National HIV Testing Week 2023 — [James Gray in the Chair]

– in Westminster Hall at 2:30 pm on 8 February 2023.

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Photo of Maggie Throup Maggie Throup Conservative, Erewash 2:30, 8 February 2023

I beg to move,

That this House
has considered National HIV Testing Week 2023.

It is a pleasure to serve under your chairmanship for this important and timely debate, Mr Gray. It is 40 years since the untimely death of Terrence Higgins, who was not only the first recorded British person to die of HIV/AIDS, but a Commons Hansard Reporter—one of our own. Since then, we have made huge progress in the testing, diagnosis and treatment of HIV. Today, people living with HIV can continue to lead very normal lives. It is essential to remember, however, that HIV remains a critical global health issue, with millions of people living with the virus and many more at risk of infection.

Early diagnosis and treatment of HIV is essential in reducing the spread of the virus, improving health outcomes and reducing the stigma associated with the disease. Charities such as the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation have worked tirelessly to lead the fight against HIV. I thank them for the phenomenal work they have done, and continue to do, to help those living with HIV and to achieve the goal of no new transmissions by 2030.

I thank the outgoing chief executive of the Terrence Higgins Trust, Ian Green, for his hard work and dedication to the charity over many years, and for his immense contribution to the fight against HIV. I also congratulate Richard Angell on his appointment as Ian’s successor. He has big shoes to fill, but I have no doubt that he is more than capable of doing so, stepping up to the challenge and driving this important work forward into the future.

As Members will be aware, human immunodeficiency virus, or HIV, weakens a person’s immune system and their ability to fight everyday infections and disease. HIV is passed from human to human and, if left untreated, can progress through a series of stages and lead to acquired immunodeficiency syndrome, or AIDS. Although there is currently no cure for HIV, there are treatments available that enable a person to live a long and healthy life. A person living with HIV has a similar life expectancy to an HIV negative person, provided they are tested and diagnosed in good time.

As the House knows, TV is one of the most powerful tools at our disposal to help educate the public, with award-winning dramas such as “It’s a Sin” bringing HIV to the forefront of the national consciousness again. I am not sure if there are any “EastEnders” fans in the Chamber, but, if there are, they will know that the character Zack Hudson, played by James Farrar, has recently been diagnosed with HIV. The story portrays Zack’s struggles in coming to terms with his HIV diagnosis and his difficulty in opening up to his friends and family. I encourage Members, perhaps over the forthcoming recess, to catch up on those powerful episodes of the Albert Square soap, which perfectly captures the stigma around HIV and the challenges those living with it continue to face. I also hope that the storyline will encourage more people to take an HIV test.

During my time in government, the work I am perhaps the most proud of is introducing the new national HIV action plan. It had the clear aim of reducing new infections by 80% by 2025 and, crucially, ending infections and deaths from HIV by 2030. As Public Health Minister, I was clear with colleagues across government, as well as in the NHS, that this goal could only be achieved if the plan was properly financed.

By securing over £23 million of new funding to support the work needed to deliver the action plan, including scaling up HIV testing in targeted, high-risk populations, including the black and African communities, and increasing access to the anti-viral drug, pre-exposure prophylaxis, or PrEP, I am wholly confident that we can, and will, eradicate HIV in the UK by 2030.

Despite progress over the years, the Terrence Higgins Trust estimates that there are still 4,400 undiagnosed people living with HIV in England. I challenge the Minister to play his part and commit to finding them so that we can achieve our goal of zero new transmissions by 2030. To do that, we need to encourage more people to test for HIV, and expand opt-out testing across the UK, especially in high-prevalence areas.

This week across the country, including on the parliamentary estate, we have been marking National HIV Testing Week with a number of events to raise awareness of HIV testing. This annual campaign aims to raise awareness of the importance of regular testing to reduce the number of people living with undiagnosed HIV and those diagnosed late. This year, the campaign’s new strapline, “I Test”, replaces “Give HIV the Finger”, which has been in place for the past five years. I urge everyone to take advantage of the services available during National HIV Testing Week and throughout the year to get tested and know their status.

Forty years ago, testing for HIV was limited and often difficult to access. We had only just begun to understand what HIV was, including its variants and its potential impact on health. Charities such as the Terrence Higgins Trust were established, but at that time could only offer support and advice to HIV-positive people. Fast forward to today, and the contrast is evident. For the first time this year, during National HIV Testing Week, in addition to the traditional test, people in England are able to order or collect a rapid home HIV test that gives results within 15 minutes. It operates similarly to a lateral flow test, which we all became familiar with during the pandemic. It only needs a few drops of blood from a small prick on the finger, and the results are known promptly afterwards. That means that, for the first time, HIV testing is quick, free, confidential, easy and will certainly save lives.

I turn to the steps the Government have taken to tackle HIV. Over the past few years, the Government and charities have worked together to try to achieve the goal of eradicating HIV transmissions in England by 2030. In 2019, the then Secretary of State for Health and Social Care, Matt Hancock, set a goal to eradicate HIV transmissions in England by 2030. In fact, I think he was set the challenge by my hon. Friend Steve Brine. That led to the launch of an independent HIV Commission, supported by the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation. Its aim is to develop evidence-based recommendations to end HIV transmissions and attributed deaths within a 10-year period.

The commission’s report, which was launched on World AIDS Day 2020, made 20 recommendations. It outlined that the single most important intervention to meet the 2025 and 2030 goals was to make widespread HIV testing readily available across the NHS, delivered as opt-out, not opt-in, testing. At the current rate, it is possible, but not probable, that we will achieve that 2030 goal. There needs to be a concerted effort by the Government, HIV charities and the NHS to come together to turn that vision into a reality. As the HIV Commission outlined:

“Opt-out rather than opt-in HIV testing must become routine across healthcare settings, starting with areas of high prevalence.”

I firmly believe that if we want to be the first country in the world to achieve zero HIV transmissions by 2030, we must rapidly expand opt-out testing at the earliest opportunity.

In particular, opt-out testing, which is a scheme whereby a patient can explicitly decline instead of implicitly accept an HIV test, can help to ensure the UK is the first country in the world to eradicate HIV transmissions by 2030. An opt-out programme refers to when a patient visits an accident and emergency department and is offered a discreet test, which screens for HIV and hepatitis B and C when blood is taken for other tests. That is usually the case for most A&E attendances.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health and Social Care)

The hon. Lady is making an excellent contribution. Is not one of the real benefits of opt-out testing that it starts to chip away at what remaining stigma is left with HIV testing by normalising it?

Photo of Maggie Throup Maggie Throup Conservative, Erewash

The spokesman for the Opposition makes exactly the right point. One of the ways that we can achieve our goal for 2030 is by taking away the stigma that, sadly, affects people who test positive for HIV.

Nobody is forced to take the test, and the patient is allowed to opt out, but I am led to believe that very few people do opt out. There have been some notable successes since the adoption of opt-out testing in very high-prevalence areas, and it is clear that the way this is being carried out is saving lives. In the first 10 months, A&E departments in London, Brighton, Blackpool and Manchester have seen 261 people newly diagnosed with HIV, in addition to finding 137 who were previously lost to care. Additionally, 710 people were newly diagnosed with hep B, and 288 people were newly diagnosed with hep C. Crucially, this means that people can access the treatment they need to live a normal life, and that they cannot pass on the virus unknowingly.

Opt-out testing has a number of benefits for the NHS, too. At a time when the NHS is under increasing pressure in terms of both the backlog and funding, opt-out testing can help relieve both of these problems. Research from the Terrence Higgins Trust has highlighted that, in the first 100 days of the scheme, opt-out testing has cost the NHS only £2.2 million and saved an estimated £6 million to £9 million in healthcare costs. That is well illustrated at Croydon University Hospital, where opt-out testing has been taking place for some time now. Before opt-out testing, the average hospital stay for newly diagnosed HIV patients was 34.9 days. After two years of opt-out HIV testing, the average stay is just 2.4 days. That frees up hospital beds, which, in turn, will help to reduce the backlog, and it shows that opt-out testing can benefit the NHS and the patient.

The pandemic clearly had an impact on HIV testing and may have affected the possibility of reaching our 2030 goal. According to the UK Health Security Agency, the total number of people newly diagnosed with HIV in England decreased by 33% in 2020. Reasons for that include the impact of the unprecedented public health restrictions and the strain on health services, resulting in a decline in HIV testing. Although covid accounts for the fall in testing, we need to address a number of problems to give us a fighting chance of being able to meet the 2030 zero-transmission target.

I therefore ask the Minister to consider the following points. The first is about the roll-out of opt-out testing in high-prevalence areas and not just in very high-prevalence areas. Despite the fantastic achievements of opt-out testing in very high-prevalence areas, we need to do more to undertake testing in areas of high prevalence. An area is classified as having high prevalence if between two and five people per 1,000 are HIV positive. Currently, there are 32 areas of high prevalence outside London. Cities that are classified as being in this class include Bristol, Liverpool, Derby and Nottingham. With my constituency of Erewash sitting between Derby and Nottingham, I have a vested interest.

The National Institute for Health and Care Excellence, the British HIV Association, the British Association for Sexual Health and HIV, and the British Infection Association all recommend routine HIV tests in areas of high prevalence for anyone having a blood test for other reasons. Despite this guidance, there is no Department for Health and Social Care or NHS England funding, and no route map for opt-out testing in areas of high prevalence outside London. If we are serious about meeting the 2030 target, the Government need to expand opt-out testing across the country, and specifically in high-prevalence areas. This form of testing has been extremely successful across London, where a decision was taken to fund opt-out testing not just in the boroughs with very high prevalence, but in those with high prevalence. It is estimated that a further £18 million is needed to expand opt-out HIV and blood-borne testing in 40 hospitals in 32 areas outside London. Anyone leaving an A&E department who is HIV positive and is not diagnosed is a missed opportunity.

Secondly, we need to reduce the chances of late diagnosis. It is reported that in 2020 42% of all people diagnosed with HIV were diagnosed late. The impact of late diagnosis can be extremely damaging. As well as meaning that people might unknowingly pass on the virus, if someone receives a late diagnosis their chance of dying in the first year after diagnosis is ten times greater than if they had received an early diagnosis. Additionally, late diagnosis can have a detrimental impact on an effective response to treatment, which in turn leads to greater healthcare costs, at a time when there are already financial strains on the NHS.

Late diagnosis is particularly common among certain groups; 54% of heterosexual British black Africans and 29% of gay and bisexual men were diagnosed late. Opt-out testing has allowed us to identify that those groups are the most likely to be HIV positive. Although opt-out testing highlighted that those groups were most likely to have HIV, we need to encourage more people from them to get tested.

A simple solution to encourage more people from those groups to get tested could be to use public message campaigns. Targeted messaging across radio, television and social media could be created to encourage people to come forward and get tested. It could also specify the importance of testing and tell people where their local test centre is. Let us face facts: during the pandemic, it became second nature to go to a covid testing centre or a vaccination centre outside of the usual healthcare settings. In a similar way, pop-up testing centres could be a useful way of reaching out to the hard-to-reach communities.

Research by the British HIV Association has shown that many people have missed opportunities to test for HIV in primary and secondary care. The most common clinically related barrier is linked to the failure to appreciate HIV risk, or to properly diagnose HIV. Other barriers include time pressures, clinicians not seeing it as their role to test, the perceived need for pre-testing counselling and unfamiliarity with discussions about testing. Clearly, all those factors can lead to a late diagnosis and to greater health risks.

Ultimately, in order to address late diagnosis in both primary and secondary care services, HIV testing needs to become more prominent across the entire NHS primary and secondary estate. If we want to turn the UK into a science and health superpower, and if we want there to be no new cases of HIV by 2030, it is essential that we address the issues that I have highlighted today. In particular, it is vital that we rapidly increase testing levels in high and very high prevalence areas through opt-out testing. That will not only save the NHS money and reduce the backlog, but it will enable patients to know quickly whether or not they have HIV.

My challenge to the Minister today is for him to fight the corner for the funding needed to expand opt-out testing to all high prevalence areas. If we achieve such an expansion, then this time next year—when I am sure there will be another debate on this subject—we can report that we are back on track to meet the goal of zero new HIV infections, and zero AIDS and HIV-related deaths, in England by 2030. As well as saving lives, Ministers’ actions in this area would also save the NHS quite a considerable amount of money. If we implement this programme properly, our country will continue to lead the way in this area of healthcare and it will achieve the status of becoming the first country in the world to eradicate HIV.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 2:48, 8 February 2023

Thank you for calling me to speak in this debate, Mr Gray.

I thank Maggie Throup for setting the scene. As the health spokesperson for my party, I think it imperative that we speak out on these issues. I have done so in the past—indeed, I do not think I have missed any HIV debate, whether it was in Westminster Hall or in the main Chamber—so I am very pleased to come to Westminster Hall today and participate in this debate.

How wonderful our NHS is. It is instrumental in providing support and care for us all. Where would we be without it? Regarding HIV, we have come on in leaps and bounds since the late 1970s and the 1980s in terms of providing diagnosis, support and treatment, and indeed in removing the stigma around it. It is good that we are where we are today, because that shows there has been progress—positive progress—and I support that progress.

It is also a pleasure to see the shadow Minister, Andrew Gwynne, in his place today. It seems like only yesterday—in fact, it was last Thursday—that we were here in Westminster Hall to discuss cystic fibrosis. And I am very pleased to see the Under-Secretary of State for Health and Social Care, Neil O’Brien, here today as well. I know that he will give positive responses to the questions that we ask; he always is positive and we very much appreciate that. There is always more we can do to improve diagnosis and keep people as healthy and safe as possible, so it is great to be here to discuss these important matters.

I also put on record my thanks to the hon. Member for Erewash for setting up the all-party parliamentary group for diagnostics this morning. I commend her for that; she has many supporters from within her party and others who wish to see things going in the right direction.

In 2021, 2,955 people in the UK were diagnosed with HIV. The number of people being newly diagnosed each year has been decreasing steadily for over 15 years, from a peak of 7,892 in 2005. That is down to the strategies pursued by the Government and the Minister, as well as by the local and regional Administrations, including my own Northern Ireland Assembly back home. Most people with HIV—some 95%—know their status because they have been diagnosed. We have a very clear strategic plan in Northern Ireland to make it easier to be diagnosed. I am sure the Minister has done his research, so he will know the success rate of our strategy. Northern Ireland has led the way for the rest of the United Kingdom.

In 2020, 60 people in Northern Ireland were diagnosed with AIDS; 47 of them were men and 13 were ladies. It is important to note that historically there was a stigma around being tested for AIDS and being diagnosed with it. I believe that stigma has disappeared. A large majority of people are eager to get diagnosed and then to start the treatment process. Today, in solidarity, we can encourage people to get tested. I want to make that statement, and others will want to make it as well. People in Northern Ireland can get a free HIV test and will receive comprehensive medical care and support. Provision is widely available in all health trusts, and HIV testing kits can be ordered online and delivered straight to the home. We can do this online as we do many things, such as shopping. Northern Ireland is leading the way.

The National AIDS Trust and the Terrence Higgins Trust have been in contact with my office ahead of the debate, and I am pleased to add some of their evidence and information into my contribution. They have emphasised the importance of opt-out testing being expanded to all areas with a high prevalence of HIV. Can the Minister tell us what has been done to address those areas of high prevalence? I am quite sure there is a direct strategy to address this. It is estimated that the first 100 days of that scheme cost £2.2 million, and saved the NHS an estimated £68 million in care costs, because those diagnosed were able to initiate treatment. It really is a win-win; people are diagnosed early and money is saved on the care down the line. It is estimated that a further £18 million is needed to expand opt-out HIV and bloodborne virus testing to a further 40 hospitals in 30 areas, which would in turn result in savings. As always, I ask the Minister in a respectful manner, as I am looking for answers, will the Minister’s Department set aside the further £18 million to ensure that happens?

Opt-out testing finds people who are more likely to be diagnosed late by other services. Fifty four percent. of people diagnosed with HIV in the first opt-out testing A&E pilots were of black African, black Caribbean or other black ethnicity—more than twice as many as the nationwide average, as the hon. Member for Erewash mentioned in setting the scene so well. Thirty five per cent of people diagnosed were women, and 10% were aged 65 or over. Again, the hon. Lady asked for that to be a target area. I reinforce her request.

Between 2021 and 2022, HIV testing did not return to pre-pandemic levels, with testing rates 20% lower in 2021 than in 2019, so there is something that needs to be done there as well. That has been driven by a 22% drop in testing among women and a significant 41% drop in testing among heterosexual men. I would suggest that someone who has not made use of HIV testing needs to do so. This debate, in HIV testing week, aims to promote regular testing, particularly among the groups most affected by HIV in England, including gay and bisexual people, men who have sex with men, and people in black African and black Caribbean communities. Testing options in the United Kingdom vary across Administrations. We are leading the way in Northern Ireland, and I am sure that everybody’s ambition is to catch up. It is important that our constituents know their first port of call, should suspicions of HIV arise.

I want to give a wee plug for what some of the organisations in my constituency are doing. I will give one example out of many. One of the churches, the Elim church in Newtownards, is very active with missionaries in Africa, in Swaziland—now Eswatini—and Zimbabwe. There is a high prevalence of HIV in those countries. They were keen to ensure help for those affected by HIV, first the orphans who have lost parents through HIV, by providing health treatment, an orphanage, education and job opportunities. That missionary-based church deserves to be commended for what it does in those two African countries. Every year the missionary society sends over some of the children and a choir to sing, and every year I attend those events. They remind us of how things were and how things can be. It is the ambition for change, which the Elim church clearly has.

I have a question about something that lies outside the Minister’s responsibilities, so I would be happy if came back at a later stage to keep us informed. What discussions has he had with the Foreign, Commonwealth and Development Office and the Secretary of State to promote the fight against HIV in other countries? I know they are doing it, but I am keen to know whether the same focus, attention and authority are given.

To conclude, it is important we do all we can to encourage early testing, for early diagnosis and better treatment. There is potential to live with HIV, to keep going and protect life from illness and possible death. I am encouraged by what Government have done, but I call on the Government to ensure sufficient access to HIV tests. I thank our health trusts and GPs for providing free testing for all, as many do, in particular in Northern Ireland.

Photo of Steve Brine Steve Brine Chair, Health and Social Care Committee, Chair, Health and Social Care Committee 2:57, 8 February 2023

It is a pleasure to see you in the chair, Mr Gray.

I thank my hon. Friend Maggie Throup for opening the debate so well. I echo her comments about the outgoing chief executive of the Terrence Higgins Trust. I have known Ian for many years. His leadership ensured that the trust was the first organisation to take the “U=U” message out there, along with “Can’t Pass it On”. Such a simple campaign and message came from the clarity of thought that Ian has brought to that organisation. The first home self-test postal service and the creation of the HIV Commission, which I will come on to, came through Ian’s leadership. He is also a lover of labradors, which makes him a good person in my book. We thank Ian, and wish him well and good luck in his new positions. I look forward to seeing him soon.

As has been said, HIV emerged some 40 years ago, when I was a mere slip of a schoolboy. The epidemic that followed still dominates some people’s lives, ended many too soon, and scarred many more. I knew nothing about HIV. When I became the Public Health Minister, I knew nothing beyond the tombstone advert on television, which I had seen as a schoolboy. I knew nothing, but I have learned a lot in a very short space of time.

Forty years ago, the situation seemed hopeless, as it did at the start of the covid pandemic in some respects, but we have seen improvements in treatments. Someone on effective treatment cannot pass on the disease. What we have achieved is incredible and a testament to the hard work of so many in our life sciences industry, as well as in the NHS, which Jim Shannon mentioned. The all-party parliamentary group on HIV and AIDS, which I am proud to co-chair, has been at the forefront of the work for 36 years as one of the longest-standing all-party groups, and kept the subject high on Parliament’s agenda. I pay tribute to Mark Lewis, who is here today. He looks after us and keeps us on the right track and focused.

The push to end new HIV transmissions by 2030, which my hon. Friend the Member for Erewash mentioned when she opened the debate, is the right target. The UK, Scottish and Welsh Governments have all committed to meeting that target and building on the work that I have talked. We can get there. I emphasise that, so I hope that Hansard will emphasise it. HIV care in our country today is excellent. The number of people living with undiagnosed HIV has declined year on year. In the majority of people with diagnosed HIV, it is undetectable because of the treatment and the antivirals that they are on. Effective treatment and the combination HIV prevention, including the pre-exposure prophylaxis treatment, has resulted in a marked decline in new HIV diagnoses annually, but despite the fact that we have access to all the tools we need to eliminate new HIV transmissions, we will not meet the targets that the HIV Commission set out for 2030, nor the Government’s commitment to reduce new diagnoses by 80% by 2025 unless we improve testing along the lines set out by other Members today.

Photo of Andrew Slaughter Andrew Slaughter Shadow Solicitor General

I agree entirely with what the hon. Member is saying. This might be a matter that the Minister can respond to or that the hon. Member’s Select Committee can take up. A lot of the arguments have been won on, for example, the availability of PrEP and making services accessible, but that has not been happening, partly as a consequence of monkeypox displacing other services and partly because of lack of resources, and that seems criminal. I have a sexual health clinic in my constituency in west London, where there is high prevalence, and people simply cannot get access to treatment. They cannot get appointments at clinics and cannot get on the escalator, as it were, to treatment. We can praise ourselves for having these solutions, but unless we solve those issues, they will not work.

Photo of Steve Brine Steve Brine Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

The point I was making was that, compared with the hopelessness of 40 years ago, we now have the tools to deal with it, but the hon. Member is right. The all-party group visited the Dean Street clinic last year and heard about the impact that monkeypox has had and is still having on its day-to-day work. Access to PrEP through, say, community pharmacies would move the dial and be a game changer. I would very much support that, and as Chair of the Health and Social Care Committee, I might be able to help.

Some people have mentioned the HIV Commission. I was fortunate to have the proposition for that commission put to me when I was in the Minister’s job. For me and my right hon. Friend Jeremy Hunt and his successor as Health Secretary, my right hon. Friend Sajid Javid, it was an easy proposition to say yes to. When I left Government in 2019, I was asked by Ian Green of the Terrence Higgins Trust to join the commission as a commissioner, which I was delighted to do.

The Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation did incredible work to put together the commission’s report. As has been said, on World AIDS Day in 2021, we published our report that developed the evidence-based recommendations that are now the foundations of the HIV action plan, which my right hon. Friend the Member for Bromsgrove published in December 2021. Those recommendations were the foundations of the 2021 report by the all-party parliamentary group on HIV and AIDS, “Increasing and normalising HIV testing across the UK”.

The message from the HIV sector and public health professionals is test, test, test. As was said in the opening speech, late diagnosis remains way too high. There are still far too many people living with undiagnosed HIV who will not be reached through the existing testing strategies alone. If we are to find the estimated 5,000 undiagnosed people living with HIV in the UK, testing must be normalised through the health service and beyond. We have made great strides in doing that, but we will have to roll it out much wider to the high-prevalence areas, as has been said.

Everybody should know their HIV status. There must be equitable and easy access for everyone to that knowledge and to effective treatment, so they can live their full and healthy lives with undetectable HIV. Undiagnosed virus is a major contributor to onward transmission. It is therefore the driver of late presentation, all the impacts on people’s health and people’s lives, and the costs to the national health service; sadly, it also significantly increases the risk of death in the first year after diagnosis.

We know that HIV testing is reliable, cost effective and highly acceptable to patients across a range of settings. As we heard from my hon. Friend the Member for Erewash, HIV opt-out testing was an integral recommendation of the HIV Commission. We know that it works. The latest data available on HIV opt-out in accident and emergency departments in London, Manchester, Brighton and Blackpool shows 238 people newly diagnosed with HIV, and a further 124 people have been returned to care. That proves that it works. We have proved the concept. I will be honest with the House that, as a commissioner, I was concerned that people would opt out, or that they would take offence at the suggestion—that the patient would say, “What are you suggesting?” I was wrong. Routine HIV testing among pregnant women is completely normalised. That convinced me that it was right to make that our key recommendation.

That was our key recommendation, but opt-out testing is done only in London, Blackpool, Brighton and Manchester. I contacted my trust in Winchester today to ask whether we can have a conversation about rolling it out in our area.

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

Only at the hon. Gentleman’s behest, of course. In my contribution I referred to the success of the pilot schemes, and he has referred to that as well. There are also quite significant cost savings to the health service from people being diagnosed, so the small money spent now will be significant in the long run. Does the hon. Gentleman accept that?

Photo of Steve Brine Steve Brine Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

Yes, and that takes us neatly on to my final point. With my Chair of the Health and Social Care Committee hat on, we have just launched a call for ideas on that, which closes in just under two hours’ time. We will be doing a major prevention inquiry, and there will be many workstreams in that inquiry, one of which will be sexual health, HIV and AIDS, and testing. This is a prevention issue—prevention of ill health, unnecessary suffering, and unnecessary cost the health service and therefore the taxpayer. The sector is responding to our call for ideas, and we will be getting that work under way and talking to the chief medical officer when we come back after half-term recess.

The opportunity to eliminate new cases of a long-term condition is very rare. We have the ambition to do it, but more than that, we have the tools to do it. We have to grab this opportunity; we would be missing the obligation upon us if we did not. I remain as optimistic as I was when the commission was put in front of me, four decades on from a subject I knew nothing about. I know a little bit about it now, and this is doable. We heard this afternoon from somebody who has shown what determination can do. We have the determination, I hope. Let us use the tools in the box and get this done. It is a great legacy that could sit on the Minister’s desk.

Photo of Peter Gibson Peter Gibson Conservative, Darlington 3:10, 8 February 2023

It is a pleasure to serve under your chairmanship, Mr Gray, and to follow my hon. Friend Steve Brine; I pay tribute to him for all his great work in this area. I congratulate my hon. Friend Maggie Throup on securing the debate. A good number of colleagues applied for the debate, including me, and I congratulate her on being the one to secure it and lead it so well. It seems appropriate in this debate to mention the late Robert Key, the former Member for Salisbury who passed away last week and who did so much work on this issue while a Member of this House.

I welcomed the Government’s commitment in 2019 to ending all new HIV transmissions in England by 2030. Normalising HIV testing is essential to meeting that target. I have done my test this week, and I am sharing the video and the means of obtaining a test on social media. While new HIV diagnoses have continued to fall, late diagnoses remain stubbornly high in England.

This February marks the 22nd anniversary of the death of a good friend of mine from AIDS. He sadly died from many AIDS-related complications, but I am confident that, had he been tested earlier and regularly, he would have been given the right medication and would still be alive today, causing the mischief and merriment that he always did. I remember him and others at times like this.

Last week, I had the privilege of hosting an event here in Parliament, along with the Terrence Higgins Trust, and it was a pleasure to welcome a number of colleagues who are here today. We met a young man, Oliver Brown, and Ollie is here in the Gallery today. Following a cycling accident, he went to hospital here in London, where opt-out testing for HIV was under way. Had the hospital not tested him for HIV when it took a blood sample, Ollie believes that, to this day, he may not have found out that he is HIV-positive. Thanks to that opt-out testing scheme, he is now getting the treatment he needs and can look forward to a normal, long life.

The Terrence Higgins Trust impressed upon us the huge and beneficial impact that further roll-out of opt-out HIV testing could have. Opt-out testing for HIV has already been rolled out in emergency departments in the areas with the highest HIV prevalence in England—namely, London, Brighton, Manchester and Blackpool. This testing has been introduced alongside opt-out testing for hepatitis B and C. Already, in the first 10 months, it has led to more than 1,500 people being diagnosed with HIV and hepatitis B and C, so it is clear that opt-out testing works.

I am, believe it or not, old enough to remember the famous “Don’t Die of Ignorance” campaign of the 1980s, for which we have Lord Fowler to thank; he led the way on raising this issue throughout his ministerial and parliamentary career. There are generations of people who do not remember that campaign, and still, 42% of people first diagnosed with HIV are diagnosed late. People diagnosed late with HIV in 2019 had a more than sevenfold increased risk of death within a year of diagnosis compared with those diagnosed promptly.

We are simply not doing enough if we are serious about meeting our 2030 target. As we heard from my hon. Friend the Member for Winchester, we have so many tools at our disposal to tackle HIV. I welcome that PrEP is available, but we need to do more to roll it out. It is estimated that there are still more than 4,000 people with undiagnosed HIV in England, so we need to be testing more. We also need to ensure that everyone diagnosed with HIV accesses care so that they, like Ollie, can live long and healthy lives.

While we take action on those fronts, we also need to tackle the enduring stigma that dogs people diagnosed with HIV. Only 38% of the British public know that someone with HIV on effective treatment cannot pass it on. Undetectable means untransmissible. We must spread that message hand in hand with testing to end new HIV transmissions.

Expanding opt-out testing has the potential to save the NHS more money than it costs and further reduce pressure on services. The Terrence Higgins Trust estimates that in the first 100 days of the roll-out of opt-out testing, which has so far cost £2.2 million, the NHS has saved between £6 million and £8 million in care costs as a result of initiating treatment earlier for those who need it. That is a conservative estimate of the savings. We can infer that expanding opt-out testing for HIV and other blood-borne viruses nationwide would save the NHS even more in care costs.

Those savings come from the reduction in care that hospitals need to provide newly diagnosed patients as a result of detecting HIV sooner. When Croydon University Hospital first started opt-out testing, the average hospital stay for a newly diagnosed HIV patient was 34.9 days. After two years of opt-out HIV testing, the average stay has reduced to a mere 2.4 days. We can save the NHS money, reduce transmission further and ensure that those who need it get the treatment they need. In essence, opt-out testing delivers a win-win-win scenario.

National HIV Testing Week is all about promoting regular testing. It is disappointing that we have not yet managed to recover to pre-pandemic levels of testing. I hope the Minister will confirm that the Government will keep a laser-like focus on this issue so we can continue to normalise regular testing across the most at-risk communities. The Government’s HIV action plan is hugely welcome, but we must go further. I urge the Minister to recognise the huge benefits of opt-out testing and do all he can to ensure we to roll it out to the whole nation.

“Test, test, test” must be our mantra if we are to reach our goal in 2030. I know the Government will have the support of everyone in this House in achieving that aim. I know the Minister will have heard the Prime Minister at Prime Minister’s questions, and I believe he will be pushing at an open door to secure the necessary funding.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health and Social Care) 3:17, 8 February 2023

As always, Mr Gray, it is a pleasure to serve under your chairmanship. I thank Maggie Throup for securing this important debate and for the detailed way she set out the issue—I do not think anyone could or would want to argue with her. She is a bit of a poacher turned gamekeeper, as a former public health Minister. In her and the new Chair of the Health and Social Care Committee, Steve Brine, we have two people who have been directly involved in formulating policy on stopping HIV transmission. I thank them and the current Minister for the work they do.

Like the hon. Member for Erewash, I want to refer to the new and outgoing chief executives at the Terrence Higgins Trust. Ian Green has led the organisation superbly, and its campaigns over many years have won successes from Governments. I look forward to working with my good friend Richard Angell, who will be superb in that job. I wish him and the whole team at the Terrence Higgins Trust the best for the future. I also thank Mark Lewis, who does so much work to facilitate the APPG. Those roles often go unthanked, but he puts so much time and effort into the group.

As has been mentioned, last year marked the 50th anniversary of the death of Terry Higgins, one of the first people in the UK to die of an AIDS-related illness. In those 50 years, we have come an awfully long way. Since Terry lost his life, we have seen major advancements in HIV treatment and testing, and in tackling bigotry, ignorance and misinformation. I acknowledge that those wins have only happened because of the tireless work of campaigners and researchers. The achievements of the last 50 years have been theirs, and when we do end all new HIV transmissions in this country, that victory will be theirs too. It is important to acknowledge that.

I thank the hon. Members for Strangford (Jim Shannon), for Winchester and for Darlington (Peter Gibson) for the way that they set out their arguments. I particularly thank the hon. Member for Darlington, who gave a very personal account, both here and at Prime Minister’s Question Time, about the loss of his dear friend. There are so many people who, like his friend, have died—probably needlessly—a very early death because of the failure to identify an HIV transmission before it was too late. The drugs have moved on massively. If we identify HIV, we can tackle it, get the viral load down and get the CD4 count back to normal levels, and that person can live a healthy and near-normal lifespan. That is a testament to the drugs that have been developed.

As the name suggests, this week is all about testing, which is a vital tool in our fight against HIV. Labour is proud to support the “I test” campaign, which sits alongside National HIV Testing Week. People can live with HIV for a long time without displaying symptoms—an estimated 4,400 people are currently living with undiagnosed HIV—so encouraging regular testing is essential to ending new cases.

Along with a number of other Members, I went to the national HIV testing drop-in yesterday and collected a free HIV self-test. They are being distributed this week and, after either a finger prick or an oral swab, they show the result within 15 minutes. That is transformational. Anyone listening to this debate can log on to and get their test. If the last three years have taught us anything, it is that getting to grips with at-home testing is surprisingly easy. If anyone has not tested, please sign up online.

Twenty per cent. fewer people were tested for HIV in 2021 than in 2019. That is having a knock-on effect on treatment and diagnosis. It is important that we do everything we can to drive up testing rates, which is why campaigns such as “I test” are so essential. Access to free at-home testing from a central source is only available during National HIV Testing Week; for the rest of the year, access can generously be described as patchy. Will the Minister set out the steps the Government are taking to improve testing rates? How can we get tests into communities with low take-up? Given the success of opt-out testing in areas of high prevalence, I would be interested in the Minister’s comments on the current scope of that testing and whether there are plans to broaden it.

Beyond testing, there is still a huge amount of work to do in tackling HIV. During a debate on World AIDS Day, I spoke about access to PrEP. Around 40% of people surveyed struggle to access PrEP, and there are huge issues with the resourcing of sexual health clinics. Unfortunately, the PrEP action plan still has not been published, despite being promised in 2021. From a recent response to a written parliamentary question, I understand that the Government still intend to publish the plan. That is all fine and well, but the HIV action plan covers 2022 to 2025, and we have already had a year of it without a proper PrEP-specific plan. We cannot afford another year without one. Will the Minister set out a timeline today? Do the Government plan to publish the PrEP action plan prior to the summer recess?

Last week, the Government announced its major diseases strategy, but there has been little or no clarity on what that means for the sexual and reproductive health action plan, also long promised by the Government. Recently, the Minister for mental health and women’s health strategy, Maria Caulfield, said that the Government were “considering the need” for that plan. Will the Minister update us on those considerations? We know that sexual health services have faced extreme pressure thanks to the mpox outbreak, and that the capacity to deliver vital services has been compromised. Given that situation, it is really not acceptable that strategies are being promised and then apparently disappearing into the ether.

On World AIDS Day last year, the Labour party committed to scrapping the outdated barrier that prevents people with HIV from accessing fertility treatment. This is really important. Is the Minister able to confirm today that the Government will match that pledge? If not, why not? We have come an awful long way, but there are still legislative barriers in place that are based on misinformation, outdated information and scientific ignorance. We in this place must remedy that.

I have no doubt that the Minister wants to see increased testing and wants the UK to reach the historic milestone of no new cases of HIV. We support him in that and will do all we can to support the Government in meeting that aim, but that shared goal requires action now. HIV is treatable. It is detectable. New transmissions can be stopped. I invite the Minister, during National HIV Testing Week, to redouble his Government’s efforts on HIV transmission, and to work towards a future where HIV is finally defeated. To take the foot off the pedal now, as we are right on the cusp of achieving something truly extraordinary, would be a profound tragedy. We support the Minister in keeping the foot on the pedal and ending all transmissions of HIV in this country.

Photo of Neil O'Brien Neil O'Brien The Parliamentary Under-Secretary for Health and Social Care 3:28, 8 February 2023

I thank Members from throughout the House for taking part in this hugely important debate and congratulate my hon. Friend Maggie Throup on securing it. We heard excellent speeches from the hon. Member for Strangford (Jim Shannon) and my hon. Friend Steve Brine; we heard a very moving contribution from my hon. Friend Peter Gibson, who spoke about his friend; and we heard an important question from Andy Slaughter.

Throughout National HIV Testing Week, we are raising awareness of the importance of testing as part of HIV prevention. I thank the Members who took part in the HIV point-of-care test in Portcullis House yesterday, delivered by the Terrence Higgins Trust. I join others in paying tribute to Ian Green for his work on this subject.

Our campaign aims to address barriers and normalise HIV testing, and to remove stigma by empowering and encouraging more people to know their HIV status. As many Members have said, people can live with HIV for a long time without any symptoms. Testing is the only way for people to know their HIV status. This is one of the cornerstones of our HIV action plan, published in 2021, which includes the strong commitment to end new HIV transmissions by 2030 in England.

The first HIV action plan monitoring and evaluation framework, which was published by UKHSA in December, shows that there is much to celebrate in the collective progress we have all made, with extremely high levels of antiretroviral therapy coverage and viral suppression. Still, as a number of Members have mentioned, there are an estimated 4,000 people living with undiagnosed HIV. For those paying attention to this debate and listening elsewhere, testing for HIV is quick, free, confidential and easy. It is fundamental to finding and diagnosing the population of people who currently do not know their status in order to protect their health, and for efforts to stop HIV being passed on. The vast majority of people get the virus from someone who is not aware that they have it.

As my hon. Friend the Member for Winchester said, what it means to live with HIV has transformed over the past four decades, from a terminal diagnosis to a manageable long-term condition, thanks to huge medical improvements in treating the virus. As part of our plan, we are investing £3.5 million in the HIV prevention England programme between 2021 and 2024, through which we are delivering National HIV Testing Week. Last year’s results were promising: 30% of the almost 25,000 users who ordered a 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 form of preventive action as a result of seeing the campaign.

What is more, throughout National HIV Testing Week, for the very first time, free HIV home tests with a result in just 15 minutes are available England-wide. As my hon. Friend the Member for Erewash said, this is completely transformative technology—something we are now very familiar with because of the covid epidemic. The test works in a very similar way to a covid-19 lateral flow test, but uses a few drops of blood from a small prick of a finger. Alongside self-tests, there is also an option for people across England to order a test that is then sent to a lab and screened for both HIV and syphilis.

The success of National HIV Testing Week is the result of close and collaborative working between key partners in and beyond Government, and I take this opportunity to thank them for their invaluable work. That, of course, includes the HIV prevention England team at the Terrence Higgins Trust, which delivers National HIV Testing Week on behalf of my Department.

Our local authorities and regional directors throughout the country are co-ordinating placed-based and regional activities to further promote National HIV Testing Week, using posters, digital imagery and other creative resources, as well as their own local projects and initiatives on HIV testing and prevention. Community and voluntary organisations have a key role in engaging their local populations and will also be providing testing and information in their local area as part of National HIV Testing Week. I take this opportunity to thank them for their vital role in helping us to end new HIV transmissions.

We know that more still needs to be done to achieve our bold ambitions. As part of our HIV action plan and to improve testing, NHS England has made a £20 million investment in opt-out HIV testing in emergency departments in areas of extremely high HIV prevalence to ensure that people get the right treatment as early as possible. A number of Members asked questions about this. Opt-out testing is a proven and effective way to identify new HIV cases, as it promotes testing on the admission to hospital of anyone who has not previously been diagnosed with HIV, therefore helping to rapidly identify the virus. Thirty-three A&E departments are now live, delivering this important initiative. We have backed this measure with funding to provide hepatitis B and C testing as well, partnering with NHS England’s hepatitis C elimination programme.

We are working closely with the NHS to understand the progress, challenges, results and learning from the initiative. I am taking a personal interest in it and the results that are starting to emerge, and have been considering the emerging evidence, which is extremely interesting and exciting in lots of ways. We will consider the evidence from the first year of opt-out testing alongside the data on progress towards our ambitions, to decide whether to further expand the programme.

Photo of Andrew Slaughter Andrew Slaughter Shadow Solicitor General

It is right that we are talking about testing and recommitting to targets, but this is part of a strategy on prevention. I will put to the Minister the same point as I put to the Chair of the Health and Social Care Committee, Steve Brine. I am sure the Minister has seen the briefing from the National AIDS Trust and the Terrence Higgins Trust on the fact that sexual health services were displaced by mpox, principally. About a quarter to a third of the routine work that they do, including testing and the prescription of PrEP, has gone and has not recovered a year on. What are the Government doing to ensure that clinics have the resources to do that?

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

I was going to address that point later in my speech but will do so directly. We are conscious of the challenges thrown up, particularly in some areas, by the huge volume of extra work caused by monkeypox. We have provided additional resources to the places that were challenged by monkeypox, but I am conscious that it has slowed down some of the progress we wanted to make.

To finish my point about opt-out testing, which a number of Members asked about, the reason for starting in the areas with the very highest prevalence was that there was a better opportunity to save more lives for a given investment. That is why we started in those areas rather than the low-prevalence areas. There is a point of balance in respect of how far we extend that out from the areas of the very highest prevalence, which is what the evidence we are gathering will help us to decide.

Photo of Peter Gibson Peter Gibson Conservative, Darlington

I am grateful for the Minister’s comments about opt-out testing in high-prevalence areas. Will he write to me and others who have attended the debate about what considerations the Department has given to tracking people who have lived in high-prevalence areas but no longer live in them? They may have been exposed to similar risks that make those areas high prevalence, but they no longer live in them.

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

That is an interesting question. I hope we can do better than that, because we will be sharing evidence as it emerges to help other areas of the country to make the case for implementing the same approach. My hon. Friend raises one new way of thinking about it, which we will consider. We will share evidence as it emerges, because there is a huge amount of interest in this extremely exciting new approach.

National HIV Testing Week gives us the chance to raise awareness of the importance of testing and of the powerful role that each of us has to play in ending HIV by knowing our own HIV status. It is also an excellent reminder of the need for a sustained, collective effort to achieve our shared ambitions and end new transmissions and deaths within England by 2030. Together, we can be the generation that beats HIV. Before I sit down, I should answer the question asked by Andrew Gwynne: the PrEP action plan will be published before summer recess.

Photo of Maggie Throup Maggie Throup Conservative, Erewash 3:37, 8 February 2023

I appreciate the opportunity to wind up the debate, which has been productive and knowledgeable. I thank Members from across the House for their contributions.

My hon. Friend Steve Brine brought to the debate a great deal of knowledge and expertise, which he has gathered over a number of years. To use the words of the Opposition spokesman, Andrew Gwynne, the fact that two poachers turned gamekeepers are present shows just how important the issue is.

My hon. Friend Peter Gibson spoke so gently about his friend who sadly lost his life due to complications of HIV/AIDS. It is for those people that we need to get it right now and eliminate HIV by 2030.

Jim Shannon brought an international element to the debate when he spoke about the work that people local to him are carrying out in Africa. We must never forget that even though we are making great strides in the UK, other countries are quite a long way behind us.

I respect the Minister deeply and am really pleased that he has committed to continue his personal interest in this topic, but I do not think I heard from him that we will be rolling out to areas of high prevalence the opt-out testing that has been carried out in areas of very high prevalence. I am disappointed in that, because the boroughs across London have already done the work for the Department. The funding was just for the boroughs with very high prevalence, but London as a whole decided to roll it out across all the boroughs, partly because people move between them. There has been take-up of the testing and cases are being found in areas of London that were perceived to be just areas of high prevalence. I would appreciate it if the Minister could follow up on that to ensure that we speed up the roll-out to the high-prevalence areas. We should not wait too long, or we will find that more people—such as the friend of my hon. Friend the Member for Darlington—lose their lives.

We have in our grasp the opportunity to eliminate what has been a killer disease. We cannot let that opportunity slip through the net, so we must all do whatever we can to make that happen and make sure that opt-out testing is there, wherever we are in the UK.

Question put and agreed to.


That this House
has considered National HIV Testing Week 2023.

Sitting suspended.