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Volume 519: debated on Wednesday 1 December 2010

That might be the best cheer I get all day. I welcome you to the Chair, Mr Leigh. It is a pleasure to serve under your chairmanship in this important debate. I also thank Mr Speaker for allowing this debate on HIV services in the UK to take place on world AIDS day. I have been in Parliament for nine years, but I am still ignorant about how debates are selected—whether there is a lottery or whether Mr Speaker has a say in the matter. If he does, I thank him; if it was a lottery, I thank the Fates for timetabling this debate on 1 December.

I begin with a point of clarification. This is not for the benefit of hon. Members present in the Chamber, as they are well aware of the procedures of this place, but for those who are watching the debate on television or the internet, and those who will read the account of the debate in days to come. This debate will focus mainly on HIV in the UK, but that is not because we think that HIV outside the UK is not a problem, or because we are unaware of the scale of HIV in the developing world.

Africa has 10% of the world’s population but 72% of the deaths from AIDS, and we are aware of that. However, parliamentary procedure means that different Departments respond to the debates on different days, and today it is the turn of the Department of Health, not the Department for International Development. Therefore, although an enormous number of points could be raised about the global AIDS epidemic, I will in the main restrict my comments to HIV in the UK. With your indulgence, Mr Leigh, I might also sneak in a few comments about the international scene; I alerted the Minister about that in advance.

If colleagues are anxious to hear about the international aspects of the HIV epidemic, I should say that a world AIDS day reception will be held this evening at 7 pm in the Commonwealth Parliamentary Association Room. You are invited, Mr Leigh, as are all hon. Members, friends and colleagues.

My hon. Friend is performing a service by raising the issue of HIV/AIDS in the UK. Does he also recognise that many people, both inside and outside the country, want to know what the UK Government intend to do about the future funding of the Global Fund to Fight AIDS, Tuberculosis and Malaria? That body has an excellent record in getting drugs to people with TB, malaria and particularly AIDS, many of whom are still in desperate need.

I am grateful to my hon. Friend, who was a distinguished and long-serving Minister at DFID. In a sense, it is a false dichotomy to say that there is an AIDS epidemic in the UK and an AIDS epidemic in Africa and never the twain shall meet. One of the largest at-risk populations in the UK is the African community––people who come from Africa and are HIV positive, or those who contract the disease in the UK within the African community. I will speak about that in a moment.

My hon. Friend is correct to highlight the need to address the problem of the AIDS epidemic in Africa. Over the past few years, one of the most effective ways of doing that has been through the Global Fund to Fight AIDS, Tuberculosis and Malaria. The last Government had a good record in ensuring that the global fund was initiated, then adequately resourced. During the most recent meeting of the fund in October, high, medium and low targets were set for the level of replenishment. Unfortunately, the global community failed to hit the low target, let alone the medium or high targets.

I understand why the Government do not come forward and state the exact figures for the replenishment of the fund. Through DFID, they are conducting a multilateral aid review, and until they decide their priorities, they cannot say how much will be made available for the global fund. Until we can provide a figure, I encourage Ministers to let the world know, at least with rhetoric, that we remain committed to the global fund.

Much of the world looks to the UK for an international lead in tackling AIDS, and other countries will be looking to our figures for the replenishment of the global fund before making their commitments. The Government have an excellent opportunity to set a global lead. I was going to make those points about the international community at the end of my speech, but I have made them now.

Let me return to matters for which the Minister is responsible—she will be pleased to hear that—rather than the rest of the world. I will make three points about how we should respond to the ongoing HIV epidemic in the UK and our public policy; priorities. First, I will speak a little about prevention, secondly I will discuss testing and treatment; and thirdly, I will say something about care and support. Those three things do not exist in isolation; they are not, to use fabled management-speak, in “silos.” One point leads into another, but for the purposes of the debate I will say a little about each issue in turn.

The backdrop to this debate is not only the ongoing financial constraints under which all Governments around the world are operating, but the NHS reconstruction and reconfiguration that the Government have embarked on, as well as the messages contained in the public health White Paper, launched yesterday by the Secretary of State. Because the national health service is undergoing a process of change and transition, there is some uncertainty. Until we get answers to some of the questions that we raise, that uncertainty will continue.

As I pointed out in the main Chamber this afternoon, although the Minister’s responsibility on such matters is constrained to the NHS in England, the HIV virus does not respect geographical borders. It is incredibly important for the Government to work closely with the devolved Administrations in Edinburgh, Cardiff and Belfast to ensure a coherent, joined-up approach. That is the only way to tackle the virus in a way that will see a reduction in the number of people affected and reverse the rate of increase in new cases of the disease. Therefore, although I am addressing the NHS in England, the message must be heard by those who configure the NHS in the devolved Administrations. I was pleased to hear that the Secretary of State for Scotland will meet the Minister responsible for health in Scotland tomorrow, and will put that important issue on the agenda.

The first issue that I mentioned was prevention. In the early days of the epidemic, not much was known about the virus. There were no drugs and no effective treatment. Messaging was, by necessity, extensive and untargeted. Those of us old enough will remember the adverts with the collapsing tombstones and the gravelly voice telling us about the new virus—AIDS—and how dangerous it was. We remember the posters and the radio adverts, which were essentially blanket advertising for the whole UK. People debate the relative impact of those messages, but we remember that campaign many years after it happened, so it did have some impact.

The situation of those who have HIV in the UK today means that that type of mass media advertising is not perhaps the best way of getting a message to those most at risk. That point was made in the foreword to the “Halve It” document, by Lord Fowler, about which I will speak shortly. Lord Fowler was a distinguished former Secretary of State for Health and Social Security, and he is remembered very fondly by people who work on behalf of and alongside those with HIV and AIDS for the forward-looking approach that he took. As he acknowledges, such mass communication messages are no longer relevant, and the campaign must be more targeted.

Will the Minister tell us whether the Government’s strategies on sexual health and HIV propose to target messages on specific, at-risk communities, and particularly but not exclusively on younger gay men, for whom some of the safe sex messages may have been lost in time, and the African community? Those communities are not mutually exclusive, of course, but the messaging to each will have to be different. Particularly now that more heterosexual people are contracting the virus, many of whom are in the African community, there is a pressing need to develop messaging that speaks to that community and to its values and structures, whether through Church or faith networks or whatever, so that we can overcome some of the ignorance and stigma in the black African community in this country. I would be grateful for the Minister’s comments on what she proposes to do about that.

Does the hon. Gentleman accept that, in addition, white heterosexual people who perhaps have got divorced recently, after having had a monogamous relationship for many years, are now going out into the world of single dating and getting into a mess because they do not realise that HIV/AIDS is out there in the heterosexual community? Is that not an expanding area that we should also be targeting?

The hon. Lady is right. I was saying that the messaging should not go exclusively to gay men and to people in the African community. There must be a message for everyone, but the messaging needs to be differentiated. There will need to be different messages to different people, within relative constraints. I hope that the Minister will deal with her point.

There is concern. I am of the generation that came to maturity at the time when the AIDS epidemic—well, I might not have come to maturity yet; it is probably up for debate whether I have reached maturity.

Yes, I am doing myself down here. I am of the generation that came to adulthood when the virus was making its first big impact, so those messages really stayed with me. I wonder whether that is the same today, particularly, although not exclusively, for young gay men of 17, 18 or 19. We cannot be squeamish about this issue. We must speak a language that they hear and will listen and respond to. I do not expect the Minister necessarily to go into that in detail today, but I want an assurance from her in that regard. I know, particularly given her former career, that she is not squeamish about these things, and we cannot be squeamish when people’s lives are at stake.

Of course, one way to prevent the spread of the virus is to ensure that everyone who is HIV-positive knows that they are HIV-positive—knows their status—and is receiving the correct drug treatment. It is not widely appreciated that when someone who is HIV-positive is on the correct level of antiretroviral drug treatment, they become significantly less infectious. I had not appreciated that—I must confess that that was ignorance on my part—until fairly recently. It means that treatment for one person is prevention for another.

When an individual is on ARVs and is less infectious, that helps to constrain the spread of the epidemic and when people know their HIV status, it alters their sexual practices. Most of the evidence and studies show that. The more people we can test and the more HIV-positive people who know their status and are receiving the right treatment, the more we will do to prevent the spread of the virus.

I have just had a baby and I was tested automatically for HIV during my pregnancy. Does the hon. Gentleman agree that extending such automatic testing could play a valuable role in identifying cases very early, so that people can receive the treatment that, as he said, will not only help them with their own medical needs, but prevent them from spreading the condition?

The hon. Lady makes an excellent point. I think that it was my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), when he was Secretary of State for Health, who introduced automatic testing in pregnancy. If we look at the graph, we see that the tail-off is quite astonishing: once opt-out testing was introduced for pregnant women, the numbers of babies being born HIV-positive plummeted.

Of course, the issue is not just about babies. Quite often when we are talking about the prevention of mother-to-child transmission, we focus on the baby, but a woman is involved as well. As the hon. Lady rightly says, if a woman’s own HIV-positive status has been diagnosed at the beginning of pregnancy, she can be put on the correct course of ARVs. That is why, in the northern world, mother-to-child transmission has been, if not completely eliminated, massively reduced— because not only ARVs but the correct education about breastfeeding are making an enormous difference. However, almost 500,000 babies born in Africa every year are HIV-positive. That is completely preventable—entirely avoidable. If pregnant women are tested and put on ARVs, they do not need to pass on the virus. It is one of the great scandals of our age that something that is solvable—we have solved it here—could be solved throughout the world with the correct financial support and the political will, but it has not been.

Is not one of the conclusions that can be drawn from the comments made by the hon. Member for Cardiff Central (Jenny Willott), as well as from my hon. Friend’s point about mother-to-child transmission, that we need to ensure that the Department of Health and DFID work closely together, so that the lessons of success in dealing with HIV in this country can be properly worked into our development policy abroad? Is it not therefore a concern that DFID’s HIV/AIDS team seems to have shrunk very small—if indeed any cadre of skills in this area is left in the Department at all?

I am grateful to my hon. Friend. He has far greater knowledge of these matters from within DFID than I have. If what he says is true, clearly it is a very worrying development. I was fortunate enough to meet some members of the HIV/AIDS team in DFID a few weeks ago. Whether or not the team is smaller than it used to be, it is certainly very committed. I also met some DFID workers when I was in Kenya a few months ago, and they are doing a tremendous job.

It is to the credit of the Government that they have protected the international development budget, but of course there will be reprioritising within that budget. Part of what we are doing as an all-party group is ensuring that these issues are not lost in the reprioritisation. This is what people find very frustrating about the international dimension of this issue. Enormous progress has been made and the tide is beginning to turn. If we withdrew funding or support or lost the political will at this stage, it would be a disaster and a tragedy, not least because in five years’ time we would have to return to the matter, because we could not let the number of deaths and new infections let rip, as we saw happen in the 1980s and 1990s.

Will the all-party group, as part of its thinking about the Government’s multilateral aid review, also consider funding for the new UN women’s agency? I ask that in the context of the comments from a previous UN Secretary-General, who said that AIDS in many parts of the developing world has an increasingly female face and that we need to ensure that we continue to champion efforts to tackle issues relating to gender equality—for many reasons, of course, but in particular to help with the fight against AIDS.

My hon. Friend makes an excellent point. The new agency has real potential to make a difference. We are all relieved that some of the world’s appalling, oppressive, anti-women regimes that were muscling in have been set to one side, which will allow the agency to focus on the issues that he mentioned.

A saying that we hear over and again now in Africa is that the face of the epidemic is female. That is not just because of mother-to-child transmissions, but because of the disempowerment of women and the limiting of women’s ability to make choices about their own sexual and reproductive health. Of course, that is not the case solely in Africa; it is the case elsewhere in the world as well. However, it is a particularly pressing problem in Africa and one that we must not lose sight of.

I was talking about the need to ensure that people who are HIV-positive know that they are HIV-positive. That is why the all-party group is pleased to support the Halve It campaign, which is composed of many agencies, clinicians and groups advocating on behalf of people with HIV. It is campaigning to halve the number of late diagnoses by 2015. That is an ambitious target, but the document sets out steps that can be taken to meet it, and I would be grateful for the Minister’s comments on them.

Yesterday, I was pleased that when I urged the Secretary of State for Health, while he was making his statement on the public health White Paper in the House, to look at the Halve It campaign, he gave an undertaking to do so and see whether it could form part of the HIV and sexual health strategy. I would be grateful if the Minister confirmed that she will look at the campaign’s document, particularly at the steps that can be taken to halve the numbers of late diagnoses and of those living with undiagnosed HIV by 2015.

I shall press on because I know other hon. Members are keen to take part and I want to hear the Minister’s reply. Once a person is diagnosed––I shall speak about some of the hurdles in a moment––the virus changes from being in its potentially lethal undiagnosed state, which poses a wide public health risk due to how it can be transmitted, to being a more normal—I use that word advisedly—long-term managed condition. That brings different challenges with it.

One thing that we are looking for in the detail of the NHS restructuring plan is how people will access services in the long-term managed phase of the condition. Who will commission those services, particularly in low-prevalence areas? Until those questions are answered, there will be uncertainty in the community. I want the Minister to answer specifically the question of who will commission HIV services in the new restructured NHS. Will it always be the GP? Is the GP the best placed person to do so? Do GPs have the time and the expertise, particularly in low-prevalence areas? I am sure that GPs in much of London, Brighton, Manchester or Glasgow have the necessary expertise because they have the caseload, but in other areas that might not be the case. Is a one-size-fits-all approach across the NHS the right solution or is something a little more granulated necessary to deal with the full complexity of the issue?

We have to face up to the fact that a lot of people who are HIV-positive simply do not want to access services through their local GP. Whether it is wise or unwise, it is understandable in some areas, particularly in smaller towns or villages, where everyone knows everyone else, and you know who works in your GP’s surgery and they know everybody and everything about you. Under those circumstances and given that the stigma prevails, and the myths, misunderstandings and prejudice that people with HIV face, it is understandable that there are those who will not want their status to be known in their own community. In evidence put forward yesterday by the National AIDS Trust, we saw how many people face discrimination in the workplace due to their HIV status.

AIDS is a complex condition. It affects people physically, emotionally and psychologically. In that complex mix, it is important that the NHS is responsive to that and allows people pathways to treatment that might not always be the same in every place. I would be grateful for the Minister’s views on that.

I congratulate my hon. Friend on securing the debate. Because stigma is still attached to this condition, people in rural localities, such as mine, will seek advice and help from further afield, thereby distorting the figures on the prevalence of the condition in certain parts of the country.

My hon. Friend is absolutely right. He represents an area that is not only largely rural but on the borders of Scotland and England, which brings me to the point that I mentioned at the very beginning. I imagine that many of his constituents will be accessing HIV services in Carlisle, for all sorts of reasons, but partly due to the stigma still associated with the condition. They do not want to access services in small villages and towns. Ultimately, we have to get to a situation in which there is no stigma, prejudice or discrimination and people can happily access GP services for a long-term managed condition, as people with diabetes, asthma and other long-term managed conditions can. Until such a time, we have to be sensitive to these issues.

Another reason why people are wary about always accessing services through GPs is the lack of awareness and understanding that many GPs demonstrate. Part of the reason why we have so many late diagnoses is that GPs do not pick up the telltale signs often enough. An alarming number of people had seen their GP on many occasions during the 12 months before they were eventually diagnosed as HIV-positive, and it was not picked up that they might have been HIV-positive. An astonishing number of people had been in-patients in the 12 months preceding their diagnosis; they were almost certainly HIV-positive while they were in hospital, but it was not picked up.

A lady recently got in touch with the all-party group—a middle-aged, professional, white lady—who had suffered serious recurrent health problems for two years and had seen numerous clinicians, including a GP on many occasions, before anyone thought to offer her an HIV test, which brings me back to the point that the hon. Member for Cardiff Central made. That lady was a textbook case: she had every symptom and yet her GP never thought to offer her an HIV test. That is clearly happening across the country, which explains why we have 22,000 people who are HIV-positive, but do not know it. It is not the case that none of them ever visits their doctor—they regularly visit their GPs, perhaps they even go into hospital as in-patients, and yet their status is not picked up. That is a public health disaster because the ability of those people to infect others is much greater than it would be if they were receiving the correct course of ARVs.

We need assurance that, within the restructuring, GPs will get very good guidelines and necessary training, and be encouraged to offer people an HIV test in the routine manner suggested earlier, to tackle undiagnosed HIV.

Will the hon. Gentleman also suggest that we need to tackle the stereotypes about the kind of person who might have HIV? That is one issue for people who do not go to their doctor, or who do go but whose GP does not pick up on it. As the hon. Member for Mid Derbyshire (Pauline Latham) mentioned earlier, GPs may not think that a middle-aged, heterosexual white woman is likely to be HIV-positive. We need to tackle those stereotypes.

The hon. Lady is correct. Part of the education of GPs must be about looking at the symptoms, not only what the GP imagines a typical at-risk person would be. Having said that, we need to show that those within high-risk groups of people are being tested as well.

The tremendous progress that has been made in testing in the past few years is truly astonishing. Someone can be tested and have the result in less than a minute. I hope that he will not mind me mentioning it, but the hon. Member for Brighton, Kemptown (Simon Kirby) saw this first-hand last night when he received a test through the services provided by the Terrence Higgins Trust in the House, and he had the result in less than a minute. Testing is not the long drawn-out process that it was years ago, but can be done much more quickly.

Finally, on care and support, people are living longer with the virus, which is a very good thing, but it brings with it challenges and complications—physical, emotional and mental. It is very important that we understand the need to have a strategy for people living longer with HIV. The AIDS support grant is no longer ring-fenced, and I am not arguing that it should be re-ring-fenced, but I am arguing strongly for it to stay within the grants that go to local government as a specified budget line.

In that way, local people can hold their local authority to account in exactly the way that the Secretary of State outlined yesterday. It is his belief that local people should be able to see the services being provided for them, and argue for services. If the AIDS support grant disappears as a title altogether and is subsumed into the general pot of money that local government gets, local people will not be empowered to come forward and demand the kind of services for which money is being made available.

In conclusion, I hope that the Minister will address some of the concerns about the AIDS support grant and the Government’s vision for it. I hope too that she will be able to calm some of the fears and uncertainties out there on how HIV services are to be commissioned, how they will be accessed, and how they will be supported under the new NHS that the Government have in mind.

Order. Five Back Benchers have intimated that they wish to take part. I intend to call the wind-ups at about 3.30 pm. Hon. Members can do the maths, so I ask for brief speeches from now on.

I congratulate the hon. Member for Inverclyde (David Cairns) on securing this important debate, whether by skill or fortune.

The Hove and Brighton area has one the highest rates of HIV in the UK. Many of my constituents live with the virus, and others have friends and colleagues that do so. It is a great privilege to speak up for them on any day, but especially on world AIDS day.

I wish to make two clear points. First, HIV does not always conform to stereotypes. HIV does not affect only young men on the gay scene, or people in or from Africa. As we heard earlier, it also affects white, middle-aged and older straight men and women. Until politicians, policy makers, doctors and the general public take that fact on board, dealing with HIV will continue to be hard work. Secondly, 26% of all who live with HIV in the United Kingdom are undiagnosed. Tackling this must be a priority.

In Brighton and Hove City primary care trust, about 450 people are HIV positive without knowing it. The Government and local services must do everything that they can to bring the number down, and I am determined to do what I can to support the NHS at the local level in this task.

My two earlier points are linked, because it is precisely those who are not in what are known as high-risk groups who get diagnosed the latest. Heterosexual men have the worst rates of late diagnosis, at 65%. That is possibly because they are less likely to consider themselves at risk, as we heard earlier, and unlike women they will never be tested in ante-natal settings. It could also be because clinicians may not consider them to be at risk. Heterosexual men over 50 years old have the worst rates of diagnosis; 73% of those not diagnosed until over the age of 50 are diagnosed late.

HIV comes in many shapes and sizes. At 54%, more than half of new diagnoses in 2009 were among heterosexuals, something that surprised me when researching for the debate. At 51%, more than half of HIV-diagnosed individuals accessing HIV care in 2009 were infected through heterosexual sex. The proportion of heterosexual diagnoses in which people are believed to have been infected in the UK has risen year on year throughout the epidemic. From 2003 to 2007, it doubled from 12% to 24%, and it continues to rise. It is now about 32%. The over-50s represent one in five of all adults seen for HIV care in 2009. That is due to an ageing cohort of people diagnosed previously, as well as an increase in new diagnoses among older people.

I dwell for a moment on the growing cohort of people of more than 50 years of age that live with HIV. This cohort will be bringing new needs to the NHS, and it should be ready for them. As people get older, they see more of their GPs. Many older people living with HIV suffer side effects from treatment; overall, they report twice as many other long-term non-HIV conditions as their non-HIV positive peers. As a consequence, they need to spend more time in health care, including primary health-care settings, than their peers. That makes their relationship with non-HIV specialist doctors almost as important as their relationship with HIV doctors.

The Terrence Higgins Trust surveyed about 400 people aged over 50. It found that

“respondents repeatedly told stories of discrimination, ignorance and poor clinical treatment in generalist healthcare, particularly in primary settings.”

The survey concluded that there was important work to be done to address HIV discrimination in primary care settings, as doctors there may not be so familiar with people who have the virus.

In Hove and in Brighton, we have some of the most HIV-aware clinicians in the country, and our specialists are among the best in the world. However, we must not be complacent, as parts of the NHS in our area will be less HIV-aware, as we heard earlier. I urge the Minister to work with her colleagues, the all-party group on HIV and AIDS and charities such as the Terrence Higgins Trust to tackle the problem. Training for GPs and surgery staff could be one way to do so.

Medical care is not the only service needed by older people. In the same Terrence Higgins survey, fewer than one in 12 older people with HIV said that they would approach a mainstream organisation for older people for support. Age UK and the Terrence Higgins Trust are working to change attitudes and to improve understanding of HIV in mainstream social care and social networks for older people. Again, I hope that the Minister will listen to the views of people living with HIV. as her Department moves to create a social care system fit for the 21st century.

I turn next to late and undiagnosed HIV. Of all adults diagnosed with HIV in 2009, 52% were diagnosed late, when their CD4 count dropped below 350. People with the worst rates of late diagnosis are over the 50s. Recent research suggests that the majority of those people will have had previous contact with their doctors. Late diagnosis, whatever the age, is a problem; if treatment is not started promptly, it can do serious damage to the body and severely cut life expectancy.

HIV treatment is excellent, and if diagnosed promptly, one can live to an old age. It is not right that some of my constituents will not have this opportunity by being diagnosed too late to benefit from it. It even makes financial sense to treat people early; it is much cheaper to have people someone stable on HIV treatment than it is to treat them for the endlessly recurring serious conditions that can result from undiagnosed HIV. HIV treatment also reduces viral load; as a result, those who are diagnosed and on treatment are less likely to pass on the virus.

Now is the time, while we are focusing on public health and while we are worrying about public finances, to take action to tackle late diagnosis and undiagnosed HIV. I am proud to say that people in Brighton and Hove are not sitting back waiting for someone to come up with a solution but are already working hard to tackle the problem. There have been two pilot studies in our area looking into ways of reducing undiagnosed HIV, using clinicians in the area. Of 596 people tested, only two positives were found. However, even more people were identified through an anonymous survey done by the university of Brighton. I urge as many people as possible to be tested, because of the 3,872 anonymous tests 54 were positive.

My constituency is proof that HIV can affect anybody, whatever their background, age or sexuality. As more people with HIV grow to old age, we must ensure that they receive services of which we can be proud. Such services should include prompt diagnosis.

I am delighted to take part in this debate. First, it gives me the opportunity to congratulate my hon. Friend the Member for Inverclyde (David Cairns) not only on securing the debate but on the important work that he does in chairing the all-party group on HIV and AIDS. Secondly, it gives me the opportunity to recommend to the Minister the work of Summit House Support. It is a fantastic charity, led by its chair Claire Pennell and its chief executive Suzanne Callen; for the last 18 years, the organisation has provided phenomenal services and support for people with HIV and AIDS in Dudley and Sandwell.

Thirdly, it gives me the opportunity to thank the Minister and her Department for the support that Summit House receives from the Department of Health through the Dudley and Sandwell primary care trusts. Finally, it gives me the opportunity to raise a number of points that I know are of interest to the staff at Summit House Support and those who work in the field.

I am delighted that the Secretary of State for Communities and Local Government has written to local authorities promising to increase spending on AIDS support over the next 10 years—I understand by £10.5 million. Is the Minister able to tell us how organisations in the HIV sector such as Summit House Support can safeguard the way in which local authorities decide to spend their grants? Will there be criteria for allocation, a needs assessment or some sort of ring-fencing process that considers the real needs of those with HIV? We have heard that is often a hidden group, so it needs to be done through specialist agencies, and it is fair to say that some of those working in the field are extremely concerned that money could be sidelined for other uses by local authorities if things are not monitored correctly.

As my hon. Friend the Member for Inverclyde said, people living with HIV are worried about the GP commissioning proposals now being considered. HIV is clearly a specialist area, and GPs historically have not had much interaction with those who have to live with it. In some cases, there is not the relationship of trust that should exist. Many people living with HIV are genuinely frightened or concerned about the proposals.

The current sexual health strategy will end shortly. What plans do the Government have to write a new strategy, given that the sexual health agenda has changed since 2004? Has the Minister also considered the extent to which NHS employees are routinely trained in HIV routes of transmission? I understand from the service users I met at Summit house that staff who have received such training and who understand the facts about transmission and infection are likely to be able to deal with people infected with HIV more effectively than those who have not had such training. Does the Minister think that training in HIV routes of transmission should be incorporated into employees’ standard training if is not already part of it?

Finally, would the Minister be prepared to visit Dudley to see first hand the fantastic work done at Summit house? If her diary does not allow her to do that, would she be prepared to let me bring people from Summit house to meet her in London?

May I say what a pleasure it is to serve under your chairmanship, Mr Leigh? I congratulate the hon. Member for Inverclyde (David Cairns). I am rather reassured that, after seven years, he does not know how these debates are chosen, because I certainly do not have a clue after seven months.

This is a significant day. It is a day to remember those who are no longer with us; it is a day to acknowledge and pay tribute to those who have worked so hard on this issue; and, crucially, it is a day to raise awareness. On the first of those issues, the scars on those who have lost people, particularly in the early years, are clearly raw. Thankfully, I do not know anybody who has died from AIDS, but I have friends who do, and they recall the pain and suffering vividly.

It is important that we remember those who have died and acknowledge their suffering. There is a wonderful quote in the film “Philadelphia”, where someone says that social death precedes physical death. That was certainly true in the early days, but I hope that things will get a lot better as time goes on. It is important, however, to look at how far we have come.

This is also a day to acknowledge those who have done so much. I pay tribute to each and every person and organisation for their work. There are too many organisations to mention, but I would like to pay tribute to the National AIDS Trust and the Terrence Higgins Trust. I would also like to mention two individuals. The first is the chief executive of the Terrence Higgins Trust, Sir Nick Partridge, who is here. He has done a tremendous amount of work over the years, and he should be acknowledged. The second is Lord Fowler, and I was pleased last night when he was acknowledged for the work that he did in the very early years.

Perhaps most importantly, today gives us an opportunity to raise awareness of HIV and AIDS here and abroad. I know that we are concentrating on the UK today, but I hope that we will have an opportunity to talk about the issues abroad, because they are significant.

The latest figures from the Health Protection Agency show that more people than ever are living with HIV. Last year, there were more than 6,000 new diagnoses, which is fewer than the year before, but only slightly. That emphasises that this is still a major problem. As many Members have mentioned, statistics also show that slightly more than half of new diagnoses are among heterosexuals, but the rate of infection in the gay community is still very high. Worryingly, there is an increase in diagnoses among those over 50, as my hon. Friend the Member for Mid Derbyshire (Pauline Latham) rightly said. We have also heard about the quarter of people with HIV who are undiagnosed. That is a huge problem, which really needs addressing.

I represent a constituency in Leeds, where the prevalence of HIV cases is average for England, with about 850 people receiving treatment and care in the city. Again, however, many of those people have been diagnosed very late, which highlights the need for early diagnosis. We also have a growing African population in the city, and there is a real link between HIV abroad and in the UK, as more and more people move around the world. In addition, we have one of the most vibrant gay scenes in Yorkshire, and I hope that we can encourage as much focus as possible on those two groups, because prevention really is the key.

It is important to mention the campaigns of the 1980s. The Conservative Government of the mid-1980s faced a massive challenge on an emerging issue, and even the best experts were learning day to day. Those campaigns were scary. I was at school at the time, but I remember them, and they still have an impact on me. As the hon. Gentleman said, those old campaigns were not exactly targeted, but they were highly effective.

Developments in medicine these days mean that people with HIV can expect to live well into old age. This generation could be forgiven for thinking that the problem has gone away, and that is a big problem, particularly in the young, at-risk groups. In the 1980s, HIV had already taken root among gay men in this country. Meanwhile, a devastating HIV/AIDS epidemic was about to take off in Africa, with inevitable consequences for this country and others. It is now estimated that, by 2012, there could be close to 100,000 people with the virus in this country. That is a tenfold increase on the 1980s figures, so the problem has not gone away.

I pay tribute to groups such as CHAPs, which have worked with community groups all over the country, and I am lucky that we have such groups in my constituency. [Interruption.] I notice, however, that I need to get a move on, so I will get rid of some of the pages of my speech.

Let me quickly say that I am delighted that we are highlighting some of the work that has been done over the past few years, although I should emphasise that work still needs to be done to save lives. There needs to be foreign aid, education and greater testing. Let me also say how happy I am that HIV and sexual health have featured highly in the public health White Paper, and that is important. It is also important that we acknowledge the problem in socially disadvantaged cases.

Finally, there is no one silver bullet when it comes to preventing HIV transmission, but we can, through a range of interventions, start to reverse this epidemic. Like the Government of the 1980s, the coalition faces a considerable challenge in tackling HIV. Unlike that Government, however, the coalition can draw on 25 years of experience in dealing with the epidemic and in understanding what works and what does not. I wish them well.

I congratulate my hon. Friend the Member for Inverclyde (David Cairns) on securing a debate on such an important topic. HIV policy has long been close to my heart, and it is a pleasure to be able to speak in the debate. It is important that I can speak on an issue that affects my constituency so greatly. Although we are discussing the effects of HIV in the UK, we cannot do so in isolation; we need to discuss many global issues as well, and I am sure that we will have an opportunity to do so. Today, however, I want to address issues relating to the UK and particularly to my constituency.

Ealing primary care trust has the seventh highest prevalence of HIV in a country that has more people living with the disease than ever before. Rates of new infections in the UK remain high, and, as my hon. Friend said, the number of over-50s infected with HIV trebled between 2000 and 2009. It is obvious that a new policy has to be developed to deal with these pressing new issues.

One of the most important factors in this complex issue, which we must acknowledge straight away, is diagnosis. Roughly one in four people with HIV in Ealing do not even know that they have it. That is roughly the same ratio as at the national level. When HIV is discovered early, people can be treated and go on to live normal lives with near-normal life expectancies. On the other hand, late diagnosis leads to more AIDS-related illnesses, increased pressure on the NHS and a higher rate of onwards transmission. We have too high a rate of diagnoses being made at a point when treatment should already have started. As hon. Members have said, in 2009, 52% of people diagnosed with HIV were diagnosed too late, and 73% of those who died were diagnosed too late as well.

What can we do to ensure early diagnosis for all cases of HIV? The Health Protection Agency believes that all new members of GP surgeries in PCTs with high prevalence rates, including Ealing, should be offered an HIV test. We need to go further, and provide incentives to GPs and other health care workers to encourage HIV testing. We also need to improve antenatal testing. We already have good provision for HIV testing of unborn babies. Even though one in 450 women who give birth is HIV-positive, only 30 babies born last year had the virus. However, we could go further.

I want to comment briefly on the growing link between HIV cases and mental health. Obviously, meeting the mental health needs of a population is important in itself, but concentrating on people with HIV can have a particularly beneficial effect, both clinically and in cost-effectiveness. People with depression have a more adverse reaction to their HIV treatment in general. It is cheaper for the NHS to invest in 10 sessions with a clinical psychologist than to pay for costly treatments further down the line because someone did not take the initial treatment properly.

Those sufferers receiving the right psychological support are less likely to miss their medication, more likely to react positively to treatment, and less likely to pass on the disease by engaging in unsafe sex; such aspects of the matter can cost more in the long run if the right support is not established immediately on diagnosis. It is therefore important for the Department of Health to integrate HIV sufferers into long-term mental health strategies.

Although I am pleased that drugs for HIV sufferers will be ring-fenced in the health budget, social care and protection for HIV sufferers, which is often provided through local authorities, will not be. Social services are hugely important for people with HIV, and a squeeze on their budget is likely to have a detrimental effect on the mental health status of many HIV sufferers and cost much more in the long term. I am aware that through the CSR an announcement was made of an increased allocation to social care for people with HIV.

I now want the Department of Health to inform local authorities of their likely budgets as soon as possible, so that councillors can start to plan a thorough care plan for people living with HIV. Only through that long-term planning for mental health cases, more social care and a greater push for early diagnosis can we really start to tackle the problem of HIV in this country, and ensure that nothing stops people with HIV living normal lives.

I am delighted to be speaking under your chairmanship, Mr Leigh, and I congratulate the hon. Member for Inverclyde (David Cairns) on obtaining this timely debate on world AIDS day. What is good about the debate is the unanimity between the parties. We often have heated debates, but we all appreciate the importance of today’s debate for people suffering from HIV/AIDS.

Now that the recent tough economic choices have been laid on the table, we are able to take an opportunity to review what is and is not working in the UK and try to make improvements. HIV/AIDS is a serious virus that poses a risk not only for those who are already suffering from it but also those around them. The ease of transmission of the disease means that, if we do not bring the number who have it back down from 83,000 or so, we run the possibility of letting the virus dictate our actions, instead of taking pre-emptive measures. Unfortunately, as a member of the Select Committee on International Development, I have seen at first hand that once the virus gets into sections of society where it becomes more prevalent, it can, left unchecked, destroy countless lives and families.

Britain is a world-leader in international development, and central in the international community’s voice and actions against HIV/AIDS worldwide. However, to be a credible voice and to make an inroad into the virus worldwide we need a credible tactic of beating the virus at home. Funding has been flatlining in recent years and we risk, if we are not careful, losing more than two decades of progress that has been made in fighting the epidemic.

The White Paper offers more flexibility to the health service, by offering GPs more control over the budgets that they inherit and how they spend the money allocated to them. Perhaps outlining the financial rewards of early screening will help to strengthen the argument. The Health Protection Agency recently estimated that the prevention of one new HIV infection saves the public purse between £280,000 and £360,000 in direct lifetime health care costs. That is a staggering amount per new diagnosed case. In 2008, had all of the UK’s 3,550 acquired infections been prevented it would have saved approximately £1.1 billion in direct health care costs.

Alternatively, we can look at the money that could be made, not saved, by early diagnosis. People living with HIV who have an early diagnosis can contribute wealth to the nation by staying in work for longer and therefore paying more in taxes; they are able to manage their health better, which results in their taking fewer days off sick. They can plan for their financial future so as not to require incapacity benefit in such large numbers, and by having quick access to antiretroviral drugs they can ensure that they do not require full-time carers, who are often family members, for so long. Their family can therefore go out and work and contribute to the national purse.

Of course, financial reward is not the only benefit of diagnosing HIV early. The significant social benefits to early diagnosis are equally if not more important. For instance, a 35-year-old male diagnosed early with HIV, and with quick access to antiretroviral therapy, would now be expected to live to 72—only a few years less than someone who would be deemed a perfectly healthy man.

Early diagnosis enables people who are HIV-positive to take positive steps in protecting others through safe sex. A recent study of newly diagnosed HIV-positive men who have sex with men reported that 76% had eliminated the risk of onward transmission three months after diagnosis. If the test comes back negative, of course, it allows the recipient a wake-up call and a chance to change their habits and think about the risks that they have been taking. In that way they are more than likely to help to prevent a future case of HIV in the UK.

Early diagnosis also allows the correct antiretroviral drugs to be prescribed. That in turn reduces the viral load and subsequently reduces the chances of transmitting HIV. By giving people the opportunity to take quick and effective measures against the virus we are putting them back in charge of their lives; they are not having their lives dictated by HIV. I should like the Minister to take note that women, and indeed men, who have been raped should automatically be monitored to ensure that if they suffer from HIV/AIDS it will be diagnosed extremely early; that is not something that they have chosen.

The truth of the matter is that the male gay community and the black African community are most susceptible to HIV infection owing to cultural sexual practice. There is a role for civil society in bringing UK levels of HIV down by bringing early diagnosis to those groups and deconstructing the stigma attached to screening for the virus. Everyone gets scared, intimidated and embarrassed from time to time and those natural feelings might be a barrier, preventing people in those at-risk communities from seeking early diagnosis.

Coming out of the financial turmoil of the past few years, it is important that we should take every opportunity that is given to us to make positive changes to the previous norm. We have the opportunity to put early screening at the heart of the public health White Paper and to create a social practice in which the stigma of screening is broken down through the participation of civil society. However, I believe that there is only one mention of HIV/AIDS in the White Paper. I simply ask that we do not let the opportunity slip away. Positive changes to the current HIV strategy can and should be made: most importantly, they need to be made.

I am pleased to have the opportunity to speak in this important debate on world AIDS day, and I congratulate my hon. Friend the Member for Inverclyde (David Cairns) on securing the debate.

Let us remember that some people who are suffering from HIV/AIDS, or suspect that they are, will have supportive partners, be in supportive communities and face the future with some positivity. Many, however, will be very frightened and very alone. It is a good thing that we in this Chamber can openly debate this issue and its ramifications, because it will reassure not just communities, activists and lobbyists but individuals who may read and see the debate this afternoon.

We must remember that we have moved some way since the early frightening adverts in the 1980s. No one who saw those adverts, with the tombstones collapsing and the voice of doom, has ever forgotten them. We should congratulate Norman Fowler on taking up the cause and using the power of his Department to put it in front of the public.

When we look at some of the indices around HIV/AIDS, we see that there has been an increase in HIV testing among gay men. Testing rose from 58% in 1997 to 72% in 2008. We have seen a plateau in new diagnoses among gay men, and we now see a consistently high rate of condom use among them—at least nine out of 10 now use condoms. The fact that we have seen such progress is partly a tribute to the people who took up the issue all those years ago. It is also a continuing tribute to the communities, activists and health providers who provide both care and commitment, and we need to acknowledge that today in this debate.

However, there is still some way to go. How we go forward on HIV/AIDS will be a test of the reorganisation of both the NHS and public health that has been announced in recent months. In principle, I do not think that anyone in this Chamber is opposed to the reorganisation, but it is just this sort of issue, which is not consistent across the country, that is not necessarily well represented in GPs’ lists and has different levels of information across the country; there may not be as much information in rural areas as there is in Brighton and London. That will be a test of the reorganisation’s effectiveness.

We know that AIDS can affect anyone, and that apart from the gay community the largest community affected by HIV/AIDS is that made up of black African men and women; currently, 38% of new HIV diagnosis is among that group. The stigma attached to HIV in that community cannot be overstated, and it very much hampers efforts to reach out to people and achieve early diagnosis.

The problem among black African men and women—and among other groups, as well—is that they present late and are therefore diagnosed late. That not only gives them a poor prognosis; it means that the cost of treatment is much more expensive than it need be. That is true of any individual or any group that presents late.

Another issue with black African men is that, even though they may be having sex with men, they refuse to consider themselves as gay. They think that HIV is something for the gay community and not for them, so they end up presenting very late indeed. They are more likely to be undiagnosed and to live in areas in which a relatively high proportion of the population are not on their GP’s list, so they are not really interacting with the authorities.

I should like to use this debate to stress the importance of educational and informative work generally and with the black and African community in particular. We must do more with the Churches, because that is probably the most effective way to reach those groups. Any Sunday morning, there will more people in African-led churches in Hackney than at any political party meetings for 12 months of the year.

We need to normalise testing and offer it in a much wider range of settings—not just for black and African men and women, but for the population as a whole. I was routinely tested when I had my son 19 years ago and thought nothing of it. We need to make testing more routine so that people do not think, “If I go for this test, it will badge me as someone at risk.” Universal testing may well be a step too far, but we need to make testing available in a wider range of contexts.

My hon. Friend the Member for Inverclyde said that he did not want to talk about international issues, but given that 38% of new HIV diagnosis is among black African men and women, I do not apologise for raising the issue of funds for the Global Fund to fight AIDS, Tuberculosis and Malaria. I know that that is not a matter for the Minister and I do not expect her to respond on the specific point. None the less, will she pass on to her colleagues the very concerning fact that the global fund is £13 billion short of what it needs? If the UK was to raise its pledged amount in line with France and other western European countries, the fund would be able to go to private sector donors such as the Gates Foundation and reach the amount of money it needs.

In that context, I should like to mention—again, I do not expect the Minister to respond on this point—that in the next few weeks we will have EU trade talks with India in Brussels. There is a great concern that as a consequence of the trade talks, India might not be able to produce the cheap generic drugs that have played such a huge role in the fight against AIDS in Africa. That would be a blow not so much for Indian industry, but for the millions of people in Africa who have benefited from access to cheap generic drugs.

HIV/AIDS is no longer a death sentence, which is good news. Thanks to new drugs, research and greater understanding, people are now living with HIV. As one of my hon. Friends said earlier, we have 65,390 people in the community living with HIV. In fact, it is increasing faster among the over-50s than among any other group, which raises new issues that were not considered in the era of the adverts with the crashing tombstones and the voice from above.

My hon. Friend the Member for Ealing, Southall (Mr Sharma) mentioned the issue of depression and how that interconnects with sufferers of HIV/AIDS and the support that they need in relation to that. There are ongoing concerns about care and support that were not an issue 20 years ago. If we are to offer sufferers from HIV/AIDS equity of health care and, as far as possible, a good quality of life, we must consider care and support, within the new health service and local authority structures, as we have not in the past.

As I said at the start of my remarks, the reorganisation of the commissioning of health care and of the public health service will be tested by this issue. Many ordinary people on the ground will judge the reorganisation by how issues such as this are dealt with. I stress, as my hon. Friends have stressed, the importance of a national strategy. We need to consider how it can go forward under the new arrangements. Will the Minister tell us who will be responsible for commissioning and funding the information work that is needed now more than ever—in particular, the specific education work that goes into the communities that I have mentioned? Who will be responsible for commissioning preventive work, care, treatment and support? I will listen with interest to the Minister’s responses to those questions.

I welcome the new public health arrangements in principle. Public health has been a core activity of local government since the 19th century and so, as a former local councillor, I am glad that public health has “come home” to local authorities. However, because I know local authorities and how they work, I want to be convinced that it is possible effectively to ring-fence the public health funds that they will receive.

I imagine that what some local authorities will do—or will be tempted to do, conceiving themselves to be under financial pressure—is to rebadge existing work in the areas of social care and environmental health as public health expenditure, and the new funds that all of us in Westminster Hall imagine are there for public health will melt away in the current climate. So this will be a test, as much as anything else, of how far it is possible effectively to ring-fence public health funds once they fall to local authorities.

Then there is GP commissioning, and the issue of HIV/AIDS will be a test of that system. The important thing with GP commissioning is that GPs should commission for their community and not for their list. As an east end Member of Parliament, I know that there are many public health issues that manifest themselves more extensively among people who are not actually on GPs’ lists, for a whole number of reasons. Tuberculosis is a case in point. A disproportionately high number of people who suffer from TB are not on a GP’s list, for a number of reasons. HIV will be a test of the extent to which GP commissioning consortiums will commission for the community as a whole and not just for the people who are on GPs’ lists and present themselves for treatment.

It will be important to know what will happen to some of the survey work that is carried out by organisations such as the London Health Observatory; I had a meeting with representatives of that organisation this morning. That survey work is the only way of seeing what the trends are in issues such as HIV. It is easy for us to say this afternoon that 43% of HIV/AIDS sufferers are in London, many more are in Brighton and so on. However, we live in a globalised environment and there are trends and changes. Only survey work—not only national survey work, but sometimes precise survey work—can track what is really happening with HIV/AIDS.

I understand that some of the figures that have been released in the past year for those who have just been diagnosed with HIV show that it is not just a young person’s disease any more; it also affects those who are 50-plus or 55-plus. I wonder whether the hon. Lady is aware of that. If she is, what does she feel should be done to address that issue of those in an older age bracket who are now succumbing to the disease?

That is an important point, and it is one that I touched on earlier. It shows that anyone can find themselves—

Sitting suspended for a Division in the House.

On resuming

In conclusion, I congratulate all those who have campaigned, worked and raised consciousness on this issue over 20-odd years. Improvements have been made, partly through the efforts of communities and campaigners and partly through the commitment of people in the House, but we face new challenges due to the reorganisation of the NHS and the fact that a generation of people are now living with AIDS.

I look to the Minister to answer some of the questions asked in this debate, particularly about how the reorganisation will affect the treatment of HIV/AIDS, and to reassure us that the information needed in a range of communities will be publicised. I will listen with interest to her response.

It is a pleasure to serve under your chairmanship, Mr Leigh; I do not believe that I have been in this position before. I am grateful to the hon. Member for Inverclyde (David Cairns) for securing this debate. I congratulate him on his chairmanship of the all-party parliamentary group on HIV and AIDS, and I congratulate the group itself on continuing to raise awareness in Parliament, in the UK and internationally.

Today, as we all know, is world AIDS day, so this debate is timely; I believe that Mr Speaker has some influence over when debates occur. It is an opportunity to reflect on what we have achieved, where we stand and the challenges ahead, many of which have been mentioned. I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for his gracious comment that this is a chance for us to pay tribute to those whom we have lost along the way to the present improvements in life expectancy for those with HIV/AIDS. A dear friend, Eric, with whom I worked in the 1980s, died from AIDS; I am sure that many of us know people who lost their lives. It is so tragic when we consider the advances made.

The hon. Member for Inverclyde focused on the situation in the UK. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) mentioned the global situation. It is important to note that the number of new infections decreased by 19% between 2009 and 2001. Today, more than 5 million people have access to life-saving antiretrovirals. That is more than a thirteenfold increase in five years, but significant challenges remain. More than 33 million people are living with HIV, 2.1 million children are infected and the World Health Organisation estimates that at least 10 million people still need treatment. There is a great deal more to be done, and no room for complacency.

I would like to mention my noble Friend Lord Fowler, and welcome the announcement of next year’s inquiry into HIV and AIDS. Like the hon. Member for Inverclyde, I am old enough to remember when the disease came on the scene. A great friend of mine, a professor of virology who went over to the States, came back and said that it was extraordinary to see an acquired deficiency, as the disease’s name suggests. He talked about a curious illness that people were getting.

At that time, a tremendous amount of work was being done by many people, not least my noble Friend, to fight HIV/AIDS. It is still a powerful model for public health campaigns; we cannot forget those tombstones. Such images enabled a lot of the preventive work from which we still benefit. I reassure the hon. Member for Inverclyde that mass communication had an effect. The rate of sexually transmitted diseases decreased across the board. However, he also mentioned targeted messages, which is where we need to focus our efforts.

Although prevalence is relatively low in the UK population as a whole, some groups are disproportionately affected, including men who have sex with men, and black African communities. In 2009, they accounted for 42% and 36% respectively of the 65,000 individuals living with diagnosed HIV infection. However, as my hon. Friend the Member for Hove (Mike Weatherley) rightly pointed out, stereotypes are dangerous, and the figures that I have quoted must be used with caution.

Sitting suspended for a Division in the House.

On resuming—

My hon. Friend the Member for Hove also mentioned the specific problems with late diagnosis, which I shall return to. The outlook for most people with HIV in the UK is more positive than it used to be, and the vast majority can now plan for their future with a great deal more certainty, which is to be welcomed. We must not forget that we have the dedicated work of many scientists around the world to thank for that, along with action from Governments from both sides of the House.

However, challenges remain. As Members have pointed out, despite our successes, a quarter of people with HIV do not know that they are infected and so are unable to benefit from the treatment available, and they can unwittingly infect others. Around half of the newly diagnosed infections are diagnosed late, after the point at which people should have started treatment. The hon. Member for Ealing, Southall (Mr Sharma) raised that as an ongoing and growing problem, along with the fact that many of the people affected have serious mental health problems. The mental health and well-being of people with HIV and AIDS is seldom mentioned, but it is extremely important to recognise.

I share the concerns raised in the debate about the need to reduce the number of people with HIV who are undiagnosed or diagnosed late. We need to increase testing, especially in those areas that have a higher prevalence of HIV. We have seen a good uptake of HIV testing in sexual health clinics and antenatal settings, but all health care professionals need to be alert to the importance of offering appropriate HIV tests.

Does the Minister have any practical proposals for increasing testing, such as different contexts in which it can occur?

I thank the hon. Lady for raising that point, which is important. I will return to it later in my remarks. The hon. Member for Cardiff Central (Jenny Willott) mentioned the automatic testing when she had her baby. The Department of Health has funded eight pilot projects, which have now been completed, that looked at the feasibility and, importantly, acceptability of providing an HIV test as part of routine services offered to newly registered adults. I am encouraged by the findings from those projects, which confirm that offering HIV tests in GP practices, hospitals and community settings is acceptable to patients.

The pilots picked up a significant number of previously undiagnosed people in high prevalence areas. It is good news that people are happy to be tested, because it means that we can pick up cases of HIV that would otherwise be missed. We are working on the best approaches to expand HIV testing in a variety of settings and, as the hon. Member for Hackney North and Stoke Newington said, that is really important. If a wide variety of settings was available, a GP practice is not necessarily where people would go for a test—far from it, I would say.

I am also pleased to note that, thanks to the leadership and drive of local HIV clinicians and others, findings from the pilots in Brighton, Lewisham and Leicester have now been embedded in local practice, which is to be congratulated. The Health Protection Agency will publish its final report on the pilots early next year, which many people will look forward to seeing. We need to see what we can do to put into practice what we have learnt. It is vital to increase testing for HIV, as it is for a number of sexually transmitted diseases, so we continue to fund targeted programmes for the groups most at risk from HIV in the UK. We have also funded the Medical Foundation for AIDS and Sexual Health to provide training resources for health care professionals in secondary care.

I would like to thank the hon. Member for Dudley North (Ian Austin), who kindly sent me a note to explain that he has had to leave the debate, for raising the work of Summit House Support. We will be looking at the findings of the pilots I have mentioned, and I would certainly not like to miss an opportunity to go to Dudley, should the opportunity arise, to have a look at what Summit House Support is doing.

For HIV, as for all STIs, prevention remains the most important response. In the UK, the majority of HIV infections are sexually transmitted, and the vast majority of those could have been prevented; that is a message that we really must hang on to.

Sitting suspended for a Division in the House.

On resuming—

We need to ensure that safer sex messages are clearly communicated and understood by all.

I think that we also have to clamp down a bit on irresponsible marketing. I have been approached by those who are unhappy about the promotion of DVDs and other material promoting “bareback” sex. We need to address such issues and I know that a lot of people and organisations, such as the Terrence Higgins Trust, are doing all they can to stop the promotion of such material. To those who are most at risk of HIV in the UK, I say that the Government work very closely in partnership with the Terrence Higgins Trust, the African Health Network and a huge number of other voluntary and community groups.

Yesterday, we published a White Paper on public health and later this month we will publish a number of supporting documents, including a public health outcomes framework. We will be thinking about what the best outcomes might be for HIV and they will be included in that document. I know that Members will look at that document with care and feed back to us their feelings on it. In the spring, we will publish a position paper on sexual health which will, of course, include HIV. That paper will take into account many of the issues that have emerged this afternoon.

I will let the Minister catch her breath and I appreciate that we are really up against the clock. She says that there will be a position paper in the spring. Does she envisage that that will lead to a full new HIV strategy, or will it just remain a position paper?

No, it will be a sexual health strategy. The Government and the NHS need to play their part, and we need to support individuals to make responsible lifestyle choices. We continue to provide the very best HIV treatment services, but others have a role to play and they are often better placed than the Government to make a difference. The hon. Member for Hackney North and Stoke Newington mentioned the role of churches in that regard and they can have a significant impact.

Voluntary community groups, industry, responsible media, churches and faith groups all have a part to play. That collaboration is so important in tackling stigma and discrimination, which is still a very real issue for many people affected by HIV. That is particularly important within those communities who find sexual health issues more challenging than other communities.

Stigma means that people refuse tests, do not take precautions and do not go for treatment. I was delighted to see that the Prime Minister highlighted the issue of stigma in his world AIDS day podcast. Tackling HIV is everyone’s business and we can all make a difference to reduce stigma, reduce new infections and enable people living with HIV to lead full and productive lives.

The hon. Member for Inverclyde raised issues about global funds. I am sure that he will also raise those issues with my colleagues in the Department for International Development. However, as my ministerial brief also covers EU health, it may be of note for him to realise that such issues are recognised by many people within Europe and across the world, and we continue to work both nationally—within our own member states—and internationally, because collectively we can do a great deal to help each other.

The hon. Gentleman also said that generally a one-size-fits-all approach does not work and, as my hon. Friend the Member for Hove said, anonymous testing and treatment is often crucial. We will announce our commissioning intentions soon. However, the hon. Gentleman’s point is well made.

I think that it was the hon. Member for Dumfries and Galloway (Mr Brown) who mentioned the issue of commissioning services in rural areas, which poses particular challenges and very real problems. It is absolutely crucial that we get that commissioning right. We will announce our intentions soon and I hope that they will address some of the points that he raised.

We need to talk about sex. We need to talk about people’s sexual health. We need to talk about people’s responsibilities in looking after their sexual health, and we all have something to offer and we all have something that we can do personally, particularly those of us who are Members of Parliament. As MPs, we have unprecedented access to media, particularly in our local areas. We need to do everything that we can to express the fact that this is everybody’s business and that people need to take responsibility for their sexual health. Their sexual health not only affects them; it affects the others around them and their families too. Only then will we be able to see a future for people living with HIV/AIDS that we all want to see.