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HIV Transmission

Volume 828: debated on Wednesday 15 March 2023


Asked by

To ask His Majesty’s Government what progress they have made towards their target of eliminating HIV transmission in England by 2030.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare an interest as a patron of the Terence Higgins Trust and vice-chair of the APPG on HIV.

My Lords, the first HIV Action Plan monitoring and evaluation framework report shows that there is much to celebrate in the progress made since the publication of our HIV action plan in December 2021,

“with under 4,500 people living with undiagnosed HIV infection and extremely high levels of antiretroviral therapy coverage and viral suppression.”

We continue working with our key delivery partners to ensure we remain on track to meet our goals for 2030.

My Lords, I start with a tribute to the long-standing and deep commitment of Baroness Masham to tackling HIV and AIDS. We will miss her greatly.

The goal of eliminating new HIV transmissions by 2030 will be almost impossible to achieve unless we find the estimated 4,500 people living with undiagnosed HIV. One way of doing this is opt-out testing, whereby blood tests are routinely done in A&E departments checking for HIV and hepatitis B and C. Is my noble friend aware that a pilot scheme in four major cities has already produced 261 new HIV diagnoses in just 10 months? That saves lives, saves money and relieves pressure on the NHS. Given the huge public health and financial benefits, is it not time to expand opt-out HIV testing to all areas with a high HIV prevalence?

I am grateful to my noble friend for that question. I too would like to pay tribute to the late Baroness Masham, to the work she did with the APPG on HIV and AIDS, to her work as a disability campaigner and to her career as a paralympic athlete. She will be sadly missed.

I agree that the preliminary results of the pilot are promising. We will be considering the full evidence from the first year of the programme alongside the data on progress towards our ambition of ending new HIV transmissions in England by 2030, in order to decide whether further to expand opt-out testing in areas with high HIV prevalence—that is, those with more than five cases per 1,000 people.

My Lords, I agree with what the noble Lord said and I too pay tribute to Baroness Masham, who, right from the beginning, was a great and very effective campaigner on HIV and AIDS. One of her concerns was the unacceptable stigma suffered by those with HIV, in spite of all the medical advances made since the 1980s. Will the Government initiate a new drive to combat such stigma? They might even consider calling it “Sue Masham’s campaign”.

I am most grateful to the noble Lord for his excellent question. I agree with him; it is an excellent idea and I will take it back to the department.

My Lords, I refer to my entry in the register of interests, and in particular to my role as a patron of the Terrence Higgins Trust. As the noble Lord, Lord Black, said, opt-out HIV testing has played an important role in tracking down people diagnosed with HIV who are not receiving care. However, the Elton John AIDS Foundation’s social impact bond found that even more success was achieved through HIV clinics’ audit and recall system. Therefore, will the Minister take action to ensure that HIV clinics are specifically funded to undertake audit and recall, to ensure that everyone living with HIV is receiving the treatment they deserve?

I am most grateful to the noble Lord for his excellent question. I absolutely agree that it is very important that we keep data for those with HIV. As part of the Government’s HIV action plan, NHS England has expanded opt-out HIV testing in accident and emergency departments in areas with high levels of HIV diagnosis and prevalence. It is a proven and effective way to identify new HIV cases, in line with the guidance from the National Institute for Health and Care Excellence.

My Lords, as a co-chair of the all-party parliamentary group, I know that Baroness Masham supported people with HIV long before it was popular to do so, and she never, ever gave up on them.

In its first 100 days, the opt-out scheme has cost £2.2 million and has saved the NHS between £6 million and £8 million. It has taken us 10 years to get to this very cost-effective intervention. Do the Government now understand that there is a robust case for rolling this out not just to very high prevalence areas but to high prevalence areas? In very high prevalence areas, the length of stay of a newly diagnosed patient has been reduced from 29 days to 2.5 days. All round, there are savings to be made for the NHS by doing this.

The noble Baroness makes a very good point. We are considering the full evidence from the first year of opt-out testing, alongside the data on progress towards our ambition of ending new HIV transmissions in England by 2030, in order to decide whether to expand this programme to areas other than those with high HIV prevalence. We will also share the findings from the opt-out testing programme with local health systems to inform local decisions on expansion.

My Lords, my noble friend will be aware that the drug PrEP is very effective in preventing HIV transmissions. What are the Government therefore doing to ensure that it is available to those who need it, and when will it be available? I too fully support the opt-out clinics; they are making significant savings and I urge the Government to expand them across the country.

I thank my noble friend for that question. We know that the HIV prevention drug PrEP is extremely effective at preventing HIV transmission. We are developing a plan to improve access to PrEP for key groups and in settings outside of sexual health services, as part of our HIV action plan commitments.

My Lords, I too pay tribute to the late Baroness Masham; she will be much missed for her work and effectiveness not just in this area but in many others too.

Following on from the Minister’s answer to the last question, I think we all acknowledge that the great game- changer in the prevention of HIV is the cheap and simple drug PrEP. However, there is a major problem with prescription, particularly for those trying to access it for the first time. What assessment have the Government made of the incidence of HIV because people cannot easily access PrEP? Will the Minister look at extending the prescribing of HIV prevention drugs beyond hard-pressed sexual health clinics to other sources, including GPs and community pharmacies?

The noble Baroness raises a very important point. PrEP is now being commissioned as a routine service, and PrEP funding has been fully included within the public health grant, which will benefit over 80,000 people at the highest risk of HIV. But I do agree that having access through GPs would be helpful.

My Lords, what is the Department for Education doing or planning to do in schools by way of sex and relationship education to prevent young people getting HIV and sexually transmitted diseases?

I thank my noble friend for that question. The Prime Minister is also concerned about reports that inappropriate materials are being used to teach sex and relationship education to young people. As the Prime Minister has set out, we are clear that the materials used must be factual and age appropriate. We have brought forward a review of the statutory guidance and will conduct a consultation on it later this year, as planned and in line with the usual process. The review will look at whether we should place clearer limits on the content being taught to children, depending on their age.

My Lords, there has been a significant and welcome increase in the number of people ordering HIV tests online, but when they go to the website they find that tests are available in only a limited number of local authority areas. Will the Minister look at the potential benefits of making this free testing service available in more parts of the country?

I thank the noble Lord for that question. I was unaware that it was not universally available to all health authorities in the UK, but I shall certainly pass that question on.

To return to the issue of PrEP, two years after its regular commissioning, do not too many people face long waiting lists or remain unaware of the tremendous benefit they could get from this great drug?

I am grateful to my noble friend for that question. If he knows of any specific cases, I shall certainly look into that.

My Lords, the National AIDS Trust found that nearly 100,000 people in the UK received HIV care in 2019. The late Baroness Masham rightly highlighted the problem of stigma. Mental health services are disproportionately greatly required for patients with HIV, and those with advanced HIV need expert palliative care. What are the Government doing to ensure that that population get the palliative care and mental health services they need? Not everybody is living easily and well, despite the treatment regimes we have.

I thank the noble Baroness —and the noble Lord, Lord Fowler—for making the point about stigma. We all recall what the stigma was like in the 1980s and 1990s; hopefully, the situation is much better. I hope and believe that that group receives the palliative care it rightly should. If the noble Baroness knows of any individual cases, she should get back to me.