delivery or via caesarean, and there is a risk factor involved in breastfeeding. All those pieces of information can effectively and easily be communicated to expectant mothers, and they absolutely should and must be.

I am conscious that my knowledge is not as great as that of other Members in the Chamber, so I have deliberately kept my comments relatively brief. We need to keep up the pressure. The hon. Member for Brighton, Kemptown referred to approaching the finish line. When I do anything that involves running, there is definitely a slowdown, usually due to exhaustion, as I approach the finish line, but we cannot afford a slowdown here. We must accelerate to the finish. We can now see a UK without HIV. He made important points about the developing world and the efforts that still need to be made there, but the end is in sight, and it is absolutely crucial that we reach it and see a world that is free of HIV.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 1:22 pm, 1st December 2022

It is a pleasure to speak in this debate, and to follow Caroline Nokes. She and I seem on many occasions to be on the same side in debates in the Chamber and in Westminster Hall. I commend her on her work to promote the values, aspirations and concerns of women in this House, this country, and the world.

I also commend Lloyd Russell-Moyle on setting the scene so well. I do not think that I have ever missed a debate on HIV/AIDS in the Chamber or Westminster Hall, and I came along to contribute, and to support him. I commend him, as I said in my intervention; he has been a shining light to many who suffer from AIDS across the whole United Kingdom of Great Britain and Northern Ireland, and he has contributed in an exceptional way today. Well done to him.

As the hon. Gentleman said, the global theme for this World AIDS day is “Equalise”. I thought to myself, “That is exactly what we should try to do.” We should not only make sure that everyone in this great United Kingdom has access to PrEP, which he referred to, but ensure the same access to medication and treatment across the world. He outlined that point very well, and I fully support it. Let us replicate what we do here across the world.

On World AIDS Day, UNAIDS asks that we take four actions. The first is to increase the availability, quality and sustainability of services for HIV treatment, testing and prevention, so that everyone is well served. The second is to reform laws, policies and practices in order to tackle the stigma and exclusion faced by people living with HIV and by key and marginalised populations, so that everyone is shown respect and is welcome. The hon. Gentleman addressed that very well. The third action is to ensure the sharing of technology, so that communities in the global south and the north have equal access to the best HIV science. Lastly, communities should be able to make use of and adapt the “Equalise” message to highlight particular inequalities that they face, and should be able to press for the action needed to address those inequalities.

STOPAIDS got in contact with my office before the debate. It informed me that the UK, which has provided some £15 million a year to UNAIDS for the last five years, has cut its funding by more than 80% to just £2.5 million this year. I concur with the hon. Member for Brighton, Kemptown that that is a worry, and I think that concern will be expressed by others in the Chamber, too. Even though the Minister does not have direct responsibility for the issue, perhaps he will speak about that. The cut jeopardises work that supports some of the most marginalised. The Government and our Ministers should uplift that funding, even if just slightly, to ensure that charitable organisations are fully funded to do their work.

I want to outline what we are doing in Northern Ireland through the Public Health Agency, which I mentioned in an intervention on the hon. Member for Brighton, Kemptown. I want to mention its achievements, even though there may have been a slight increase in the number of those with HIV; the issue is how we combat that. I think that what it has done is excellent. Its 2022 annual surveillance report on sexually transmitted infections, which is based on data from ’21, showed that there were 76 newly diagnosed cases of HIV in Northern Ireland in 2021. That is a 12% increase from 68 diagnoses in 2020, but—this is the key—more HIV testing was being done. Almost 80,000 HIV tests were carried out in Northern Ireland in ’21, which is a 21% increase on the approximately 66,000 done in 2020. The PHA said:

“We are making great progress towards eliminating HIV transmission by 2030. Frequent HIV testing, the offer of PrEP to those most at risk of HIV, together with prompt treatment among those diagnosed, remains key to achieving this.”

So there is more testing, more contact, and fewer people getting AIDS. That is an example of what we are doing in Northern Ireland, and I commend the PHA for doing that so very well.

In 2019 in Northern Ireland, 40% of those newly diagnosed with HIV were gay and bisexual men. In comparison, 52% of cases involved heterosexual contact. There is a stereotype and an assumption that all people with HIV or AIDS are gay or bisexual, but the stats clearly dispute that. As the right hon. Member for Romsey and Southampton North said—this applies to Northern Ireland as well—there must be greater awareness that not only gay men get AIDS. It has impacted the lives of many women, too. Unfortunately, many of the people represented by those 52% of cases in Northern Ireland are ladies. The right hon. Lady outlined the point exceptionally well. It is good that we have it on record that the disease needs to be tackled head-on, always. The HIV strategy must reflect the fact that more heterosexual people get HIV than gay or bisexual people. A new strategy is clearly needed—one that takes on board the figures, and helps us to understand the issues even better.

In Newtonards in my constituency, the Elim church, which is very active, has had an incredible strategy for Swaziland in southern Africa. It has helped to build hospitals, health clinics, schools and other buildings, which has provided jobs. It has also actively helped to address the AIDS epidemic in Swaziland. Those things need to be done proactively and positively. I commend the Elim church and mission in Newtownards as an example of what can be done where there is the will and understanding, not through their own efforts alone but working collectively with others to reduce the number of people in Swaziland who have AIDS.

There are many orphans in Swaziland whose parents died due to AIDS, and some of them were born with AIDS through no fault of their own, and the Elim church and mission actively works with them. They come to my constituency every year as part of the church’s missionary work, and I have never failed to be moved by their singing and joy. They are receiving treatment and medication, too.

Northern Ireland has only one HIV charity, Positive Life, which I commend for how well it does for us in Northern Ireland. Positive Life attends the Democratic Unionist party conference every year, and I make it my business to thank the charity every year for its tremendous work to promote a positive future for people living with or affected by HIV in Northern Ireland. It provides free rapid testing for those who are concerned that they might have HIV, and it offers support along the way. We are all indebted to Positive Life in Northern Ireland, and to all the other charities that play an invaluable role in battling HIV and making the stereotypes and stigma a thing of the past.

The Public Health Agency has a clear strategy for those in Northern Ireland who have AIDS, whether through transfusions, activities or whatever it may be. I am pleased to say that the positivity not only in Northern Ireland but elsewhere encourages me and gives me great hope. The hon. Member for Brighton, Kemptown is an example of that positivity, for which I commend him. I also commend the Minister in anticipation of his answers, which I hope are along the lines we expect.

Photo of Nicola Richards Nicola Richards Conservative, West Bromwich East 1:32 pm, 1st December 2022

I thank Lloyd Russell-Moyle for leading this debate and for his commitment to this cause. As the number of new HIV cases in this country falls, the importance of the issue does not. We stand on the shoulders of giants and of the 38 million globally lost to AIDS-related illness. Their early passing will not be forgotten. In fact, it inspires us to work harder and quicker.

This Government are proud to be one of the first in the world to commit to ending new HIV cases by 2030, and we are proud to put our money where our mouth is. This time last year, my right hon. Friend Sajid Javid, as Health Secretary, provided £20 million to fund opt-out testing in London, Brighton and Manchester. Thanks to the campaign of the Terrence Higgins Trust and my hon. Friend Scott Benton, Blackpool was also rightly included. This investment has had remarkable results and is already garnering savings for the NHS.

In the first 100 days of this programme, around 128 people were newly diagnosed and roughly 65 people who were previously diagnosed returned to the care of an HIV clinic. On top of all the standard HIV testing, that is almost 200 people who no longer have HIV attacking their immune system and who cannot pass on the virus to others. What a triumph. Adding that half the hospitals also tested for hepatitis and found 325 cases of hepatitis B and 153 cases of hepatitis C, the success only builds. Well over 500 people have been prevented from becoming very unwell on our watch.

Having spent about £2.2 million on four months of testing, the savings are calculated at between £6 million and £8 million. These are not pipe-dream savings but a real reduction in the pressure that accident and emergency departments and hospitals face this winter. When Croydon Hospital started opt-out testing, the average hospital stay for a newly diagnosed HIV patient was 34.9 days. Two years later, it is 2.4 days. I know a few hospitals that could also do with such pressures being released.

In the west midlands we have five areas of high HIV prevalence, and my borough of Sandwell is among them with a prevalence of 2.92 cases per 1,000 adults, which is well above the national average. The National Institute for Health and Care Excellence says that areas such as Sandwell should

“offer and recommend HIV testing on admission to hospital, including emergency departments, to everyone who has not previously been diagnosed with HIV and who is undergoing blood tests for another reason.”

Such testing is not yet happening in Wolverhampton, Coventry, Sandwell, Birmingham or Walsall. We have to find our undiagnosed and lost-to-care residents and get them into treatment as soon as possible.

The Mayor of the west midlands, Andy Street, has written to the Health Secretary asking for this “invest to save” resource for our region, and I add my voice to his call and ask the Minister if he can help level up the HIV response outside London. With funding for opt-out HIV testing, we can put the west midlands on track to end new HIV cases by 2030.

Andy Street rightly said

“This is not a World AIDS Day stunt but a serious call for action. I don’t want ‘The Ribbons’ to simply be a tribute. It needs to be a reminder that HIV is still happening to many”.

I know my hon. Friend Gary Sambrook and local councillors in Sandwell, such as Councillor Scott Chapman, join Andy and me in asking for an extension to opt-out testing to cover my West Bromwich East constituency.

We have made such incredible strides. As well as remembering the devastation that HIV has caused for so many around the world, we have to celebrate how far we have come. We have preventive drugs available on the NHS—drugs that stop any trace of HIV so that those who contract it cannot pass it on to others—and we are now seeing the major success of opt-out testing in some of the country’s worst HIV hotspots. In an odd way, the medical question is not really the problem; it is the stigma.

I recently met Harry Whitfield, also known as Charity Kase, who last year made his debut on “RuPaul’s Drag Race UK” to showcase his incredible talents. He talked about how hard it was to deal with his HIV diagnosis. For last year’s World AIDS Day, Harry said:

“The stigma around HIV is far worse than the disease itself. I take one tablet per day to stay healthy and completely undetectable so I can’t pass the disease on. I’m thriving in my life every day, but that’s not the narrative that gets told when talking about HIV.”

Last year, like so many, I was completely engrossed in “It’s A Sin.” Until then, I had not thought that much about HIV. Probably because of my age, I had not properly considered how terrifying that period of time was for so many. When I was sent an HIV test to raise awareness during testing week, I took the test and posted about it on social media. I knew it had the potential to create some odd feedback, but I felt it was important. Some of the comments came from people who thought HIV was a thing of the past, and they accused me of talking about it only as a means to control people now that we are out of the covid pandemic. It showed me the importance of keeping this issue alive.

My experience is similar to that of my right hon. Friend Caroline Nokes, with people questioning why I thought it was necessary to take a test and what I had been up to. However, one constituent thanked me. He said:

“I’m a victim of this myself. I was fortunate to be born at the right time for effective treatments. But only just. These new tests were not around when I was diagnosed. I just happened to randomly find out through routine MOT as they call it.”

He also said told me that the stigma is the main issue.

Photo of Tan Dhesi Tan Dhesi Shadow Minister (Transport)

I congratulate my hon. Friend Lloyd Russell-Moyle on securing this important debate on World AIDS Day. Like Nicola Richards, my Slough constituency has a relatively high prevalence of HIV. It is vital that our town is properly supported in the fight against HIV and AIDS in order to meet the 2030 target, which is why I wrote to the Health Secretary to request that Slough be included in the opt-out HIV testing scheme.

Does the hon. Lady agree it is important that the Government support areas like ours so that we get the right level of support? Without that support, we could experience a resurgence that none of us wants.

Photo of Nicola Richards Nicola Richards Conservative, West Bromwich East

I completely agree with the hon. Gentleman. Opt-out testing is one of the easiest ways to end the transmission of HIV and become the first country to be HIV-free by 2030, which would be incredible. Opt-out testing is clearly a great route to do that.

“It’s A Sin” has helped to bring this issue back to life, not just as a reminder of the 38 million people around the world lost to AIDS-related illness, but as a reminder of how far we have come. The series also makes it glaringly obvious that we have more to do to tackle the stigma.

I place on record my thanks and appreciation for the Terrence Higgins Trust. It is 40 years since the death of Terry Higgins, one of the first to die of an AIDS-related illness. The trust does incredible work to end the stigma around HIV, which is one of the biggest barriers that stops people getting testing, and therefore one of the biggest barriers to ending the transmission of HIV by 2030.

HIV is no longer a death sentence. It is no longer the terrifying disease that “It’s a Sin” so intensely brought to life for people like me who did not live through those incredibly difficult times. I thank the Government for supporting opt-out testing, and I call one last time for the pilot to be extended to other hotspots, including the west midlands.

Photo of Chris Clarkson Chris Clarkson Conservative, Heywood and Middleton 1:40 pm, 1st December 2022

It is a pleasure to follow my hon. Friend Nicola Richards. I welcome this debate and I thank Lloyd Russell-Moyle for bringing it to the House today. I also wish to praise him for his leadership in this area and for the work he has done to educate the public on the realities of people living with HIV. Unfortunately, there are still a lot of prejudices out there, and his speaking openly about his own experience as somebody living with HIV is incredibly powerful and important. When people see that their representatives are representative of society as a whole it makes a real difference. I will not speak at length, because we have heard a series of excellent speeches and I am going to use some of the same facts and figures that have been mentioned. However, I want to say how pleased I am that we are still having these debates, because this problem has not gone away.

The Government committed in December 2021 to achieve zero new HIV infections, HIV or AIDS-related deaths in England by 2030. That is an ambitious target, but I am sure everyone across this Chamber can agree it is essential. The framework for achieving that means ensuring equitable access to and uptake of HIV prevention programmes, scaling up testing in line with national guidelines, optimising rapid access to treatment and retention in care, improving the quality of life for people living with HIV and addressing the stigma surrounding infection and testing.

We must work to address the lazy stereotypes associated with HIV/AIDS, especially those surrounding the LGBT community. I am pleased to see that real progress is being made. The Government have provided £20 million to ensure that HIV opt-out testing is expanded to areas with a high prevalence, including Manchester, London, Blackpool—I pay tribute to my hon. Friend Scott Benton for his dogged determination in getting Blackpool included—and Brighton. That has helped to reduce diagnosis times and improve diagnosis rates.

In Rochdale borough, where my Heywood and Middleton constituency is located, 2.2 in every 1,000 adults are living with HIV. I would particularly like to thank the teams at Middleton health centre and Heywood clinic for their work in providing sexual health testing and support, and I hope we will be able to take advantage of opt-out testing too, as it is essential. The roll-out of opt-out testing saw 128 people newly diagnosed with HIV, 325 people newly diagnosed with hepatitis B, as has been mentioned, and 153 people newly diagnosed with hepatitis C. At a cost of just £2.2 million across 100 days, the opt-out testing paid for itself, saving the NHS an estimated £6 million to 9 million, through early diagnosis and treatment. Opt-out testing also goes some way to addressing health inequalities, with higher proportions of women and people from black African and black Caribbean backgrounds being diagnosed compared with the national average.

In March 2020, the Department of Health and Social Care provided £16 million in funding to local authorities to provide PrEP. I warmly welcome that, but barriers still exist. More than 57% of people waited more than 12 weeks to access PrEP and only 35% who attempted to access PrEP services were successful. It is essential that that changes. PrEP is a game changer for all of us. It is an essential tool if we are to end new infections by the next decade in the UK.

Of course, we know that this is not just a problem here at home. The truth is that covid-19 was the second pandemic of our lifetimes and we are still living through the first; this is a global matter. That is why I am proud that the UK provides funds to UNAIDS, the Robert Carr Fund and the Global Fund to Fight AIDS, Tuberculosis and Malaria. I will join the hon. Member for Brighton, Kemptown in saying that I would have liked to have seen the levels sustained, but my hon. Friend Anthony Mangnall made the important point that there are other things we can leverage as a country to help other countries in their fight against this disease. The UK is a co-founder of Global Fund and the third largest donor historically—my hon. Friend mentioned the figure of £4.4 billion in that regard—and the Foreign, Commonwealth and Development Office announced on 14 November that the UK will contribute a further £1 billion, so at least we are still in the fight. As with covid, the truth is that none of us is safe until all of us are safe, and we have a role to play in supporting those parts of the world less able to tackle HIV/AIDS than ourselves.

As we aim for our 2030 target, I would also like to draw the Government’s attention to the recommendations of the Terrence Higgins Trust and National AIDS Trust, which are calling for the expansion of opt-out testing to all areas of high prevalence—I cannot stress how important that is—the provision of PrEP to all who could benefit from it, which is very important, and a refocusing of sexual health services that have been displaced by the recent mpox outbreak.

There is a huge amount of work to do if we are to reach our 2030 target, and that will rely on adequate funding, access and information across society. It will need those of us in this place to speak openly and honestly about HIV/AIDS and to be collaborative, working across the piece. I am confident that we can get to that 2030 target and I will continue to support everyone working to that endeavour for as long as I have the privilege to be in this place.

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member) 1:44 pm, 1st December 2022

. I join all Members in commending Lloyd Russell-Moyle for leading this debate and for informing us so well on a subject on which he is such a powerful crusader and advocate. I thank him and commend him for his contribution today.

Today, 1 December, is the annual World AIDS Day. From the inaugural World AIDS Day in 1988, the first ever global health day, until today, it has given an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV and to commemorate those who have, sadly, lost their lives as a result of AIDS-related illnesses. More than 105,000 people are living with HIV in the UK, and globally an estimated 38 million people have the virus. Despite the fact that the virus was only identified in 1984, more than 35 million people have died of HIV or AIDS-related illnesses, making it one of the most destructive pandemics ever known.

Each year in the UK more than 4,000 people are diagnosed with HIV. Many people do not know the facts about how to protect themselves and others, and stigma and discrimination remain a reality for so many people who are currently living with this condition. About 6,000 people in Scotland are living with AIDS, according to Health Protection Scotland data, and 98% of those attending HIV specialist treatment and care were receiving antiretroviral therapy—ART. In 95%, the virus cannot be detected in their blood, meaning they have an undetectable viral load and cannot transmit HIV. We know that many within our society are still largely unaware of the disease and the risks of it. A recent survey from the National AIDS Trust found that only 16% of people surveyed knew that if someone with HIV is on effective treatment, they cannot pass on HIV and can expect to live a long, happy, healthy and fulfilling life.

HIV continues to be a major public health crisis both in the UK and across the world, as we have heard today. Although we know that HIV disproportionately impacts segments of the LGBTQ+ community, the two issues should not be conflated; HIV is by no means confined to LGBTQ+ communities or certain black or ethnic minority communities. The fact is that anyone, regardless of sexual orientation, gender, age or any other factor, can acquire HIV or AIDS.

We in Scotland are extremely proud to be the first country in the UK to make PrEP available free of charge to those at a high risk of acquiring HIV. We have made huge progress in detecting and treating HIV, and people with the virus are able to live those long, happy and fulfilling lives. PrEP is free of charge from NHS Scotland for anyone who is more at risk of getting HIV. As we have heard from the hon. Member for Brighton, Kemptown, it is simply an oral medicine, in pill form, comprising two HIV antiretroviral drugs. It is prescribed to HIV-negative people at risk of becoming infected as part of a comprehensive approach to HIV prevention. We know that the drug is highly effective at stopping HIV from being passed on. In clinical trials, PrEP has been shown to reduce the risk of sexually transmitted HIV by between 75% and 86%, so it is hugely successful. Research lead by Glasgow Caledonian University’s Professor Claudia Estcourt shows there has been significant reduction in HIV infections since the implementation of the first PrEP programme in Scotland in July 2017, and that new diagnoses in Scotland have fallen by 20%.

The SNP Scottish Government will continue work to reduce the stigma of HIV, raise awareness of the condition and reduce its transmission. Support is being provided for new research on reducing transmission of the virus, and a separate working group will also look at the clinical utility of PrEP in Scotland.

The SNP Scottish Government have also provided £337,000 to develop a national online service for sexually transmitted infections and blood-borne viruses, which will allow people to request a test online and conduct that home self-sampling that we have heard about today from across the House. Every tool possible will be required in our fight against HIV/AIDS. These are all excellent tools and the Scottish Government remain committed to being on course to reach their target of eliminating HIV transmission in Scotland, and across the rest of the UK, by 2030.

As a fierce defender of minorities in this place, I must also mention the plain fact that many of those living across these nations with HIV are vulnerable. Some experience language, faith and cultural barriers associated with long-standing stigma, while others have complexities, such as mental health and societal issues, that impact their access to health and social care services, leading to poorer health outcomes. As we are all too aware, socio-economic inequalities drive health inequalities. Will the Minister outline the steps being taken by his Government to mitigate the impact of austerity and reduce inequality for all our minority communities?

The Government need to take an intersectional approach to healthcare—an approach that recognises that many people in the United Kingdom will face multiple and often overlapping disadvantages and barriers to accessing good healthcare, and sometimes, as we have heard, a postcode lottery.

Finally, on the matter of funding, the SNP is once again calling on the UK Government to reverse, in effect, the 83% cut to UNAIDS funding, which is a consequence of their decision to cut the aid budget from 0.7% to 0.5% of our GDP. On 31 Oct 2022, the UK Government missed the deadline to donate to the Global Fund to Fight AIDS, Tuberculosis and Malaria. At the time, Mike Podmore, UK Director at STOPAIDS, said:

The UK is acting as an unreliable partner and preventing the Global Fund from communicating clearly to its grantees about what funding is now available for them to work with, creating uncertainty.”

The consequences of that action could be immeasurable when it comes to the number of lives affected. Although the UK did provide some funding, it was £400 million less than in 2019. Again, we in the SNP call on the UK Government to do the right thing. The aid budget must be restored to its 0.7% level, especially if the UK does not want to be known as an unreliable partner among its counterparts.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health and Social Care) 1:52 pm, 1st December 2022

I, too, congratulate both my hon. Friend Lloyd Russell-Moyle on securing this debate, and the Backbench Business Committee on granting it. In thanking my hon. Friend, I want to say that we listened intently to his opening contribution. It was full of wisdom, insight and personal advocacy and showed the commitment that he brings to the issue in this place. The House of Commons is a better place when we speak openly and challenge those in power about the issues that still prevail, not just in this country but across the world when it comes to HIV/AIDS.

On this day, we remember the 40 million people who have lost their lives to the worldwide AIDS pandemic and related illnesses since the disease was first found in the 1980s. In this debate, Members from across the House, in a small, but perfectly formed manner, have raised some important issues. I particularly thank Caroline Nokes for the way in which she always challenges inequalities around the world, especially inequalities facing women and girls, and, of course, this is an issue that affects women and girls around the globe. It is an equalities issue, and I thank her for her contribution. I also thank the hon. Members for West Bromwich East (Nicola Richards), for Heywood and Middleton (Chris Clarkson), and for Strangford (Jim Shannon) and even the SNP spokesman, Steven Bonnar, for their contributions. The great thing about this issue is that it brings us together in unity on World AIDS Day. This is not a party political issue. As with covid, if we are to defeat the first pandemic, we must work together across party lines, and this has been a good debate because of that.

We all recognise the extraordinary work of those who have fought to eradicate the virus. As has already been said, we have come a long way since the first World AIDS Day in 1988. Here in the UK, we have seen unprecedented scientific advancement. We understand more about HIV, and we have legislated against discrimination to better protect those living with HIV. We have seen some long-overdue justice delivered to victims of the contaminated blood scandal, with interim payments being granted for some—but not all—of those impacted. This victory is a testament to the unstinting work of campaigners and, indeed, colleagues from both sides of the House. However, as has been made clear in the Chamber today, there is still much more work to do with regards to this injustice. I hope that, in his response, the Minister will provide an update to the House on when the Government will respond in full to the 19 recommendations laid out in Sir Robert Francis’s framework for compensation.

This World AIDS Day is not just about recognising and celebrating how far we have come, but about issuing a call to action. There can be no room for complacency in the late stages of this campaign. Today, we stand on the brink of achieving something extraordinary: ending all new HIV transmissions in England by 2030. That goal is ambitious, but achievable, and it is one that Labour is proud to support and to push the Government on to achieving. None the less, too many opportunities are still being missed, and sexual health services are struggling to keep up with demand. A total of 46% of people diagnosed with HIV are still diagnosed too late, and 38% of people attending sexual health services were not offered an HIV test last year. That is not good enough. Some 20% fewer people were tested for HIV in 2021 than in 2019, and research shows that 57% of people have waited more than 12 weeks for PrEP.

Shockingly, in 2021, no local authority in England—not one—reported more than five women accessing PrEP, and there are still stark racial disparities in treatment and in support that must be addressed. I wish to use this debate to press the Minister on what steps the Government are taking to tackle unequal access to sexual health services and, in particular, to PrEP.

In a recent study, 40% of people surveyed reported difficulty in booking a sexual health appointment online; 23% of people were turned away due to a lack of available appointments. With that in mind, what assessment have the Government made of sexual health accessibility levels, and what consideration has the Minister made of making PrEP available beyond sexual health services—for example in GPs, gender clinics, pharmacies and abortion clinics? I assume that that work would be included in the promised PrEP action plan, but that has yet to materialise. Will the Minister commit to an implementation date for this plan today, and if not, why not? Furthermore, what recent assessment has the Minister made of the eligibility criteria for PrEP, and are there any plans to expand it?

PrEP is one side of the coin, but we do not often talk about the other side anymore—partly because of the success of PrEP—and that is access to post-exposure prophylaxis. The publicity has fallen for that, but it is still an important tool in the box for people who are fearing that they may have been inadvertently exposed to the HIV virus. There is a small window for those people who fear that they may have been exposed, or who have been exposed to HIV, to get access to PrEP for it to be successful. What are the Government doing to ensure that there is adequate advice and information on the availability of post-exposure prophylaxis?

Sexual health services are under unprecedented pressure due to mpox. Service displacement means that appointments for PrEP, STI testing and long-active, reversible contraceptives have been cut. That has also led to reported hesitancy by clinics to deliver mpox vaccines. What action will the Minister take to ensure that all those who need the mpox vaccine can access one, and not to the detriment of other vital sexual health services?

Moving to testing, the Minister will no doubt be aware that yesterday, NHS England released its report on HIV and hepatitis opt-out testing in areas of very high prevalence. Labour has been proud to support that for several years. The report shows that because of the tests, more than 800 people living with undiagnosed HIV and hepatitis have been identified in these areas. We have saved an estimated £6 million to £8 million on treatment costs. Put simply, opt-out testing has been a huge success. With that in mind, can the Minister set out whether there are any plans to change the current scope of HIV opt-out testing to include all areas of high prevalence?

Finally, I want to touch on stigma. A study recently published by the Terrence Higgins Trust found that just 38% of people knew that those living with HIV and on effective treatment cannot pass the virus on to partners. Only 30% of people said that they would be comfortable dating somebody with HIV. The HIV epidemic is exacerbated by stigma, ignorance and misinformation. If we want equitable access to HIV treatment, we must proactively tackle the myths and bigotry that still permeate discussions around HIV. I am sure that the Minister will agree wholeheartedly with me about that.

I would be interested to hear the Minister’s assessment of current legislative barriers affecting those living with HIV. A clear example is the fact that LGBT+ people with HIV are still not allowed to access fertility treatment, despite the fact that heterosexual people with HIV are able to do so. That is an out-of-date barrier and it needs scrapping. I am proud that the next Labour Government will equalise access to fertility treatment for LGBT+ people living with HIV. Will the Minister join us in committing to that, and pledge to introduce legislation now—before the general election—to end the restrictions that prevent people with HIV from starting a family?

Labour is committed to the HIV 2030 pledge. It is more than prepared to work on a cross-party basis to make this ambition a reality. But we must address some incredibly concerning trends in HIV treatment and access, and not become complacent because of the progress that has come before us. No new transmissions of HIV by 2030 is still possible. We want to succeed, but there is no time to waste. As my hon. Friend the Member for Brighton, Kemptown said, let us all, together, sprint to that finish line.

Photo of Neil O'Brien Neil O'Brien The Parliamentary Under-Secretary for Health and Social Care 2:03 pm, 1st December 2022

Let me start by congratulating all Members from across the House who have taken part in what has been an incredibly informative and high quality debate. Let me join others in congratulating Lloyd Russell-Moyle, on a speech that mixed huge personal experience and knowledge, years of advocacy and successful campaigning, and a huge number of insights.

I undertake to look at numerous issues raised by the hon. Member, but to pick just a few, he asked about: the bureaucratic barriers stopping syphilis testing from being added to the opt-out testing that we already do for HIV and hepatitis B and C; some of the risks around the shift to online clinics; people on PrEP being tested regularly; and the promising experiment by the Terrence Higgins Trust with saliva testing for HIV. He raised a number of other points, including the important issue about patent waivers. There was a huge amount in his speech to take away and look at.

The same is true of other hon. Members. My right hon. Friend Caroline Nokes made hugely important points about women and girls, and gave some incredibly striking and harrowing statistics. She made important points about the barriers to testing, particularly among minority groups. We can learn from the way that we are tackling that problem in other fields, including in covid vaccination work.

Jim Shannon gave us insights on what is happening in Northern Ireland, such as the role of the Public Health Agency there and what it is doing on PrEP. He talked about the role of the church in his constituency and the connection between Swaziland and Strangford, which might surprise outsiders. He talked of the work of the Positive Life charity in Northern Ireland, which I commend.

My hon. Friend Nicola Richards spoke powerfully about her constituents’ experiences of stigma. She made the important point that, as a high prevalence area, it should be considered for the expansion of opt-out testing. A similar point was made by Mr Dhesi and my hon. Friend Chris Clarkson. I join my hon. Friend in commending the work of Middleton Health Centre.

Steven Bonnar talked about some important lessons that we can learn. We are keen to learn across the UK about the rollout of PrEP in Scotland. On the roll-out of our world-leading vaccination campaign against mpox—one of many issues raised by Andrew Gwynne in his speech—we are talking to that relatively small number of clinics that have had to deliver the huge majority of the campaign about its impact financially and on their day-to-day work.

World AIDS Day is an invitation to underline our commitment to tackling HIV, to show our support for people living with HIV and to remember those we have lost to AIDS. I am proud of how far we have come: from the stigma and the sidelining of the past, which a number of Members have mentioned, to where we are today thanks to collaborative efforts and the commitment of the Government, together with HIV patients, their friends and family, campaigners, medics, researchers and the health and care system at all levels.

Today, when diagnosed early and with access to antiretroviral therapy, most people living with HIV in England can expect a near-normal life expectancy. People diagnosed with HIV can expect to receive world-class, free and open-access HIV care. That has been a result of our collective and collaborative partnerships. However, despite successes, HIV has not gone away. There is still more that we should do. That is why last year, this Government published their commitment to end new HIV transmissions in England by 2030 through the HIV action plan. That plan is the cornerstone of our approach in England to drive forward progress and achieve our bold ambitions.

We have come far in the first year since its publication. The UK met the UNAIDS 95-95-95 targets for the first time in 2020: 95% of HIV-positive individuals were diagnosed; 99% of those diagnosed were receiving treatment; and 97% of those receiving treatment were being virally suppressed. I am pleased that the number of people being newly diagnosed with HIV in England continues to fall. The latest data on HIV diagnoses shows that 2,955 people were diagnosed with HIV in England in 2021—a 33% decline compared with 2019, when the Government first made their commitment to end all new HIV transmissions in England by 2030. We are conscious of the need to avoid flatlining or slowing the pace in any way. We are still understanding the impact of the covid pandemic and the things that happened during that period, but there has been progress.

Those successes have been underpinned by clear national leadership and strengthened partnership working. I am grateful to Professor Kevin Fenton, the Government’s chief adviser on HIV, who has been chairing the HIV action plan implementation steering group, involving the key partners in the delivery of the HIV action plan, including local government, the NHS, and our voluntary and community sector. The steering group has met quarterly throughout the year to monitor progress on our commitments and ensure that appropriate action was taken to keep us moving forward with our objectives. Within the remit of the group, they have established specific task and finish groups focusing on key priority areas for action, such as improving equity and access to HIV drug prevention—PrEP—and addressing workforce challenges, among others.

We are also thankful for the work of the UK Health Security Agency, which excels as a world-class leader running high-quality data collection and surveillance systems to help us to better understand and address the challenges on HIV. Those have enabled us to truly understand developments, emerging issues and where we can have the greatest impact with our prevention efforts, and add to our growing repertoire of world-leading British innovation, systems and technology.

Of course, none of this could have been possible without the brilliant efforts of our local government, NHS and voluntary and community sector partners to deliver the highest-quality healthcare tailored to the needs of their local populations. We know through their work that different areas face different challenges, and we remain committed to helping level up outcomes for the whole population across the country.

A key priority, therefore, of the Government’s approach is to ensure that all under-served populations benefit equally from improvements in HIV outcomes. A range of important suggestions have been made in this debate about how to go further. The approach includes scaling up our prevention efforts and increasing access to PrEP. We have already invested £33 million to roll out PrEP access across sexual health services over the past two years. PrEP is now being commissioned as a routine service through the public health grant.

In delivering against these commitments, UKHSA has now developed and published a monitoring and evaluation framework to support local authorities, sexual health services and other key stakeholders to inform continuous service development in PrEP commissioning and delivery, using the existing available data. I am sure many of the people involved in delivery of those services will have followed this debate with great interest and noted some of the challenges posed by different hon. Members.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown

One of the problems is that the Department does not collate data on the average wait times for sexual health clinics or the availability of stocks for PrEP appointments in those clinics. Without that data, we rely on voluntary organisations to make freedom of information requests and report periodically. Having a baseline set from the Department would make a big difference and help us to understand areas that are struggling to roll out PrEP versus areas that maybe are not. Is that something the Minister could take back to the Department? I understand why in the past we have been nervous about publishing data on sexual health issues, but now is the time when we can be a bit more open about that and maybe publish that data, or collate it if that is not already done, so we can start to target our actions.

Photo of Neil O'Brien Neil O'Brien The Parliamentary Under-Secretary for Health and Social Care

That is certainly something I will take away and look at. As the hon. Gentleman points out, there are a number of challenges in doing that and in unpicking the activities of sexual health services on different diseases, and he has already alluded to some of the risks. However, I will certainly undertake to go away and look at that important point.

We know there is still more to do to improve PrEP access for key groups and we are in the process of developing a plan for provision of PrEP in settings beyond sexual and reproductive health services, to help us to reach those who are underrepresented—something a number of hon. Members have called for. Our efforts are also focused on scaling and improving testing levels in targeted, high-risk populations, including in black African communities, to be able to reach those 4,500 individuals who we believe are living with HIV but unaware of their status.

As part of implementation of the action plan, NHS England is investing £20 million over the next three years to expand opt-out HIV testing in A&E departments in the local authority areas across the country with the highest prevalence of HIV and across the whole of London. As a number of hon. Members have pointed out, it is a proven effective way to identify new HIV cases, as it promotes testing on admission to hospital of anyone who has not previously been diagnosed with HIV, therefore rapidly helping to identify the virus. Some 33 A&E departments are now live, delivering that important initiative.

We also took the opportunity to link the initiative to the hepatitis C elimination programme, backed by a further £6.85 million, to provide hepatitis B and C testing as well. As several hon. Members alluded to, NHSE published its report on the first 100 days yesterday, describing the progress, challenges, results and learning from the first period of this initiative.

Those very early findings show the benefits of the approach: more than 200,000 HIV tests were conducted over just the first 100 days of opt-out testing across London, Manchester, Salford, Blackpool and Brighton, which meant that more than 600 people were identified with a previously unknown blood-borne virus. Of those, 128 people were newly identified as living with HIV and an additional 65 people living with HIV who were previously diagnosed but were not under the care of an HIV clinic were also identified.

This approach is important to ensure everyone living with HIV can access testing and rapid linkage to treatment and care, allowing them to live a long and healthy life. Moreover, 325 people were newly identified with hepatitis B and 153 people were newly identified with chronic hepatitis C virus; a further 50 were found who had disengaged from care for both diseases and seven people were identified who had previously cleared the hepatitis C virus.

We will be considering the initial evidence from the first year of testing alongside the data on progress towards our ambitions to decide how and whether we further expand this programme. We are in the very early days of evidence on this, but I must say that evidence is extremely encouraging. I hear what hon. Members across the House are calling for, given the success of that programme in its first 100 days, but we need further evidence as it develops.

We redoubled our efforts to increase HIV testing throughout the country during National HIV Testing Week, which took place in February this year. Results are promising: 30% of the almost 25,000 users who ordered an HIV and syphilis self-sampling kit during the campaign had never tested before, and a majority of the campaign’s target audiences reported having taken some kind of preventative action as a result of the campaign.

We know there is still more we need to do to achieve our ambitions. The HIV action plan monitoring and evaluation framework developed by UKHSA, published today, will explore in detail the inequalities and gaps in HIV prevention, testing and care and other indicators of the progress required to achieve our shared ambitions and will help inform our progress. Our actions continue to be closely monitored by the HIV action plan implementation steering group, which includes key delivery partners such as local government, the NHS and the voluntary and community sector, to ensure we remain on track to meet the 2025 and 2030 objectives. The Secretary of State will report annually to Parliament on progress towards our objectives.

World Aids Day gives us the chance to reflect on progress and challenges, being accountable for what we have done over the past year and where we need to continue improving. But, most importantly, it gives us the possibility of coming together to restate our collective commitment to continue working together to end new HIV transmissions in England by 2030 and to finish the race.

Photo of Lloyd Russell-Moyle Lloyd Russell-Moyle Labour/Co-operative, Brighton, Kemptown 2:17 pm, 1st December 2022

I thank everyone who has spoken today: Caroline Nokes, the hon. Members for Strangford (Jim Shannon), for West Bromwich East (Nicola Richards) and for Heywood and Middleton (Chris Clarkson), and the Front-Bench speakers. All the speeches and interventions have been very good.

I am pleased that the Minister talked about the continued roll-out of opt-out testing. My feeling is that when results come back that are so good, there is sometimes an argument to start making moves now. I am not saying it should be rolled out tomorrow in all those hospitals, but we know that the lead-in time takes a number of months to make sure clinicians and others are co-ordinated. Messages from the Department now, saying, “We will be rolling this out next year when the final results come back, unless something happens,” would enable a smooth roll-out. Some of those things we can go a bit further on, but I am pleased that he mentioned them.

I am also pleased that the Minister will work to ensure better outreach for PrEP in community settings. Those community settings should not just be for hard-to-reach groups, but they, especially pharmacists and doctors, will be particularly helpful for those groups. I am delighted about that.

I will finish by thanking my local organisations, because it is always nice to mention them: the Lawson Unit, which continues to support my care and the care of everyone with HIV in Brighton; Peer Action; the Martin Fisher Foundation, named after one of the HIV consultants who passed away in Brighton and works on stigma; the two anti-stigma buses, with “Undetectable = Untransmittable” stats plastered on the outside, which drive around Brighton and to Tunbridge Wells and back again every day so that even the rural areas of Sussex get to see our messages; Fast-Track Cities, which the Minister mentioned; Lunch Positive; the Sussex Beacon, one of only two residential care centres for people with HIV and AIDS in Britain; MindOut; the Terrence Higgins Trust and, of course, Frontline AIDS, one of the leading global HIV development organisations, based in Brighton and Hove. All those organisations will be there at the memorial at 6 o’clock tonight, and I am sure that many of our community will be too. Thank you again to everyone.

Question put and agreed to.

Resolved,

That this House
has considered World AIDS Day.