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Volume 505: debated on Wednesday 3 February 2010

I am grateful for the opportunity to raise the issue of HIV/AIDS in this Adjournment debate. I have discussed these matters frequently with my hon. Friend the Minister in her present role in the Department of Health and in her previous role in the Department for International Development. As chairman of the all-party AIDS group, I have dealt with the significance of the disease overseas and also in the UK.

I wish to concentrate this morning on HIV/AIDS in the UK, and to focus initially on the problems of late diagnosis of HIV status. It is estimated that 27,000 people in the UK are HIV-positive but have not yet been diagnosed as such. Of the 7,000 diagnoses that are done in most years, more than half are classed as late diagnoses, by which we mean that the CD4 count has dropped below 350, which is taken by the British HIV Association as the measure of a late diagnosis.

The significance of late diagnosis and the fact that 27,000 people have not been diagnosed is, first, that when they are eventually diagnosed and get treatment, the treatment is likely to be less successful because their CD4 count has dropped below 350. Secondly, the fact that they have not been diagnosed means that they are likely to continue to engage in the risky behaviour that resulted in their HIV status in the first place. If they are diagnosed, the chances of their changing that risky behaviour will improve. Also, when people go on antiretroviral treatment, the drugs reduce their infectivity, so even if they continue to engage in risky behaviour, the likelihood of their transmitting the disease to somebody else is vastly reduced.

If we could reduce the number of people in the UK who are HIV-positive and do not know it, and end the situation in which more than half the people who are diagnosed are diagnosed with CD4 counts below 350, we would have an opportunity to do something significant in reducing the number of new cases and infections. That is where I am coming from in this discussion.

I know that the Department of Health is working on this matter, and I welcome the work that it is doing. During the Labour party conference in Brighton last year, I visited a pilot that the Department is running there. I visited a general practitioner surgery that was preparing to offer new patients the HIV test in a routine manner—it was not doing so then but should be by now. A similar scheme was operating in a hospital in Brighton—I have discussed this with a number of people—where people were being diagnosed HIV-positive as a result of being offered the opportunity to be tested. The key is to increase the number of people who are tested.

At present, we have a system for routinely offering pregnant women an HIV test, and take-up of that is generally reaching the targets, but I was told about a situation in my region, in Liverpool, where the figures were much lower than in the rest of the north-west. When that was investigated, it emerged that when the medical practitioners in the hospital offered pregnant women the opportunity of a test, they would often say, “It is only if you sleep around that you need the test.” The way in which people were given the opportunity to be tested was changed, and the figures in Liverpool rose. There is a great deal of work to be done.

I would like the Department to focus on this issue in a major way, and perhaps set a target to halve the number of undiagnosed individuals in the UK, which is now 27,000. In London, the NHS has done a great deal of work, setting and focusing on targets to try to reduce the number of undiagnosed infections.

Work needs to be done in a targeted way; there is no simple solution. What one does for men who have sex with men is very different from how one would work with the African community. That raises a broader issue in relation to sexual health services. I remember visiting the local genito-urinary medicine clinic in Preston a few years ago and being told that one had to wait more than a month to get an appointment. When I went back 18 months later, it had a daily drop-in clinic, and I believe that that was a result of NHS targets. Targets can work and make a difference.

In my part of Lancashire, which is a low-prevalence area, there is only the one GUM clinic. It is the centre for people who want to be tested, but it serves a large area from Preston down to Skelmersdale and Ormskirk. Further developments are required, and I know that the matter is being discussed locally. We need to focus on areas with high prevalence, which obviously explains what is being done in Brighton, but we must recognise the need to work in low-prevalence areas as well.

We should also acknowledge that for the many people who are HIV-positive, receiving treatment and living successful lives, the primary contact for health services should be their GP. That has not traditionally been the case for many HIV-positive people, so some work needs to be done there as well.

We need to make it easier to be tested. At present, it is illegal in the UK to do home testing. In the same way that there are home-testing kits for pregnancy, there are home-testing kits for HIV. One can order them illegally on the internet.

I remember visiting a coal mine in Johannesburg where the aim of the owners of the mine was to get every member of staff tested every year, on a voluntary basis. That was the target. Testing was done not by taking a blood sample but simply by taking a mouth swab. Within a short time, one could tell with the mouth swab whether someone was HIV-positive. The test is not as accurate as a blood test, but it is a quick and easy way of doing it, and people can then be tested by taking a blood sample at a later stage.

If we could legalise a good home-testing kit, it would be much easier for many individuals to get tested on a regular basis, and it would go some way towards reducing the number of people—27,000—who are undiagnosed but HIV-positive. I hope that the Minister will look favourably on that point.

I congratulate the hon. Gentleman on his consistent, caring and effective work on HIV/AIDS over many years. Will he explain whether the testing kit would flag up the need for those who had a positive result to get a full and proper test because it would not be definitive in itself? Will he explain why such kits are not legal so that we can understand him better?

Twenty years ago, if someone tested positive for HIV, the odds are that that would have been a death sentence. Therefore, pre-test and post-test counselling was regarded as important. Much less counselling is needed now because in most cases if people test HIV-positive, particularly if they are tested early when their CD4 count is above 350, the odds are that they can be put on antiretroviral treatments fairly quickly, that they can live ordinary, active lives and keep their jobs going, and that the trauma will not be as great as it would have been 20 years ago. HIV and AIDS are now regarded as chronic conditions rather than as a death sentence, which has changed the dynamic somewhat. However, if people assume that they do not need to bother about the risk of becoming HIV-positive because they can take a pill and they will be all right, which is not 100 per cent. correct, that is a slight difficulty.

I want to talk at some length about the stigma, which makes it more difficult for people who are HIV-positive to get access to services. Initially, the focus should be on general practitioner services. More than half of people who are HIV-positive have not told their GP about their status: they get their HIV drugs from a clinic, but their GP does not know about their condition. Given that ever more people are living with HIV and getting older, and getting the diseases and conditions of maturity, there is a problem: if they are on medication for HIV and taking medication for other things, those may not work smoothly together. It is important that the GP is informed and knows about the condition of their patient.

Many HIV-positive people are concerned about confidentiality. There are examples of GPs’ receptionists passing on information and of files for HIV-positive patients being coloured in a particular way. In areas such as mine, which is semi-rural, it would be fairly clear if things were not done discreetly in respect of a handful of HIV-positive patients in a practice. The NHS needs to tackle that issue at GP level, because people should be able to be tested at their local general practice, as I have seen taking place in Brighton. That should become much more commonplace. We should be looking to develop more skills within general practice.

Another thing is common in the NHS. I attended a meeting with the Minister and the Secretary of State with a young man who had been refused access to dental treatment on the basis of his HIV status. I sometimes think that dentists have not really caught up with the changes that have taken place in the past 20 years. It is not uncommon for people to be denied dental treatment or to be told that they must be the last patient of the day because the dentist needs to take special precautions, which is not the case.

I recently received a letter from an individual who complained that although he needed a muscle biopsy medical staff told him they could not take the sample because they did not have the facilities to handle that safely. Again, that is nonsense. The NHS should be able to do that, but obviously there is a great deal of ignorance.

A report from UK People Living with HIV Stigma Index, which I discussed with the Secretary of State, shows that many HIV-positive people feel discriminated against, particularly in health services and more generally. That is not an issue of spite and nastiness, but is to do with ignorance. If a head teacher, out of ignorance, does not respect the confidentiality of a child who is HIV-positive and whose mother has taken them to see the head teacher to explain the need for their treatment and so on, and the parents of the other children subsequently demand that that child is removed from the school, that happens out of fear and ignorance not out of spite towards that child. We need to begin to tackle such issues.

The George House Trust, which is an HIV charity in Manchester—in my area— offered a positive speakers training programme on HIV. It found, when training NHS staff, that fewer than half of the health professionals interviewed were able to identify correctly the routes for HIV transmission from a list of routes shown to them. I spoke to a former nurse who worked at an NHS hospital in the north-west, who was diagnosed as HIV-positive and had some difficulty coming to terms with that. In a short space of time his employment at the hospital was ended because he was made to feel so uncomfortable by the staff whom he had worked with. He currently receives treatment at another hospital some distance away. A lot of the problems are down to the fact that there is still a great deal of ignorance on the part of NHS staff. One would expect that people working in the health service would have the best knowledge, but that is not so at the moment.

I have some data from MORI, which did some polling in 2000 and 2007. In 2000, 91 per cent. of people knew that HIV could be transmitted during sex between a man and a woman without a condom, but by 2007 that was down to 79 per cent. In 2000, 77 per cent. of people agreed that people with HIV deserve the same level of support and respect as someone with cancer. That figure had dropped to 70 per cent. by 2007.

There is growing ignorance about HIV among the general population. In the past, and currently, the Department has focused HIV prevention work on the groups that are most at risk: intravenous drug users, people with an African connection and men who have sex with men. That is good in the sense that it reduces the risk of people becoming infected. However, to tackle stigma, there needs to be a reasonable level of knowledge and understanding among the general population about the disease and how it can be transmitted. That will affect how HIV-positive individuals are dealt with and will lead to HIV-positive people finding it easier in the workplace and easier to deal with health services—and it will make them less fearful of being tested in the first place, which is a problem.

I ask my hon. Friend the Minister for better training for NHS staff and third sector services. People living with HIV need to be involved in the development of that training, because often they are excluded from this area. The Department needs to work with professional bodies to educate those already employed in the NHS and needs to consider working with qualification bodies to integrate HIV awareness into the medical student curriculum.

There needs to be zero tolerance of any breach of confidentiality, because having spoken to a number of people living with HIV I know that such breaches, or the thought that there could be a breach, stops them telling their GP that they are HIV-positive. Their GP needs a full picture of their medical condition to give them the best treatment and to be the main support.

It is nearly 11.20 am, which is when I intended to finish my speech, so I shall now sit down and listen to the response from my hon. Friend the Minister.

I congratulate my hon. Friend the Member for South Ribble (Mr. Borrow) on securing this debate on a matter that he champions as chair of the all-party group on AIDS, a role to which he brings a sound knowledge and persistence that I and many others inside and outside the House welcome. The debate is timely, because tomorrow I shall host a conference on sexual health. Reducing HIV infections must remain at the forefront of our minds and actions as we start to develop a new sexual health strategy to take us forward in the next 10 years.

We face a number of challenges, which my hon. Friend set out well. We must remember that the prognosis for a person in the United Kingdom who is diagnosed with HIV today is a world away from what it was in the 1980s, when it was a killer with no treatment available and no hope. With the development of highly effective treatment, HIV is now a condition, albeit a chronic one, that can be managed with medication and regular monitoring. However, we are not complacent, and we are still some way from a cure, so prevention remains the most important and effective weapon for tackling HIV.

The difficulty is that although treatment has improved and the death rate is lower, which is welcome, some people have let their guard slip, as my hon. Friend said, when it comes to protecting themselves from HIV. It has not gone away. Treatment is lifelong, gruelling and complex, and people must take precautions to protect themselves and their partners from infection. My hon. Friend made a good point when he said that late diagnosis is the biggest contributor to mortality, but the condition is preventable.

The UK has a good track record of preventing HIV infection, but we want to do even better. Our prevalence rates are comparatively low by European standards, and much lower than in Spain, Italy, France and Portugal. A quarter of those living with HIV in this country are undiagnosed. Figures from the United States suggest that more than half of infections are transmitted by people who do not realise that they are HIV-positive. That is why the Government’s fight to increase detection and reduce transmission of HIV continues. We have increased investment over the past 10 years in national HIV programmes run by the Terence Higgins Trust and the African HIV Policy Network. We are pushing the boundaries by funding eight pilot programmes in HIV hot spots to see how we can normalise testing in places such as GP surgeries, hospitals and community health settings, instead of just in sexual specialist health clinics. I was pleased to hear that my hon. Friend had visited the pilot in Brighton.

My hon. Friend referred to self-testing, and I understand why. I hope that he will welcome the fact that the pilot in Sheffield involved home sampling. We focused on tests being carried out by people in the privacy of their own homes, with diagnosis by experts. That is legal, and takes advantage of the available technologies, but the difficulty is that technology does not at present provide a decent quality test, and we know the consequences of a misleading test. I am optimistic about that pilot and look forward to such a test. I will share the results of the pilot with my hon. Friend.

Our progress is backed by nationwide changes in policy and medical practice. The decision in 1999 to start recommending HIV tests to pregnant women prompted a dramatic fall in the proportion of those giving birth to HIV-positive babies. HIV tests are now standard for sexual health screening, so the proportion of those who voluntarily take such a test in genito-urinary medicine clinics rose from 77 per cent. in 2004 to 93 per cent. in 2008. That shows the benefits to which my hon. Friend referred.

I share the view that the biggest enemy of progress is stigma. HIV still has the power to define someone in a way that other illnesses do not. Too many people with HIV still experience shame and isolation because of the diagnosis, which may manifest itself in discrimination in the workplace, the community and, as was said today, even health services. It is hardly surprising that many people are extremely wary of being tested, and may react with shock or hostility if a GP or nurse suggests an HIV test.

I agree that if we want to increase testing and reduce the number of undiagnosed cases even further, we must demolish stigma and discrimination. That is one of the five goals set out in our national strategy for sexual health, which funded voluntary organisations to produce information for journalists, employers, health professionals and people with HIV. Much of the stigma surrounding HIV cannot be separated from homophobia, and we are acting to root out discrimination and prejudice against the gay, lesbian and transsexual communities. We should not forget that this Government equalised the age of consent, repealed section 28, and passed the Gender Recognition Act 2004 and the Civil Partnership Act 2004. Those are landmark achievements that have changed people’s lives by giving them respect, dignity and equality on the basis of who people are, not what they are labelled as.

My hon. Friend referred to his concern about denial of treatment and the way in which treatment is given by some health professionals. People should not be denied treatment by dentists because they are HIV-positive. It is not a bar to access to the full range of NHS health care. People with HIV should be treated the same as everyone else and in the best clinically appropriate way. I assure my hon. Friend that we are raising awareness among the health community, because we know that doctors, nurses and community health teams are important in offering and encouraging more people to take HIV tests, as well as in delivering services.

Does my hon. Friend agree that because GPs and dentists operate as private businesses and are not employed directly by the NHS, the difficulty is that individual dentists and GPs are doing their own thing? It is not as easy to pull levers to tackle such issues as it would be with doctors and nurses working in hospitals or local clinics run by the NHS.

I note that point; it is extremely useful to work with professional bodies. For example, British Dental Association guidelines say that dental practices should treat everyone the same, and that good cross-infection control applies to all of us. Our work with such bodies has been helpful, and we will continue it. The chief medical officer wrote to several royal medical colleges and faculties to highlight the role of all health care professionals in offering HIV tests, but perhaps we could go further in getting them even more on board.

Advances in treatment may have turned HIV from a killer virus to a chronic illness, but we must maintain our vigilance, and do everything possible to reduce transmission. We must encourage safer sex among the general population, which is what our new campaign, “Sex: Worth Talking About”, is all about. We must also tackle the stigma and discrimination surrounding HIV. That is vital if we want more people to come forward for testing and treatment.

I am proud to say in the Chamber that our record on HIV and AIDS over the past 12 years has made a difference, but I am deeply conscious that a lot remains to be done. I am keen to work with my hon. Friend, the all-party group and the entire sexual health community to move forward in the years ahead on something that affects us all.

Sitting suspended.