To ask Her Majesty’s Government what assessment they have made of the impact on public health outcomes of people being turned away from sexual health services, as reported by the British Association for Sexual Health and HIV.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. I refer your Lordships to my registered interests; in particular, I am patron of the Terrence Higgins Trust.

My Lords, local authorities in England commission comprehensive open-access sexual health services based on the needs of their communities. Services have responded to meet increased demand, with attendances at sexual health services increasing by 13% between 2013 and 2017, from 2.9 million to 3.3 million.

I thank the Minister for that response. Much has indeed been achieved but there are worrying trends. As we know, sexual health services are funded by local authorities, which have endured reduced funding year on year and, to maintain other essential services, councils have disproportionately cut funding to sexual health services. Clinics have closed, staffing levels have reduced and capacity has reduced further because walk-in sessions have been replaced by appointment-only sessions that cap demand. The overall effect has been to reduce access to screening and treatment, with subsequent increases in sexually transmitted infections and considerable public health impacts, notably infertility, teenage pregnancy and HIV transmission. I therefore ask the Minister, in the context of these worrying developments, how the Government will ensure that councils maintain an adequate level of comprehensive sexual health service provision.

I am grateful to the noble Lord for raising this important issue. First, it is worth saying that the public health grant to local authorities is ring-fenced, and that is meant to provide for sexual health services among others. He mentions STI rates and says attendances have increased. I know that service configurations are happening and there are changes in different parts of the country. It is important that attendances have increased. I think there is a mixed picture on STI infections; some are increasing but there is good news. The noble Lord mentioned teen pregnancy—not that that is a sexually transmitted disease, of course—the rates of which are down. HIV diagnoses are down and we see a positive picture in the new data today, so there is cause for optimism. As we look to the future in the spending review, we will be making the case for improved services at sexual health clinics through the public health spend.

My Lords, what impact will the closure of sexual health services on the one hand and the reduction in the capacity of other services on the other have on the prevention strategy for HIV in particular and the PrEP trial?

As I have just said to the noble Lord, Lord Cashman, we are seeing a change in services. More services are going online, for example. An e-service for sexual health was launched in January 2018, with 20,000 kits being distributed. So there is a change in the health services being provided. I can tell the noble Lord that there has been no impact on the PrEP trial; indeed, we have already recruited nearly 10,000 of the 13,000 people to that trial, and we are hoping it will be successful.

My Lords, I declare an interest as a trustee of the Bloomsbury Network. Does my noble friend agree that, with the advent of PrEP and the certain knowledge that people on effective medication cannot pass on HIV, we now have within our grasp the possibility of eliminating new HIV infections, and therefore the burden on sexual health services? Will the Government make a clear commitment to achieving that noble goal of zero new HIV infections by 2030 and ending once and for all this horrible disease?

My noble friend makes an excellent point: we have cause for optimism not least because of the work that he, the noble Lord, Lord Cashman, and so many others have done. I mentioned the decline in diagnoses year on year. The UK has met the UN’s 90-90-90 ambition in every part of the country, including London. Having done that, which is a huge achievement, of course we should set our sights higher. I should be very happy to discuss with noble Lords exactly what our target should be. Clearly, a zero infection rate must be where we want to get to in the end.

My Lords, given the Minister’s Answer to the noble Lord, Lord Cashman, about the general population, does he agree that the over- representation of people from black and minority ethnic communities, with high incidences of HIV and late diagnosis, is a continuing problem that Public Health England has yet to address?

I agree with the noble Baroness that that is a continuing problem. Infection with certain diseases is disproportionately distributed. Testing and screening are not taking place uniformly among different groups. Public Health England published an action plan about a year ago on how to improve sexual health services and is trying to address that specific issue.

Following on from the question asked by the noble Baroness, Lady Barker, what is the current assessment of the undiagnosed incidence of HIV? There is usually a quantum that is reckoned to be about where we are with undiagnosed incidence. The Minister says that diagnoses have gone down and that that is a good thing, but it is not necessarily. Can he give us some information on that?

Of course, I am very happy to. In this case, it is good news that diagnoses are going down because 92% of people with HIV in the UK have been diagnosed. The UN target was 90%, and we have exceeded it. That leaves 8% to reach and, clearly, we want everyone diagnosed and on treatment, with their viral loads suppressed, so that no new infections can take place.

My Lords, the importance of PrEP has been mentioned by noble Lords. The British Association for Sexual Health and HIV has shown in its survey that in the past year, in 25% of local areas there was reduced access to PrEP and in 11% of areas no access at all. What are the Government doing to ensure equity of access to PrEP across the country?

I shall certainly look into that issue. This is the largest trial of its kind in the use of PrEP, and we are determined to ensure that all 13,000 people are recruited to it, and that they are spread across the country. As I said, we have already reached nearly 10,000. I shall do a little more digging on that and write to the noble Lord.

My Lords, what actions are the Government taking to end HIV-related stigma and discrimination, which unfortunately still exists?

First, we are giving it an extremely high profile. Indeed, Governments have given it a high profile since the noble Lord the Lord Speaker raised the issue in the 1980s. All Governments since have been committed to that and this Government continue to be so. We do that through a mixture of public health campaigns and working with schoolchildren to ensure that there is no stigmatisation or bullying of any groups of young people with HIV.

My Lords, as there is a moment left, I ask the Minister to return to the question I asked him. Forgive me if I misunderstood his answer, but I do not think he said what the current assessment is of undiagnosed HIV in any of the populations. If he has that information, perhaps he could let me have it in writing.

I thought I said that 8% are currently undiagnosed across the country. As to how that is split across different socio-demographic groups, I shall have to write to the noble Baroness with more detail.