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HIV Commission

Volume 685: debated on Tuesday 1 December 2020

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

Through you, Madam Deputy Speaker, I thank Mr Speaker for granting what is a special Adjournment debate on the launch of the HIV Commission, falling as it does on World AIDS Day. I am very grateful.

World AIDS Day is a campaigning moment, a day when we wear a red ribbon and, on this World AIDS Day, when we launch the final report of the HIV Commission. That is very much how I viewed it when I was the Public Health Minister, but actually World AIDS Day is a day of remembrance and reflection.

Terry Higgins, who gave his name to the Terrence Higgins Trust, was one of the first people in the UK to die of an AIDS-related illness. He was only 37 when he died in July 1982, just across the bridge from here, in St Thomas’ Hospital. He was of course followed by many more. Today, we remember not only someone whose name is well known and synonymous with the fight, not only the rock star who made Live Aid what it was, but the dad, the mum, the son, the daughter, the brother, the sister, the partner, who we will never know, but those they left behind certainly did.

We also pay tribute to the HIV activists—many are still with us, and too many are not—who have never given up in their pursuit of better treatment for HIV, a cure one day, an end to new transmissions, improved services and the fight against the dreaded stigma of HIV, which still persists. The best way we can honour all those people is to refocus our efforts and to end new cases of HIV by 2030. Today, it so happens we have a plan to do just that.

In 1986, I was one year into secondary school when AIDS touched down. No one can forget seeing the tombstone advert—never mind the iceberg version, which was actually more scary—of the “Don’t Die of Ignorance” campaign, with the raspy, menacing voiceover provided by the wonderful John Hurt. I want to read out the opening words of that TV commercial:

“There is now a danger that has become a threat to us all. It is a deadly disease, and there is no known cure...Anyone can get it, man or woman. So far it has been confined to small groups, but it is spreading”.

Does that sound familiar? Back in 1986, AIDS seemed to be a threat that would overwhelm us—also familiar. Those words of John Hurt that I read out—those adverts —terrified a nation, and they were meant to. I would argue that it was the most successful public health message in our history—until, perhaps,

“Stay at home. Protect the NHS. Save lives.”

Fast forward 30 years and I find myself, much to my surprise, the Public Health Minister with the opportunity to put what has become scientifically possible—ending new cases of HIV by 2030—into policy. When we first proposed the idea to my right hon. Friend the Secretary of State—I am deeply touched that he is here to respond to the debate, today of all days—it was not a tough sell. We had already done so much as a country, meeting the UNAIDS 90-90-90 targets on testing, treatment and early suppression, and the Secretary of State understands that prevention is better than cure more than most. It was terrific to watch him tell the AIDS-free cities global forum in London in January 2019 that this Government would set themselves the ambitious—but we think wholly achievable—goal of today’s commission. Just as Lord Fowler, in 1986, as Secretary of State for Health and Social Security, rejected a moral crusade against a way of life in favour of a practical plan to fight a virus, so we, in creating the HIV Commission, turned the possible into policy and the policy into this practical plan.

I pay tribute to Dame Inga Beale, who chaired the commission with a firm hand and great style, as well as the hon. Member for Ilford North (Wes Streeting) and the eight other commissioners, who put so much into producing what we launched this morning, with the help—wearing a fabulous jacket, if I may say so—of Sir Elton John. I also pay tribute to the three CEOs who made this possible—Ian Green of the Terrence Higgins Trust, Deborah Gold of the National AIDS Trust and Anne Aslett of the Elton John AIDS foundation; thank you so much. I also pay tribute to many, including the chair of the all-party group on HIV and AIDS, the hon. Member for Cardiff South and Penarth (Stephen Doughty), and my hon. Friend the Member for Finchley and Golders Green (Mike Freer) who cannot speak this evening, who have done so much to assist us in this journey.

The prize is clear: England could be the first country to end new cases of HIV, and we can help the world do the same.

It has been such a privilege being a member of the independent HIV Commission, not least because of the wide range of people we have met and engaged with during our work. That has helped us to put together a concrete action plan that could help us, if we get this right, to end HIV transmissions by 2030. That is such an enormous prize.

I want to join my hon. Friend in thanking everyone who took part in the commission, particularly the chair, Inga Beale, for her wonderful leadership. If I may do so from the Opposition Benches, I want to thank the Secretary of State for Health and Social Care for being in the Chamber this evening to respond to the debate. We have seen great cross-party leadership from him, and from the Leader of the Opposition—the leader of my party. Therein lies the hope that, with joined-up political leadership locally and nationally, we will turn the report into not just a worthy piece of work, but a concrete plan of action that changes people’s lives and changes the course of history.

I bless my hon. Friend for that. It has been a pleasure to work with him on the commission. He has Front-Bench responsibilities himself and it is a big commitment. We had to be sure that that commitment would lead to something proper, something realistic, something deliverable; and I do not think we could have asked for better in the plan that has been produced. The cross-party element is so important. There is no room for an inch of partisanship in the all-party group for HIV and AIDS in this fight because, whatever happens at the 2024 general election, we cannot reset after that election if there should be a change of Administration; we need to keep up the focus and keep working across the House. I give way to the Chair of the all- party group.

I absolutely commend the hon. Gentleman’s work and leadership on this, not only as a Minister but as a member of the commission. I commend my hon. Friend the Member for Ilford North (Wes Streeting), the Secretary of State, and the Health Ministers in the devolved Administrations as well—including my colleague Vaughan Gething, the Health Minister in Wales—because it is only with leadership on this issue and cross-party working, and cross-UK working, that we will get to that crucial target of zero infections by 2030. Does the hon. Gentleman agree that, as on so many public health issues, this is a global fight as well, and that our continued support as a country for things such as the UN Global Fund is crucial to getting to that 2030 target globally, as well as in this country?

I most certainly would. As a Health Minister I travelled around the world to G7 and G20 meetings. The NHS and what we do within it, as the Health Secretary has said many times, is so well respected around the world that we often set the tone and the lead. Yes, this is a plan for England, but I hope it will work across the devolved nations of the UK. I hope that we will set the standard around the world, as we have in so many areas of public health policy, so that others will then follow. I take the hon. Gentleman’s point exactly.

First, I congratulate the hon. Gentleman on securing the debate. I just want to add my support for the HIV Commission project. I spoke to him beforehand. It is important that we put on record the hard work that has been done by so many people, including by those in my constituency. The Elim Church’s missions have helped to address HIV in Swaziland. Over the years I have known them and what they have done, they have been instrumental—it is a wonderful thing—in assisting the Swazi Government to reduce the number of adults who have HIV from 50% to 27%. A programme of education and medical support has helped. Does he agree that what they have done in Swaziland could enable us, through the House of Commons, to deliver that to the rest of the world as well?

Yes. The faith element is very important. We have done very well on driving down the numbers, but we have to do even better, and it will get harder as we get closer to the goal. Reverend Steve Chalke, a Baptist minister and the founder of the Oasis Charitable Trust, was one of our commissioners. He provided a very important element and the hon. Gentleman’s point is very valid.

Why do I say that this is scientifically possible? A HIV diagnosis is a notification of a serious condition, but these days, thank goodness, it is not the death sentence it once was and many understand it to be. An end is therefore in sight. Treatment has come such a long way. People on the right treatment have their viral load suppressed, meaning that they cannot pass on HIV. That, frankly, was a game changer. Overwhelmingly, people in England and the UK now know their HIV status. Of the 106,000 people with HIV in our country today, 94% know they are HIV positive, 98% are on treatment, and nearly all are virally suppressed and therefore cannot pass it on.

In addition, we have a wonder drug, PrEP— pre-exposure prophylaxis—which is taken by people who are HIV negative. It stops transmission during sexual intercourse. The PrEP impact trial data comes out in the new year, but we know already that it is a massive success—I hope I am proved right in that assertion. The Secretary of State made the drug readily available, free on the NHS—that was important. That took a little longer than it might have done but, legal challenges notwithstanding, let us not dwell on old ground. Let us ensure that all communities that can benefit from it know about its virtues and its availability.

If we are to get the benefits of PrEP to all who need it, HIV testing is needed in GP surgeries, pharmacies—I refer the House to my entry in the Register of Members’ Financial Interests—termination clinics, gender clinics and much more besides. Then, PrEP prescribing powers need to be given to each of those bodies. Again, it can be done—we need the will to do it. I commend the PrEP Protects campaign, focusing on black African women and men. If we can get take-up in other communities as there has been with gay and bisexual men, we will be changing lives and saving money. So thank you to the Terrence Higgins Trust, the National AIDS Trust, I Want PrEP Now, who lobbied me heavily as a Minister, and PrEPster for their amazing campaigns on the issue.

I thank the hon. Gentleman very much for giving way. Does he commend the efforts of community groups who are going out and selling that message to their own communities? Those who work for Waverley Care in Glasgow and the Hwupenyu Health and Wellbeing Project are making sure that the message gets out into the community.

Absolutely. The big society groups have been so important to the work of the commission. We have heard from many of them and I know they are very important north of the border, so I thank the hon. Lady for putting them on the record.

With the cavalry—the science—in place and the policy agreed, we needed a practical plan. For 18 months, the commission met, listened, learned and deliberated. Its recommendations are clear and I will close with a few of them. The first benchmark is to get new instances and the number of people undiagnosed down by 80% by 2025. Most of those will be in communities we already work with to reduce HIV transmissions, but the last 20% most likely will not. They will be hard to find, but the rewards will be great.

Secondly, we want Ministers to report to Parliament annually on the 2025 target and the 2030 goal. This will focus minds and track progress. To make these kinds of advances, we need the promised HIV action plan in very short order.

Thirdly, HIV testing—this is the crucial bit—must become normalised in the system. No longer should 250,000 people go to a sexual health clinic and not be offered a test, but we must go so much further. When someone presents at A&E or registers with a GP and the NHS or whoever else is taking blood, an HIV test must be carried out—so not opt-in, but opt-out. The default assumption is that it will happen.

We know that that can happen. Maternity services have shown that it is possible. Midwives test pregnant women for HIV, in non-judgmental settings, and there is a 99% take-up and therefore near zero vertical transmission to newborn babies. It could be the same elsewhere if we get this right, but there are many challenges in doing that. The funding is with local government. The testing needs to happen in primary care as well as secondary, but it is all possible with political will. In short, it is a policy of test, test, test, and if ever there was a time when we can successfully land that message, it is surely at the end of this ghastly 2020.

Underneath these recommendations lies a 20-point action plan to bring all this to life. Rarely has a commission been presented with such an implementation-friendly set of actions. If the Government are minded—and they have one or two other things on their plate right now—they could do a lot worse than copy and paste our findings into the first draft of the aforementioned HIV action plan. Each action is assessed for its impact on health inequalities and its contribution to fighting stigma. It looks to everyone who is and could be affected by HIV, and that was important to us. We are not denying that some of this will require investment, but I think that it is investment worth making, because bluntly, it will change and save lives, and we have shown how to do that after the Government asked us to.

If the moral case does not persuade people listening to this debate, hard cash might. Modelling by the Elton John AIDS Foundation found that over £200,000 in future healthcare costs were saved per person who was diagnosed and linked into the right treatment and care, so, not unlike the dynamic we face in cancer care, early diagnosis is the magic key in HIV as well.

Finally, to the wider sector, I say this: I hope that we have done you proud in our work with the HIV Commission. You got us here. We now need to come together to get this done. To my colleagues in the House tonight and listening elsewhere who will join us in campaigning for exactly what we are asking, I say: many thanks in advance. We will be in contact.

We could end HIV transmission on our watch. How amazing would that be to that 12-year-old schoolboy and many others who saw that advert in 1986? Let us not pass up the opportunity and, with this man as Secretary of State, I do not think we will.

Just a few minutes ago at this Dispatch Box, I was here to update the House on the national effort to fight the new pandemic of our times. As we grapple with this one pandemic of coronavirus, so too we need to look today at both the progress we have made and the progress still needed, to mourn the loss of those who have been taken from us, and to redouble our efforts in our fight against another killer pandemic, HIV.

Just like coronavirus, HIV was a challenge for humanity that, at times, especially early on, seemed almost impossible to surmount, but thanks to the ingenuity of scientists, the compassion of healthcare professionals and the determination of people living with HIV and their loved ones, we have made so much progress against this disease. So today, on World AIDS Day, let us all commit, across the House and in all parts of our country, to stand firm against the disease that threatens us and commit that we will give it no ground.

I thank my hon. Friend the Member for Winchester (Steve Brine) for securing this debate. He worked tirelessly on this issue when he was a ministerial colleague—a brilliant Public Health Minister—and I want to tell the House in all honesty that he was absolutely pivotal to so many of the achievements and aspirations that we are discussing today. Without him, I wonder whether the 2030 commitment could have been made. We should all be grateful to him for his dedicated work in office and his continued powerful advocacy. He mentioned the “Don’t Die of Ignorance” campaign and I can tell him and the House that the early messaging in the coronavirus pandemic, including “Stay at Home”, was explicitly inspired by that campaign, which was so successful and so brave.

Every day when I walk into my Department, I walk past a list of my predecessors on the wall, and I feel honoured to follow in the footsteps of Lord Fowler, who did so much to tackle this pernicious virus and who, in particular, took a view and a judgment that we must face it on the basis of compassion and science. That was central to the decision that this country took all those years ago, and I am glad to say that we have followed it ever since.

We have made significant progress since those dark days when, as my hon. Friend said, HIV was a death sentence for so many. Now, if diagnosed early and with access to appropriate treatments, the majority of people with HIV in this country can have a life expectancy that is close to normal. I am so proud that, here, the overall number of people with a new HIV diagnosis has fallen by over a third over the past five years and that the number of gay and bisexual men with newly diagnosed HIV has fallen to its lowest point in 20 years. I am also really proud that, through the efforts of so many people, we have met our UNAIDS 90-90-90 target for the third consecutive year and that we were one of the first countries in the world to do so. That means more than 90% of people who live with HIV being diagnosed, more than 90% of those diagnosed getting treatment, and more than 90% of those who are treated having quantities of HIV that are so small that it is undetectable.

The Secretary of State is talking about the excellent progress that has been made, and I acknowledge that that is true, but one area where there is still significant difficulty is among intravenous drug users, particularly in the city of Glasgow. We want the public health intervention of a supervised drug injection facility, but the Home Office is blocking this. Does he agree that there needs to be a public health approach to this, otherwise we will not be able to treat those remaining percentages of people who still have the virus?

I was immediately going to turn to say that despite the successes, there is further to go and we would all agree on that. We need to follow the evidence of what works and, crucially, we need to work together. I know that the Home Secretary has been working with the Administration in Scotland on the approach to be taken. The attitude that we should have is that every new case of HIV is one case too many.

That brings me to the commitment that we were able to make two years ago. At the suggestion of my hon. Friend the Member for Winchester, I announced the commitment to ending new HIV transmissions by 2030. I remember being told at the time that this was an ambitious target, but I know that we can get there. This year, we have been making PrEP routinely available across England to those who need it, and have backed that with funding for local authorities. None the less, it is really this report from the HIV Commission that shows us the way. I want to thank all those who have been involved: the Terrence Higgins Trust, of course; the National AIDS Trust; the Elton John AIDS Foundation; Public Health England; and work across the devolved Administrations. I also take this opportunity to thank Sir Elton for his exceptional personal advocacy for people living with HIV and the sterling work that he has done to raise money for HIV prevention and treatment across the world, and to thank all those who have played their part in getting us to where we are.

Let me turn now to the work of the commission itself. I know that colleagues across the House have played an active role in it. The report that the commission has published today makes many important recommendations for how we can progress on our path to zero. I pay tribute to all the commissioners for their hard work and thank each and every one of them. I wish to put on record my thanks and praise for Dame Inga Beale for her expert leadership.

My hon. Friend set out the core recommendations, which include the interim milestone of an 80% reduction in new HIV transmissions by 2025, early diagnosis at the core of the approach we should take and the default assumption of test, test, test—that sounds familiar, and we know that it works—as well, of course, as the expansion of testing.

The reason I wanted to come to the House personally tonight was so I could say this: we will use the excellent report of the HIV Commission as the basis of our upcoming HIV action plan, which I commit to publishing next year. I want that to be as early next year as is feasible to ensure that the work is high-quality, can be delivered and can set us fair on a credible path to zero new transmissions in 2030. I look forward to working with Members from all parts of the House in making that happen.

May I, on behalf of the all-party group, thank the Secretary of State for that commitment, which is absolutely crucial? I know it will be welcomed by me and my predecessor, who cannot speak here. Will the Secretary of State also commit to doing all we can as a country, working with his colleagues at the Foreign, Commonwealth and Development Office and elsewhere, not only to ensure that our commitments globally are met in the UN Global Fund, but also to support the world-beating research that goes on in places such as the international AIDS vaccine initiative at Imperial College, which is leading the way towards treatments and vaccines not only for HIV but for so many other infectious diseases, including covid?

The cross-party nature of the support for this work could not be better demonstrated than by the fact that when our colleague from the Scottish National party, the hon. Member for Glasgow Central (Alison Thewliss) intervened, she anticipated my very next sentence, and so has the hon. Gentleman. I wanted immediately to turn to the global matters, because no one is safe until everyone is safe. If we have learned anything this year, we have learned that. We also need to work on shared solutions together and across the world, and we as a country will lean into the global efforts to tackle HIV and AIDS, as we have done under Governments of all persuasions over the past three and a half decades.

In my intervention on the hon. Member for Winchester (Steve Brine), I referred to the good work that has been done in Swaziland. From a global point of view, I just wonder whether the Secretary of State will be able to make contact with Swaziland and see how it has reduced the numbers.

I would be very happy to ensure that that happens and to work with the hon. Gentleman on a subject that I know is close to his heart. I reiterate that over the past three and a half decades, here in the UK we have played our part in supporting efforts right around the world. I am proud that we are the world’s second-largest donor to the Global Fund, which is reallocating up to $1 billion to support the prevention and treatment of HIV and other threats to global public health during the pandemic. We have to make sure that work goes on, even in the clutches of another public health emergency. It is absolutely critical that we do not let up, because we cannot let one virus undo the progress we are making in fighting another.

Today is a day to look back and remember those we have lost to HIV. It is a day to look back and acknowledge the progress we have made, but it is also a day to look forward and together reaffirm our resolve to keep working towards that goal of no new infections in 2030, because HIV is a virus that has taken too many people before their time. We should all redouble our efforts to make it a thing of the past.

Question put and agreed to.

House adjourned.