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HIV: Barriers to Treatment

Volume 777: debated on Thursday 1 December 2016


Asked by

To ask Her Majesty’s Government what assessment they have made of barriers to accessing treatment to prevent the spread of HIV; and what steps they are taking to address those.

My Lords, HIV treatment in itself is preventive. HIV positive people are now being given early access to HIV drugs, resulting in an undetectable viral load, which makes it very unlikely that the virus will be passed on to others. To ensure that we continue to make progress in preventing HIV, NHS England and Public Health England will say more about their further plans for a new programme in the next couple of days.

I thank the Minister for his response and indeed for his commitment on this issue. However, there has been much prevarication and procrastination over who is responsible for providing access to PrEP, a drug that is known to prevent transmission of HIV. More people are at risk than ever before, so will the Government explain how they are working with NHS England and Gilead, the supplier of PrEP, to take the lead on this issue? If the price of PrEP does not decrease, how and when will the Government ensure that those at significant risk from HIV will have access to it?

My Lords, negotiations have been going on between NHS England, Gilead and others, and we expect a positive outcome in the very near future—in the next few days. I cannot comment on the details at this time, but as soon as we have that information, I will ensure that it is placed in the Library of the House of Lords immediately.

My Lords, I declare an interest as a former participant in the PROUD project and as someone whose former partner was HIV positive. The reasons why some men do not use condoms are many and complex. Why will the Government not fund PrEP when it has proved so effective in preventing HIV? Would the Minister not agree that having PrEP on the NHS would potentially save the NHS money?

My Lords, one of the purposes of the Act promoted by my noble friend Lord Lansley was to remove the Secretary of State, and indeed politicians, from these very difficult clinical decisions. That decision will be made by NHS England, and we expect a positive decision to be made in the very near future.

My Lords, Ministers cannot evade their responsibility for the NHS in the end. NHS England is not a clinical body; it is a quango wholly owned by and wholly responsible to government. The decisions it has made have been purely about money, and it is continually endorsing crude rationing of services and the restriction of drugs. In the current agreement with the drug companies, the Minister’s Government have received nearly £2.5 billion back in rebates from those companies. Why on earth has his department allowed the Treasury effectively to ambush that money, instead of it being spent, as it should have been, on innovative new drugs for NHS patients?

My Lords, I think the noble Lord will agree that there is a clinically driven process, through the specialised commissioning groups and the clinical priorities group within NHS England, that attempts to look at all these drugs in an objective, clinical way. Surely it is better that these decisions on priorities should be made by clinicians acting in that way than by politicians, who are subject to all the pressures of which we are all only too well aware. Of course affordability is an issue in assessing whether a new drug should be commissioned; it always has been and always will be. The £2 billion, which the noble Lord has mentioned before and which I think comes from the PPRS, is taken into account when setting the overall budget for NHS England.

My Lords, one of the significant barriers to effective HIV treatment is that it is often present with a co-infection such as hepatitis. What steps are the Government taking to identify, diagnose and treat people who are co-infected with HIV and hepatitis C, the most deadly form of the infection?

My Lords, I am afraid I cannot answer that question, or at least I could answer it in only a very inadequate way. I would like to reflect on it and write to my noble friend as soon as I can.

I do not like to have two questions on the trot that I cannot answer, but I do not know the answer to the noble Baroness’s question. I shall have to research it and write to her.

My Lords, what steps are being taken to ensure that prisoners have access to treatment, testing and care while in prison? They are more likely to be drug users, more susceptible and more likely to be from communities that do not get themselves tested, even when they are in good health. Could the Minister say something about prison health?

There is a particular problem in prisons, as the noble Baroness refers to. There is a higher incidence of HIV in prisons, for all the reasons that she has alluded to. The NICE guidance and the PHE resources report that came out today echo her point. We have to reinforce and redouble our efforts in prisons to identify HIV earlier through better testing.

My Lords, does the Minister agree that the HIV virus is a very difficult virus, and that this is one of the problems of getting a vaccine?

I thank the noble Baroness for coming to my rescue on that. It is very difficult, as she knows, because the HIV virus is complex. What is remarkable is the extraordinary advances that have been made in treating HIV over the last 20 years; that has been a real triumph of the pharmaceutical industry. I will still write to the noble Baroness, Lady Tonge, about vaccines.

My Lords, I was not going to refer to vaccines but to something else, but a report on the radio this morning said that South Africa believes it has developed a vaccine that will prevent HIV. Maybe we could find out more about that in due course.

I wanted to ask the Minister about barriers, of which there seem to be two. My noble friend has raised one—stigma—and I got the impression that the Minister felt it was perhaps not as serious as it used to be. It is very serious; there are still many examples, particularly of women, who will not go to a clinic, thus creating a barrier, because of the stigma that is attached. The other barrier that is equally important is that local authorities that fund testing are having huge difficulty in raising the funds to do so. Maybe we should be looking at whether there is a positive way in which the Government can help with resources to local government.

Frankly, this is an area where government can never do enough. We should take some comfort from the fact that the level of undiagnosed HIV is consistently coming down; it is now down to 13%, and we are within touching distance of the WHO’s 90% level. So we are making progress, but I accept what the noble Baroness says. On stigma, I am sure there is much more that we can do.