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HIV Prevention Services: Public Health Funding

Volume 787: debated on Thursday 30 November 2017


Asked by

To ask Her Majesty’s Government how reductions to the public health grant since 2015-16 have affected access to sexual health services and HIV prevention services, particularly in London, for (1) men who have sex with men, and (2) people from black and minority ethnic groups.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and refer to my entry in the register of interests, particularly as patron of the Terrence Higgins Trust.

My Lords, the UK is one of the first countries to witness a substantive decline in new HIV diagnoses in gay and bisexual men. Between 2015 and 2016, new HIV diagnosis fell by 21% across the UK and by 29% in London due to reduced transmission of HIV. New diagnosis in heterosexual black, Asian and minority-ethnic groups fell by 16%, mostly due to changing migration patterns.

My Lords, I thank the Minister for that response. Great progress has been made and I pay tribute to all those concerned, but there is concern at the cuts seen in HIV support services and sexual health services across the United Kingdom, not least in the two areas with the highest prevalence of HIV, Lambeth and Southwark, through to Oxfordshire, Portsmouth and Bexley. How are the Government working with local authorities in England to ensure that such services are fully funded and meet the needs of local communities at risk of HIV? Furthermore, what steps are they taking to ensure that people living with HIV have access to support services that fully meet their needs?

First, I pay tribute to the work of the Terrence Higgins Trust and its leadership in this area in making progress in the UK in dealing with the HIV/AIDS epidemic. The delivery of open access to sexual health services is mandated for all local authorities, which are funded to do so by the public health grant. It is incredibly important to point out that over the last four years there has been a 500,000 increase in the number of attendances at sexual health clinics, and more testing and treatment is taking place. That is starting to show in the reduced number of diagnoses, as well as in other factors. It should also be pointed out that as regards looking after those suffering from the consequences of HIV/AIDS, the Care Act 2014 is extremely clear that the legal framework for social care applies to adults, including those who live with HIV.

My Lords, very large populations of gay men live in metropolitan areas such as London and Manchester, but my question is about the far-flung corners of the country: the north-east, the north-west and the south-west. Can the Government be confident that young men are able to access services and have PrEP available in those sorts of areas?

The noble Baroness is quite right to point out the difference. If you look at the performance in London against the UNAIDS 90-90-90 targets, you will see that they have been met. However, England as a whole is at least slightly behind on at least one of those factors—people with HIV not being diagnosed—which points to the fact that out of metropolitan areas there is more work to do, as she says. One of the ways in which local authorities meet that challenge is through offering home testing kits, which are being sent out and which are now seeing the kind of return and diagnoses levels that you would see in sexual health clinics.

My Lords, is it correct that six clinics have closed in London recently? Is he aware that other infections, such as gonorrhoea, have become drug-resistant? Many people from ethnic minorities need to know where to go, and communication is so important.

I did not know about the closures that the noble Baroness mentioned. I reiterate that more tests are taking place. Indeed there has been a substantial decrease in the amount of new diagnoses, which is good news because it means that transmission is falling. We want to focus on the outcomes here, which are positive, particularly in London. She is of course quite right about other STIs being important. There is good news there as well, because diagnosis is falling, so some of the public health plans being put into place are starting to pay dividends.

My Lords, following on from the question from the noble Baroness, who is quite right, the facts are that there was a 28% decrease in HIV support services between 2015 and 2017, and in London that is 35%. Combine that with the local government public health cuts of £200 million this year and the wider impact that will have on all sexual health services. Does the Minister agree that the long-term implications of this reduction in services could have serious implications for both individuals—some of whom, perhaps, have not been diagnosed with HIV—and specific vulnerable communities? Can he commit to bring to the House an assessment of the impact of these reductions in services and expenditure?

The data that the noble Baroness refers to on spending also shows that STI testing and treatment in general has risen year on year. There is clearly still an improvement of the picture in the amount of testing and treatment. As I pointed out, the benefit of that is that fewer people are being diagnosed, which means transmission levels are falling due not just to testing but to other factors, including good treatment and preventive work. Indeed, the number of undiagnosed people is falling as well. This is all good news.

My Lords, despite HIV testing being free and universally available across the United Kingdom, there are very good estimates that around 13,500 people are not aware that they are carriers and have HIV. I note what the Minister just said, but surely that figure is still unacceptable and there needs to be more testing, particularly of people living on the fringes of society or those who are not registered with a GP and do not come into contact with health services. There need to be some targeted efforts to reach those people to ensure that once they are tested they receive treatment.

I quite agree with the noble Baroness. As I said, across England about 12% or 13% of gay and bisexual men and other men who have sex with men are undiagnosed. That is clearly unacceptable and means we are still not yet meeting the UNAIDS target. I will point out a couple of the interventions happening to try to address that in addition to the ones that I have already mentioned. A new contract has been awarded by Public Health England to the national HIV prevention programme for the most at-risk populations precisely to try to reach them. Another £600,000 is being given to 12 schemes under the HIV innovation fund. By definition, the people we need to reach next are the most difficult to reach because they have not come into the system.

My Lords, as PrEP is clearly scientifically assessed through meta-analysis to be the most effective treatment for reducing incidence of HIV for the at-risk population, will the Minister say how widely this treatment is available for the at-risk population through the NHS?

Yes, I am happy to do so. PrEP will be provided by the NHS through an initial three-year trial to an estimated 10,000 people, which makes it the largest single study of its type in the world. That is happening in a handful of cities throughout England. Once we know the results of that study we will be able to understand how best to roll it out beyond that.