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HIV Awareness: PSHE Lessons

Volume 621: debated on Friday 24 February 2017

Motion made, and Question proposed, That this House do now adjourn.—(Mr Syms.)

The issue that I wish to raise today with my hon. Friend the Minister is sex education in our schools. For once, however, I do not want to stray near the issue of statutory sex education; I wish to focus on HIV awareness in the teaching of health and sex education to pupils. Before I touch on the issue of how the subject is taught, I think it is important that we understand the ongoing public health issues that need to be addressed, in part through improved sex education.

As chair of the all-party group on HIV and AIDS, I am conscious of the work we still have to do to eradicate HIV/AIDS. Despite the groundbreaking public health initiatives of the 1980s—for which much credit must go to the leadership and tenacity of the then Secretary of State for Health and Social Security, Norman Fowler, who is now Lord Speaker—HIV/AIDS continues to be a health issue in the UK. There are now more people living with HIV in the UK than ever before. In 2015, an estimated 101,200 people in the UK were living with HIV, 13% of whom were unaware of their infection. Infections used to occur predominantly among men who have sex with men—MSM—but that has changed over the past 10 years. The majority now occur through heterosexual transmission: in 2015, 57% of new infections were among heterosexuals. Most telling is the fact that 90% of those new infections came through unprotected sex—sex without condoms.

We continue to have a public health issue and a problem with sexual behaviour. I believe that we must therefore redouble our efforts not just to change, but to ingrain behaviour. We need to ingrain the safe sex message at the time in people’s lives when it can have the biggest impact—in our schools, with the 15-to-18 age group. I do not propose to touch on the arguments about statutory sex education—as I said, that is a debate for another day. Instead, I want to touch on why targeting 15 to 18-year-olds is important and, crucially, on why we need to look at a different approach to teaching this important topic.

Overall infection rates were on a steady downward trend until recently, but we have seen a slight increase in infection rates in the 15-to-24 cohort. There could be many factors behind that increase. HIV/AIDS is less visible in the media than it used to be; it receives less attention from celebrities, who have been invaluable in raising awareness. Major breakthroughs in treatments and in the accessibility of anti-retroviral drugs—ARVs—mean that HIV/AIDS is no longer life-threatening, although it is certainly life-changing. The fact that it is no longer deemed a terminal illness might be a factor in why people are becoming a little complacent: because living with HIV is manageable, people think that they can cope by just taking a daily pill.

You will remember, Madam Deputy Speaker, and so will other hon. Members, that when we were under the age of 24 we felt invincible—nothing could touch us. Now, when we drive past a club at 3 in the morning, it might be minus 6° outside, but under-24s are scantily clad because they think they are invincible. They think that nothing will happen to them, or that if it does they do not have to worry, because there is a pill or because by the time it becomes a problem there will be a cure. Importantly, the safe sex message about the use of condoms has been lost or diluted. It is important to remember that condom use protects against not just HIV, but a range of other sexually transmitted infections.

How do our teenagers learn about sex? We know that access to the internet has changed how many teenagers view sex, and that online pornography can provide a distorted and unrealistic view of sex. The ability to find a date or sexual partner via phone apps has changed how teenagers learn to have sex and the frequency with which they can have it, but sadly online pornography and hook-up apps rarely teach or stress safe sex. Too many provide no sexual health messages at all.

That, of course, is not a matter for the Department for Education, but how we combat that distorted view of sex and address the lack of safe sex messages is a matter of education. We have to be honest and accept that few teachers relish delivering sex education, and it is probably true that few pupils relish discussing sex with a teacher. It is embarrassing for both. There is likely to be a credibility gap. Even a teacher in their 30s will be deemed old by teenagers in school and being taught about sex by them is likely to be viewed as being taught by their mum or dad. That is how cringe-worthy much sex education can become.

I believe, therefore, that we need to use people closer to the age range of the students, especially those I would call young advocates—those with personal experience of living with HIV or chlamydia, of having a cervical cancer test or of the implications of losing a parent to HIV/AIDS. If sex education is delivered by people closer to the age range of the audience, it becomes personally relevant and much more powerful in getting the audience to listen. Young advocates can explain sex beyond the mechanics without embarrassment—I realise it was a long time ago, but my sex education was very mechanical and quite rudimentary.

If we can update how we teach teenagers about sex, we can have a significant impact on their sexual health. We need to show how life-changing illnesses such as HIV can be, and that message is much more powerful if taught by somebody going through that experience. It is important to stress not just the implications of dealing with an infection or life-changing illness but—most importantly—how teenagers can protect themselves from HIV/AIDS and a range of other sexual health issues. Young advocates can deliver a more powerful and personal message—one that students can relate to and are more likely to take notice of. We need a radical change in how we approach sex education, especially HIV awareness.

I thank the chair of the all-party group on HIV and AIDS for giving way. As a vice chair of that group, I wholeheartedly agree with his comments. Will he join me in praising the work of people such as the Student Stop AIDS campaigners, who are raising awareness of the epidemic not only in this country but of its impact globally, and setting an example for their peers?

The hon. Gentleman makes a very good point. The all-party group often invites young advocates and voices to come in and talk to parliamentarians and others, and we have seen at first hand the impact that a young person can have talking about the impact of an HIV infection on their life and their family. It is much more powerful than middle-aged men or women talking to teenagers—not that he is a middle-aged man yet.

I shall provide just three examples of people and organisations that I would ask the Department to consider meeting and using. One of the most inspirational young men I have met is Robbie Lawlor. He is an HIV advocate based in Ireland and the UK. He was diagnosed as HIV positive at 21. He was taught little about sex in school, let alone safe sex. His diagnosis sent him into depression and he abandoned the university place he was about to take up, but he has now become an inspirational advocate for HIV awareness. He tours and speaks passionately about the need to talk more openly about sex and safe sex and about how to challenge stigmas and ensure that people are more aware of risky behaviour and the importance of testing. He says:

“If we can’t talk openly about sex with our friends and family, how are we going to negotiate safer sex with people we may potentially sleep with? Shame inhibits people from going to get tested, and prevents people from getting the information they need.”

Robbie has also advocated for people living with HIV to be at the heart of education on HIV to ensure that individual stories are heard and some of the most damaging misconceptions about what it is to live with HIV are confronted by people who know how their diagnosis has affected their day-to-day lives. I urge my hon. Friend the Minister to meet Robbie and hear at first hand how we need to change the way in which we approach HIV in sex education.

There is also a group called Positive Voices, whose speakers are fully trained to deliver sexual health presentations to diverse audiences in a range of settings including schools, colleges, faith-based groups and community organisations. They cover HIV prevention and safer sex messages, as well as sharing their own experiences of living with HIV. Those presentations are very powerful. They are tailored for young people and adults, and the speakers work with organisations in advance to ensure that they are both appropriate and engaging.

I recently came across the Elizabeth Taylor AIDS Foundation, which is now doing work in the UK. It has launched an initiative called the sex squad. I must say that I became rather excited by the idea of a sex squad: it is certainly a catchy title for a sexual health education initiative. Imagine the sex squad coming into your school! It would certainly catch the imagination of the pupils.

The sex squad initiative is part of an arts-activist movement to improve sexual health education. It started in Los Angeles, and, interestingly, in the very traditional, conservative southern states of the United States, and it involves a multiple-component presentation and peer education. It is a new model for community-based sexual health education, which targets young people in communities that are at risk of HIV and other sexually transmitted infections. As well as organising live and digital interventions, it is inspiring the creation of youth-led high school sex squads at four state high schools in Los Angeles. It harnesses the power of humour and story-telling to create performances for teens that are memorable, inclusive, and fun. I can only recommend the work done by the foundation, which is driven by Elizabeth Taylor’s grandchildren. They are still heavily involved, which is to their enormous credit.

HIV continues to be a problem in the 15-to-24 age group, accounting for 11% of new infections, while 33% of new infections are in the 25-to-34 age range. It therefore accounts for 44% of new infections in people under 34. We need to reach people when they are most susceptible to behaviour change. We need to stop the conveyor belt towards inappropriate behaviour that puts their health at risk. We need to change the way we deliver sex education, especially HIV education, so that we can protect the next generation. The current sex education system is not ingraining the message on safe sex. It is time for a more innovative approach. It is time to introduce youth ambassadors where they will be listened to, and where we stand the best chance of changing behaviour and changing lives. Let us change the teaching, and let us change our approach.

I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for raising this important issue, and I congratulate him on his ongoing work as chair of the all-party parliamentary group on HIV and AIDS, which I know is making a huge difference. The dedication and tenacity that he and his group show are to be applauded.

HIV/AIDS is a serious public health concern that affects the lives of many, both in the United Kingdom and internationally. Stopping the spread of HIV is still a priority in the UK, as is supporting people living with it so that they can lead full and healthy lives. I believe that if we look at our efforts to tackle the HIV epidemic in this country, we can be very proud of our record so far. The United Nations’ 90:90:90 ambition to eliminate HIV-related mortality and transmission by 2020 calls for 90% of people living with HIV to be diagnosed, 90% of those diagnosed to receive treatment, and 90% of those treated to be virally suppressed. We are responding to that challenge. The UK has already met the second and third components of the 90:90:90 targets, with 96% of those diagnosed receiving antiretroviral treatment and 95% of those treated being virally suppressed.

Of course, there is still much more to do. In 2013, an estimated 13% of individuals with HIV were undiagnosed. Awareness of HIV status is important not only because it enables people to get treatment and allows them to live long and healthy lives, but because it can prevent the infection from being passed to others. That is why the work to improve testing is critical to the public health response to HIV. Local authority services funded through the public health grant do a vital job in that regard, but we need to go further and faster in making testing routine.

I agree with my hon. Friend that it is crucial that we ingrain the safe sex message, particularly in young people. Schools have an important role in preparing young people for the challenges they face in modern life. That includes building their knowledge and raising awareness of HIV and other sexually transmitted infections.

Education can help to improve young people’s ability to make safer, healthier choices as they progress through life, in a sensitive and age-appropriate way. HIV is part of both the science curriculum and sex and relationship education, which is frequently taught as part of personal, social, health and economic education. The national curriculum and the new combined science and biology GCSE stipulate that pupils be taught about HIV within the context of communicable diseases during key stage 4. They are also taught about how HIV is spread.

HIV awareness is also taught as part of sex and relationship education, which is mandatory in all maintained secondary schools. Academies are encouraged to teach sex and relationship education as part of their requirement to teach a broad and balanced curriculum. Primary schools are free to teach the subject if they wish to.

When teaching sex education, all maintained schools and academies have a statutory requirement to have due regard to the Secretary of State’s sex and relationship education guidance. The guidance makes it clear that all sex education should be age appropriate and that schools should ensure that young people develop positive values and a moral framework that will guide their decisions, judgments and behaviour. We want all young people to feel that SRE is relevant to them and sensitive to their needs. The guidance is clear that teaching should help pupils to clarify their knowledge about HIV and AIDS, to understand risky behaviour and to become effective users of services that can prevent and treat STIs and HIV.

Teaching sexual health is a key part of SRE. Effective SRE does not encourage early sexual experimentation, but teaches young people to understand human sexuality and respect for themselves and others. It enables young people to be mature, to build their self-confidence and self-esteem and to understand the reasons for delaying sexual activity. It equips young people to tackle the many different and conflicting pressures they experience today.

To teach young people about HIV effectively, teachers need accurate and up-to-date knowledge. The Government are funding the network of science learning partnerships to provide continuing professional development for science teachers. That includes providing support to teach the new science curriculum and GCSEs. A number of resources to support teaching about HIV are also available on the National STEM Learning Centre’s website.

I agree with my hon. Friend that innovative, engaging ways of delivering sex and relationship education are important in supporting young people. Schools are free to develop peer education models to complement SRE and I would encourage them to do so. As a mother of teenagers, I know how anyone over the age of 25 is regarded as old and anyone over the age of 40 is regarded as practically prehistoric. Therefore, having young role models—I have seen some great examples up and down the country in schools I have visited—is helpful and a powerful tool. The guidance identifies that as good practice, stating:

“Secondary schools should…use young people as peer educators”.

I am grateful to my hon. Friend for highlighting organisations working in that field, including Robbie Lawlor, Positive Voices and the intriguingly and quite excitingly named sex squad. I would be delighted to meet them and hear more about the work that they are doing.

Of course, young people are an important target group. Schools play an important role in ensuring all young people are equipped to develop safe, healthy relationships. We know that young people get information about this from a wide variety of channels and we want to ensure that they are accessing factually accurate information.

That is why I am pleased that Public Health England has developed “Rise Above” specifically for young people. “Rise Above” is a digital platform, with engaging interactive content, which aims to prevent or delay young people between 11 and 16 from engaging in exploratory behaviours, and that includes risky sexual practices. It is also developing a schools programme for launch at the end of March 2017.

Public Health England also funds the “Worth Talking About” free helpline for young people providing information about all aspects of sexual and reproductive health. We also continue to fund the Terrence Higgins Trust to deliver social marketing and digital media messages to groups at increased HIV risk and to promote National HIV Testing Week.

I agree with my hon. Friend that the age-appropriate teaching of safer sex in line with guidance is very important. The guidance makes it clear that

“young people need factual information about safer sex and skills to enable them to negotiate safer sex.”

Schools that deliver this effectively do so in partnership with parents and reflecting the needs of their community, but we can do more both in PSHE and SRE.

According to the HIV Stigma Index UK, the stigma sometimes experienced by those living with HIV can, unfortunately, lead to low self-esteem and a reluctance to access specialist services, thus preventing individuals from receiving the best treatment available. Raising awareness of HIV in schools can help young people overcome prejudice and understand that it can affect anyone.

Overall, I believe that schools make a considerable contribution through the core science curriculum to providing young people with the knowledge they need to have an informed understanding of HIV, AIDS and sexually transmitted infections. But this is about much more than just knowing the facts. As I said earlier, SRE is often taught as part of PSHE, and effective PSHE teaching makes a critical contribution to a broad and balanced curriculum in schools that promotes pupils’ spiritual, moral, cultural, social, mental and physical development.

PSHE is a non-statutory subject, but we know that many schools and teachers already recognise the importance of good PSHE education, and know that healthy, resilient, confident pupils are better placed to achieve academically and be stretched further. We want to help all schools to deliver high quality PSHE and SRE so that all young people are equipped to have healthy and respectful intimate relationships at the appropriate age, and leave school with the knowledge, skills and attributes to prepare them for life and work in modern Britain.

That is why we are committed to exploring all the options to improve the delivery of SRE and PSHE. My boss, the Secretary of State, has committed to update Parliament further on the Government’s plans during the passage of the Children and Social Work Bill, and I would very much value the input of my hon. Friend the Member for Finchley and Golders Green on this very important issue as we move forward.

Question put and agreed to.

House adjourned.