§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Malone.]9.35 am
§ The Secretary of State for Social Services (Mr. Norman Fowler)
This is the first time that the House has had the opportunity for a full debate on AIDS. I welcome the opportunity this provides to set out the facts about the disease, the serious threat it poses to public health, and how the Government propose to meet that threat. I do not believe that anyone should underestimate just how serious that threat is, in this country as in most of the rest of the world.
AIDS — acquired immune deficiency syndrome—is a new disease. There were no known cases before 1981. The first case of transmission by blood transfusion was reported in the United States in 1983 and a reliable test for routine screening of blood donations was developed in 1985.
What makes AIDS a serious threat is, first, the disease itself is believed to be invariably fatal. There is no cure, nor any immediate prospect of one. So it is a deadly threat, and already in this country there have been 565 cases of which 284 have died.
The second reason is that it is infectious and there is no vaccine by which to protect people. It is not infectious in the same way as diseases such as measles, which are spread in the air by social contact. The disease is actually caused by a virus called HIV—human immune deficiency virus — getting into the bloodstream. The main ways of becoming infected are as a result of sexual intercourse, then, for drug abusers, by blood from an infected person being injected into another's and through babies being infected by the mother before or during birth. In sexual intercourse, we now know that the virus can pass not just from infected man to man, but from an infected woman to a man and from an infected man to a woman.
There is a third factor which makes the disease particularly difficult to counter. It has to do with the characteristics of the virus. Although it does not live long outside the body, once inside it will survive a very long time—possibly for life. Furthermore, it can take several years between catching the infection and becoming ill with AIDS. The average is five years. During that time individuals will mostly be completely well and unaware that they are affected. They are, however, infectious to others. In the United Kingdom it is estimated that about 30,000 people are infected with the virus. They are carriers capable of transmitting the virus. It is not known how many carriers will eventually contract the disease themselves and die, but the proportion is relatively high. So far it is 25 to 30 per cent., but it may be more.
800 So those are the key factors. The AIDS disease is fatal and incurable. The virus is infectious in certain specific ways — principally through sexual intercourse and by drug abusers sharing needles — and has a long incubation period.
It must be emphasised that AIDS is a long-term problem. It is not a problem that will disappear in the next six months or so. The likelihood is that it is a problem for at least the next 10 years, probably for the rest of the century. The number of AIDS cases will inevitably increase whatever we do. Even if no one else becomes infected from tomorrow, there are still the estimated 30,000 carriers—many of whom will eventually develop the disease.
I believe that in that position — a challenge over several Parliaments—it is important to seek as much common ground between the parties as possible. My aim will be to seek as much agreement as possible in the methods to be used to tackle AIDS. I do not think that anyone should be under any illusion that there are some profoundly difficult issues to address.
The Government will seek to ensure that the fullest information is available to the public, and briefings by my staff will be offered not only to Opposition spokesmen but to all Members of the House who want to know more about the position and the background. I shall write to all Members next week with a full factual brief on the issue.
There is another important issue and lesson. We can do something about the threat; the position can be contained. We have the opportunity of learning from the experience of other countries where the disease has gained a greater hold. In the United States, for example, the latest figures show that almost 25,000 cases have been reported and an estimated 1.5 million people infected with the virus. In Europe there are countries where the position is substantially worse than in the United Kingdom. In parts of Africa it is worst of all.
There is no comfort in those figures, but we have the opportunity to prevent the position here from becoming as serious as it tragically is elsewhere. At the moment, only a relatively small group of people are infected in this country. In the main, they are homosexuals or drug addicts or their partners. In addition, there are the tragic cases of haemophiliacs who have been infected with contaminated blood, and, perhaps worst of all, of small babies who have been infected by their mothers.
But the virus is spreading. Unless we all act to protect ourselves, it will not be long before we find the numbers infected rising as high here as in other countries. In those circumstances, there is clearly an important role for Government. But the key to containing the spread of the infection ultimately rests with the individual's own behaviour.
Over the past four years, the Government have already taken a range of measures. Since 1982 AIDS cases have been reported on a voluntary basis to the Communicable Disease Surveillance Centre. The same is true of HIV infection since it first became possible to identify it by a blood test. Since 1983, warnings have gone to all blood donors telling those in high risk groups not to give blood. The evidence is that those warnings have largely been successful. Since the end of 1984, heat treated Factor VIII —the clotting factor deficient in haemophiliacs —has been available to clinicians in this country and has been produced in this country since April 1985. Since 1985, as soon as the present reliable test was available, all blood 801 donations have been tested to eliminate the risk of anyone getting AIDS from infected blood or blood products in this country.
The Government have issued guidance for health care, social services and other staff about dealing with AIDS. We have provided funding for courses to train counsellors and 1,500 people have undergone training in the past 18 months, and the numbers will increase. Most importantly, we have mounted a wide-ranging public education campaign which has involved a series of national press advertisements, a Health Education Council booklet of which about 1 million have been printed, and the telephone advisory service, which has reached 2,500 calls a week.
Before I set out the other measures that the Government now propose, there is a strategic question on the action that the Government should be taking. I am in no doubt that the first priority in combating the disease must be public education and that a concerted attempt must be made to inform the public, and particularly the public most at risk, of the dangers. I believe that clear, explicit language must be used and that we must spare no effort to ensure that the measure is getting through. I understand clearly that there are other concerns and other suggestions, and we will listen to all of those during the debate. But public education is the first priority.
If proof of that approach is needed, we should look at the report that has just been published in the United States by the Institute of Medicine of the National Academy of Sciences in Washington — a body of national and international repute. As I have said, the position in the United States is much worse than here. One estimate is that by the end of 1991 there will be a cumulative total of 179,000 deaths in the United States, with 54,000 of them occurring in 1991 alone. Against that background, the report looked at the different options that were open to Government. It came to this conclusion:Neither vaccines nor satisfactory drug therapies for HIV infection or AIDS are likely to be available in the near future, but action can be taken now to reduce the further spread of HIV infection and thus to alter the course of the epidemic.For at least the next several years the most effective measure for significantly reducing the spread of HIV infection is education of the public, especially those individuals at higher risk. People must have information on ways to change their behaviour and encouragement to protect themselves and others.A similar point was put in a letter to The Times from a group of doctors at St. Mary's hospital in London, who also argued strongly thathealth education must be our main defence at the present time".Meanwhile, in the briefing that it sent round before the debate the British Medical Association quotes the United States surgeon general as saying:Information is the only vaccine we have".I agree with that assessment. For that reason, the Government will expand and intensify their public education campaign. We shall be making £20 million available over the next 12 months for that purpose. The main elements of the campaign that I shall shortly be launching are as follows: from this Sunday there will be a further intensive round of newspaper advertising lasting over the week—the fifth round of such advertisements; that will be backed up by a general poster campaign, with posters appearing in 1,500 sites around the country; 802 shortly after that there will be a youth campaign, using magazines, radio and cinema; early in the new year there will be a leaflet drop to all 23 million households in this country accompanied by television and radio advertising to maximise its effect; the HEC leaflet "Don't Aid AIDS" will be sent to all pharmacies—around 11,000 outlets—where members of the public can get them free.
In addition, I have had talks over the past few days with the chairmen of the BBC and the Independent Broadcasting Authority about the role of broadcasting in the education campaign. Both chairmen recognised the gravity of the situation and agreed that the broadcasting organisations had a role to play. They also showed their readiness to co-operate in public service broadcasting. I am extremely grateful for their co-operation and advice. The IBA yesterday issued a statement welcoming our proposals for radio and television advertising on AIDS and also announcing its intention to follow up those advertisements by a series of public service announcements on both independent television and independent radio. I am sure that the House will join me in welcoming that initiative.
At the same time, the Government are having talks with the Newspaper Society and are approaching members of the Newspaper Publishers Association. I should like to congratulate the many newspapers that have carried specific factual articles on AIDS and how its spread can be prevented.
With regard to the approach to be adopted in the Government's advertising, the advertising will aim basically to get over these messages: "Stick to one partner, but if you do not, use a condom." For drug misusers: "Do not inject drugs; if you cannot stop, do not share equipment." Over the next weeks and months we shall be seeking to get those messages across. What we must all seek to achieve is a change in people's behaviour —everyone taking responsibility for his own actions.
We are fortunate in having the market research results of our previous advertising campaigns to guide us. Clearly, however, the advertising will have to go into detail and will have to use language that is easy to understand. It may be that some will be offended by it. I regret that—but I have to say that I believe the greater danger is that the message does not get over.
There is also a difficult balance to be struck. At the moment, the infection is still virtually confined to the few relatively small groups. Unless we all take action, it will spread more widely into the heterosexual population, as it is already doing in other countries. So our message cannot be confined to those groups. That means striking a balance between warning everyone of the risks, while not causing unnecessary panic. There is next the important problem of long-term policy.
§ Mr. Gavin Strang (Edinburgh, East)
As the Minister knows, there is an important Scottish dimension to this disease in that more than 50 per cent. of the injecting drug misusers in eastern Scotland are now carriers of acquired immunity deficiency synrome. For that reason we attach great urgency to a response to the McClelland report. Do the Government intend to respond to that report today? If they do not, will the Minister give an assurance that we will have a response within the next week or so?
§ Mr. Fowler
The Government understand the importance of the issue. The hon. Gentleman's question raises 803 complex issues and I shall not be able to respond to it today. I entirely share his view that we need to respond relatively quickly. Of course the issue is not just the problem of AIDS but whether the free supply of needles may encourage drug misusers to inject. As the hon. Gentleman said, the McClelland report proposes the issue of clean needles and syringes to misusers basically in return for their dirty ones.
I must underline that any such scheme would need careful supervision and would need to go hand in hand with expert assessment, counselling and treatment. The Government are considering the matter seriously and urgently and I hope that we will be able to make our intentions clear as soon as possible.
There is also the long-term problem of public education. The Government must carry out a publicity effort over the next few months because there is no alternative to that. However, in the longer term we need a new body to develop and carry forward the education campaign for the good reason that the threat and the challenge posed by AIDS will continue. The campaign is intended to inform the public about risks such as this and will be a major part of health education.
The importance of this task and the resources that the Government need to devote to it make it right to enhance and strengthen the role of the Health Education Council. To that end I propose to reconstitute it so that it becomes a special health authority with a clear line of accountability to Ministers and to Parliament. The new authority will initially assume the current responsibilities of the Health Education Council. I also intend that from an early date it should be given the major executive responsibility for public education about AIDS and that it should be resourced accordingly. Therefore, it will have responsibility for a much larger budget than the Health Education Council.
As a special health authority, the new authority will be an integral part of the National Health Service in England. As a result, it should be more responsive than an outside body can be to the needs of the service and in turn will have more influence in setting priorities for the service and ensuring that the needs of health education and promotion are properly recognised. We envisage that the new body will also have a United Kingdom dimension to its work, particularly, for example, in relation to AIDS where there is clearly a need for a nationwide centrally conducted campaign. The exact relationship of the new agency with health education arrangements in Scotland, Wales and Northern Ireland will need to be settled and may vary from country to country. The current statutory arrangements governing health education in Scotland will not be affected, but effective working collaboration will be established.
My aim is that the Health Education Council should be reconstituted on its new statutory basis with effect from 1 April 1987. I should like to place on record my appreciation and that of my colleagues of the work and achievements of the staff and members of the council. It is, I know, held in high regard in the Health Service and beyond.
The new authority will provide enhanced opportunities for its staff to carry forward and develop the important and wide-ranging programmes which the council already has in hand as well as its vital new task in relation to AIDS. There will, of course, be full consultation with staff and trades union representatives to ensure that proper regard 804 is paid to the interests of council staff in the handing-over arrangements. We want to ensure that there is no loss of momentum in the work of the council, and the transitional arrangements will have to take account of that requirement.
I intend to make a statement shortly about membership, staffing and budget of the new authority. The terms of office of existing members of the Health Education Council end in December, but I shall invite them to serve for a further period until the arrangements for the handover to the new body are complete and the formal dissolution of the council as a company limited by guarantee takes effect. Essentialy, these new arrangements underline the crucial importance that health education must have.
§ Mr. Leo Abse (Torfaen)
We have listened with interest to what the Minister has said about the advertising campaign. However, I am quite sure that we are all waiting to hear about extra funding to enable local health authorities and hard-pressed hospitals, counsellors and pyschotherapists to cope with the problem. That is what we want to know because we cannot cope with the problem simply through an advertising campaign.
§ Mr. Fowler
I am coming to the matter raised by the hon. Gentleman. Given his knowledge and experience in these areas, he will appreciate that public health education must be the number one priority. I have just announced a major increase in funding for that.
§ Mr. Frank Dobson (Holborn and St. Pancras)
The Minister spoke about the abolition of the Health Education Council and its replacement by a special health authority. Will he give the House a guarantee that the changes will not undermine the right of the council to be critical of policies carried out by his Department or by other Departments in relation to actions on health taken by the council?
§ Mr. Fowler
Yes. That is an important point and I expect the new body to have the same sort of sturdy independence as the existing body while at the same time making a contribution to the Health Service. I have discussed this with the chairman of the Health Education Council, Sir Brian Bailey. The whole point is that we are seeking to increase the effectiveness of health education and not to detract from it. In no way do I run away from the fact that the Health Education Council and the proposed new health education authority may have different views and may want to campaign in the way that the hon. Gentleman suggests.
§ Mr. Fowler
No—or at any rate primary legislation will not be required, although I think that some regulations will be required.
As the hon. Member for Torfaen (Mr. Abse) said, there are other areas in which the Government need to take action. It is clear that the first parts of the Health Service to be affected by greater public awareness and anxiety about AIDS are the clinics for sexually transmitted diseases. Those large cities, especially in London, are seeking increasing numbers of people who are worried that they may have contracted the AIDS virus. The clinics are offering these people counselling and tests to see whether they are carrying the virus.
805 I fully recognise that these clinics are in the front line and under great pressure, especially to provide the extensive counselling necessary for people who are found to be infected with the virus. I am therefore asking all health authorities to ensure that their clinics for sexually transmitted diseases are given adequate resources to meet the demands that are made upon them. All districts will submit their plans for dealing with AIDS by the end of next month, and I expect them to reflect this priority need.
Another priority is the treatment and help that must be made available to people who have already contracted the disease. The bulk of the cases so far have occurred in the London area and a number of London hospitals have acquired great expertise in treating AIDS patients. Indeed, they are in the forefront of medical treatment in the world. Extra funds have been provided to the Thames regions for this purpose this year and more money will be provided next year. I am currently considering the allocation of resources to health authorities following the statement two weeks ago by my right hon. Friend the Chancellor. I can assure the hon. Member for Torfaen that resources for handling AIDS will be taken into account in that allocation.
As more AIDS cases develop, more districts and hospitals throughout the country will need to become involved. It is crucial that district health authorities prepare themselves for this. I emphasised this at the meeting in Sheffield on Wednesday last of regional health authority chairmen and I am in no doubt about the importance they attach to the issue. I am also writing to every district health authority chairman in the country asking them to plan for appropriate action in their areas. Obviously the kind of action will differ according to the area.
Counselling is and must be an important part of the plans. Because AIDS is incurable and fatal, the knowledge that someone has got the virus can obviously have an appalling impact on them and their families. People who are tested for the presence of the virus should be carefully and sensitively counselled about the implications if their test proves positive. We have devoted priority to setting up effective counselling systems. Three centres for training professionals in AIDS counselling have already been established and are funded directly by my Department. Already over 1,500 counsellors have been trained. Each of these can pass on the benefits of his training to his colleagues. Our training arrangements are being expanded further and we are supporting training courses for nurses as well.
There is the additional question of research. It is imperative that no effort is spared in seeking a cure for AIDS and a vaccine against the virus. Public sector research in this country is co-ordinated by the Medical Research Council under my right hon. Friend the Secretary of State for Education and Science.
§ Mr. Martin Flannery (Sheffield, Hillsborough)
There is an educational dimension to this problem which involves the schools. Can the Secretary of State say whether there are any plans to ensure that young people in the upper forms receive the education that everybody else is to receive?
§ Mr. Fowler
Yes. My right hon. Friend the Secretary of State for Education and Science has that aim very much in mind and will be seeking to ensure exactly what the hon. Gentleman suggests.
I understand that no worthwhile research project has gone unfunded. However, the Government will talk with the Medical Research Council about this issue.
Over and above this, there is the contribution of the British pharmaceutical industry, which has built up an outstanding international reputation for the quality of its research. Currently the industry is spending more than £500 million a year on research and development in this country, and some of this work is relevant to the AIDS problem.
For example, Burroughs Wellcome was responsible for developing the test for antibodies to the HIV infection which is now in use as the method for screening blood in this country. The same company, which has an excellent track record in vaccines and anti-viral drugs, has developed and produced AZT—currently the subject of clinical trials in this country. We know that a number of other major pharmaceutical companies in this country are devoting increasing resources to research into this problem.
But it is essential that the research effort to fight AIDS is not looked at simply on a national basis. This is an international effort to which massive resources are being devoted worldwide, a point to which I shall return in a moment. Before doing so, I should like to make this point. I have spoken about the measures we have taken, or are taking, to contain the spread of the HIV virus. There are other important issues still to be addressed, particularly those related to screening for the virus. A number of proposals have been put forward for compulsory or voluntary screening. They range from screening particular groups to general screening.
Some of the more limited measures could be incorporated into existing arrangements for individual medical tests. I make no apology for the fact that no decisions have yet been taken on this or on the wider issue, for a decision to take any such measure—even the more limited measures—could not be taken lightly.
Obviously I understand why some people advocate wider screening measures, but it is important to recognise the questions that would have to be addressed before deciding to go down this road. There are real practical difficulties in embarking on any general, large-scale screening — whether of residents or of visitors to the United Kingdom. It is doubtful whether it is even practical, and the medical profession generally has made it clear that in its view a test should be administered only on a voluntary basis and only if the implications are understood by the person being tested. There is a fear that any element of compulsion may drive people away from seeking advice or help. We have to recognise that the results of screening tests can become out of date very quickly indeed.
But the most fundamental question is this: what is the purpose of screening and what happens after it? From the point of view of the patient, there is no vaccine or cure. AIDS is quite unlike the notifiable diseases which can be treated. From the point of view of the general public, we are not talking about an infectious disease to which the traditional response of quarantine for a short period is 807 relevant. The virus stays with the person for life. Other people are not at risk through normal day-to-day contact with them in ordinary working or social circumstances.
The House would wish to be aware of these problems, which arise on any proposal to introduce screening, and to reflect on them. The House will also wish to bear in mind the personal impact on an individual of being told that the result of a test is positive — which can be devastating. The United States Institute of Medicine has come down in general against screening, and in the recent referendum in California people voted against compulsory screening by more than two to one. To return to the international dimension, AIDS is a problem for all of us.
§ Mr. Chris Smith (Islington, South and Finsbury)
Before the Secretary of State returns to the international dimension, may I say that he has mentioned a very wide range of problems. We are aware that a special Cabinet committee has been established under the chairmanship of Lord Whitelaw to co-ordinate the work of Government Departments. Is the Secretary of State able to say whether that committee will be prepared to meet rapidly some of the voluntary organisations, including the Terrence Higgins Trust, which have a great deal of experience and wisdom to offer?
§ Mr. Fowler
The hon. Gentleman is right when he says that a Cabinet committee has been set up, for the very good reason that the issues do not relate simply to my Department. They relate also to the Departments of my right hon. Friends the Home Secretary and the Secretary of State for Education and Science and to many other Government Departments. It is right that Government Departments should be in contact with the voluntary organisations, and my Department is, I hope, in very close contact with the Terrence Higgins Trust. If the trust or any other voluntary organisation feels that further meetings are required, I hope that they will let the Department know and I shall ensure that those meetings take place.
§ Mr. David Crouch (Canterbury)
Before my right hon. Friend leaves the question of screening, I suggest to him that there may be a very strong clamour for the screening of visitors to this country, particularly for the screening of visitors from those areas of the world where AIDS is prevalent such as east Africa. I should warn him, while my right hon. Friend the Home Secretary is also on the Treasury Bench, that if such measures were taken against visitors to this country, it might be counterproductive in terms of the medical research that we are seeking to do in east Africa, in co-operation with the medical authorities and the research workers there.
§ Mr. Fowler
We shall obviously remember my hon. Friend's words. He mentioned east Africa, but the problem is not remotely confined just to Africa. It applies to countries like the United States. For that reason, I have sought to set out some of the practical difficulties that will be involved, quite apart from any of the other difficulties that are involved in implementing such a policy.
§ Mr. Fowler
I think that it would be for the convenience of the House if I did not give way on this occasion.
AIDS is basically a problem for all of us, not only in this country but in many other countries. This international dimension is important in a number of ways. 808 First, we are able to learn from the experience of other countries—both from the way in which the disease has spread and from the measures taken to combat it. Second, we are able to share the effort of responding to it—for example, by seeking a vaccine or cure.
Third, some of the screening measures proposed —those for overseas visitors to which reference has just been made—would clearly involve other countries. Therefore, it is of the utmost importance that nations should be in very close contact on these issues and should be aware of policy developments. For this reason, I propose to make an early visit to the World Health Organisation and to the United States to discuss these matters, and I shall also be talking with some of my main European counterparts.
I have sought to be frank with the House about the dangers that we face, and we shall want to listen very carefully to the views expressed in the debate in developing policy. AIDS poses a uniquely difficult public health challenge. Nevertheless, there is no doubt that the spread of AIDS can be prevented and the problem contained. The Government will do all in their power to emphasise to the public the seriousness of the position and the action necessary to combat AIDS. Over the next years, however, the action needed can be taken only by individuals.
§ Mr. Michael Meacher (Oldham, West)
We very much welcome this important and long overdue debate and the constructive speech by the Secretary of State, who made a much wider statement of Government proposals than we have had so far. We shall wish, however, to ask a number of detailed questions, especially about resources. I believe that the Secretary of State said that resources to combat AIDS would be "taken into account", but we need to know exactly how much new extra money will be provided and for precisely what purposes. I hope that when the Minister for Health winds up the debate he will be able to give more detailed information along those lines.
I hope that the debate will serve two main purposes. First, I hope that it will play a part in alerting the nation to a potentially national crisis of epidemic proportions and in securing broad agreement on the role of the Government in initiating and carrying out a range of essential and increasingly urgent measures. Secondly, I hope that the debate will bring balance and perspective to the problem. In the past few months, as a nation we have gone from hardly talking about AIDS at all to scarcely talking about anything else. Without firm leadership there is a real risk of moving from complacency to hysteria as the fears and anxieties so often fed on ignorance gain momentum. It is against that background that the Government's proposals must be judged.
At the outset it is necessary to root out certain misconceptions that have gained ground in some quarters. AIDS has been described as a "virulent gay plague" when it is nothing of the kind. It is not a plague like smallpox or cholera, it is not confined to gay men, and it is not particularly virulent. A plague is a disease that is easily and indiscriminately transmitted through normal casual social contact. That is not true of AIDS. Although the virus has so far been largely concentrated among the homosexual community, it is becoming clear that promiscuity, rather than homosexuality, is the real source of risk. AIDS is not especially virulent and is able to spread rapidly only because carriers are ignorant of their condition or neglect suitable containment measures.
809 Another serious misconception is that the virus has already spread so far that, with no cure or vaccine in prospect for at least five years, little can be done. I believe that such despair is seriously misplaced. I think the Secretary of State said that 565 new cases had been reported this year and that the figure was likely to rise rapidly to some 3,000 within the next two years. The vast majority of those cases, however, are still confined to the high risk groups. Heterosexual transmission is believed to apply in only some 3 per cent. of cases. Out of 2,500,000 blood donations, in which known high risk groups are asked not to participate, the rate of HIV infection detected has been of the order of 0.002 per cent. and only three donors who were found to be HIV positive denied being in the recognised risk groups. That strongly suggests that the general heterosexual population is at present largely free from infection and that there is nothing inevitable about the general population succumbing to AIDS. That is a very important fact.
We are now at a crucial turning point. The United Kingdom figures for heterosexually transmitted AIDS are similar to those for homosexual men three or four years ago when there were just 36 new cases. The incidence of AIDS outside London is now comparable with its incidence in the Greater London area three or four years ago. Again, the implications are clear. Whether AIDS now spreads extensively throughout the general population depends on people's readiness to modify their behaviour where necessary and on the willingness and ability of the Government to mobilise supportive measures to help bring about that modification of behaviour.
The vital need for a full range of preventive measures backed by an immediate increase in resources is shown by the knowledge of what would happen if the current rate of increase in AIDS cases—I believe that the figure is now doubling every 10 months — were to continue unchecked for the next five years. A parliamentary answer at column 858 of Hansard on 21 October stated that by October 1991 there might be 35,000 cases and 18,000 deaths. A further five-year projection is more speculative, because it depends on people's readiness to modify their behaviour, but if figures are calculated on the same basis, by December 1995 there could be a total of more than 1 million reported cases, with well over 500,000 deaths. As the average cost of treating an AIDS patient is between £10,000 and £20,000, any niggardliness in preventive action now would clearly constitute the most extreme false economy.
Although the tone of this debate, which has been well set by the Secretary of State, should be constructive and non-partisan, it cannot be denied, and should not be concealed, that the Government's response has been too little too late. By 1985, four years after the first cases began to appear in Britain, the Government were spending a total of only £2.5 million on treatment and counselling, development of screening and laboratory services, public health education and the voluntary sector. Frankly, that is peanuts compared with many advertising campaigns for commercial products. In the same year, Proctor and Gamble, for example, spent £47 million on advertising.
I do not think anybody will disagree that getting across the right message in regard to AIDS is far more intricate and infinitely more important to the national well-being than any commercial campaign. Every £1 million spent on 810 prevention will probably save £10 million which would otherwise have to be spent caring for AIDS victims. The Secretary of State mentioned a budget of £20 million. That is a considerable advance, but I doubt whether it is enough. Spending £30 million on national publicity in a public health education campaign does not seem unreasonable or excessive.
§ Mrs. Anna McCurley (Renfrew, West and Inverclyde)
If the Labour party had encouraged some Labour-controlled local authorities to spend more money on this type of campaign rather than encouraging groups which are known to be promiscuous, perhaps we would have got somewhere much earlier.
§ Mr. Meacher
That is not a very helpful intervention. By suggesting that any health authority, regardless of its political persuasion, should deliberately encourage promiscuity is unworthy of the hon. Lady. She should withdraw any such suggestion.
I hope the Government agree—there are some signs that they do—that television commercials must be quite frank, explicit, direct and hard-hitting. Over-moralistic caution can be counter-productive.
My hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) mentioned the good medical briefing put out by the Terrence Higgins Trust. Other good examples of the types of material that might be produced are the recently produced leaflet and programmes put out by Scottish Television, which seem to have done more during the past one and a half weeks than, I sometimes think, the Government have done in the past one and a half years. It is very good material and worth taking seriously.
Preventive action by the DHSS must be matched in every region and district in the National Health Service. The Secretary of State touched on that. If a district has not yet experienced any AIDS cases, that is no reason for neglecting prevention—quite the reverse. The first step should surely be the appointment of a team to draw up a regional programme on prevention, including regional telephone information services where appropriate. Each district should also appoint an AIDS prevention officer, whose duties would include liaison with voluntary groups. A broad average of £50,000 a year would be a reasonable sum to enable each district to provide an AIDS prevention officer and support services.
Extra assistance is needed for general practitioners. They are in the front line probably more than any other group. They are most likely to be approached first by people who are anxious about themselves or their relatives. District health authorities should take the lead to organise an education programme for all GPs in their area.
I do not doubt that my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) will say more about London. More than three quarters of the AIDS cases that have so far come to light have been in the Greater London area and the burden on certain London hospitals and London's services has been correspondingly severe.
London has been doubly hit. It has been hit by the disease and it has fared badly financially because the Resource Allocation Working Group system has been put to uses which were never intended. I hope the Secretary of State agrees that, under the impact of AIDS, London needs support over and above that given to the rest of the 811 country. It must be new money, not money which is artificially manufactured by so-called efficiency savings, which are really cuts in other parts of the Health Service.
§ Dr. M. S. Miller (East Kilbride)
We must consider the awful potential of the disease, but we are poised as never before in view of the technological and scientific advances that have been achieved. Does my hon. Friend agree that a great deal of money should be injected into research organisations, as more is known about this virus than has been known about any other disease at this stage in its development? We should consider how long it took to find out about tuberculosis and smallpox. An enormous amount of information has been gained on this disease. There should be a concerted effort to find out more, and a great deal of money should be given to help organisations which are trying to find a cure or a vaccine.
§ Mr. Meacher
My hon. Friend has almost entirely anticipated what I was about to say, and he has said it so well that I wonder whether I should leave out that part of my speech.
I agree that voluntary bodies have a vital role to play. The truly remarkable achievement of the Terrence Higgins Trust in a short time is well recognised. Many other organisations have played an important part and could play a bigger one. I refer to the Albany Society, Body Positive, the London Gay Switchboard, the Haemophilia Society and SCODA, all of which should be enabled to expand their important functions.
The London Lighthouse Project needs support when it is being used to set up a hospice. It serves a double purpose, as it also saves money. There is a striking difference in the cost per patient in San Francisco and New York, because in the former much care is provided in hospices or special housing, whereas in the latter hospitals are used. I hope that that lesson will be learnt in Britain.
As my hon. Friend the Member for East Kilbride (Dr. Miller) said, a great deal is already known about AIDS, although we are short of a vaccine or cure. It is reasonable to assume that a reasonable budget for the whole range of preventive measures against the spread of AIDS would, as I proposed in my letter to the Prime Minister of 10 November, be within the range of £50 million to £100 million. I wonder whether even that is adequate. That should be compared with a budget of £1.9 million which was allocated to combat AIDS last year by the DHSS. It was topped up in December with another £6.3 million. That represents a paltry 0.04 per cent. of the NHS's budget. That is frankly a ridiculous sum for protection against a problem which many people in the West regard as the biggest threat to public health this century.
The dribs and drabs approach that we have so far had has meant that the relevant services have had to live from hand to mouth since AIDS was first recognised in Britain. That has systematically prevented the development of serious national planning of services.
§ Mr. Chris Smith
Is my hon. Friend aware that several leading medical practitioners who are working on AIDS in London proposed to the Chief Medical Officer only some two or three months ago that, for between £5 million and £10 million, they could launch a major research project into AIDS and the spread of the virus? I understand, however, that they have been told that no decision can be made until next year. Would my hon. Friend like to comment on that?
§ Mr. Meacher
That comment is well directed at the Government. If it is true, it is a sad reflection of their priorities. Perhaps the Minister who is to reply to the debate will comment on that matter, because if the Government are serious that sort of work must surely command priority.
I make no apology for reiterating the importance of funding, because it is crucial in the fight against AIDS. In the end, it is the measure of the Government's seriousness in facing the problem. Nobody is suggesting that AIDS or any other problem can be solved by throwing money at it. We say, however, that it cannot be denied that AIDS, which is on the brink of exploding in this country like a time bomb of lethal proportions, cannot be resolved without a major increase in expenditure, not only for medical research into a vaccine or cure, but for much more widespread provision of health education, screening and advice and counselling services.
When faced with a death rate from AIDS which could — I hope to God that this does not happen — rise seventyfold in the next five years, and when the clinical care costs for nursing AIDS victims could rise to £300 million a year, any under-provision of prevention, counselling and research facilities could only constitute the grossest form of false economy.
Against that background, I have to say to the Secretary of State that it passes comprehension that, according to press reports—perhaps he will deny them if they are not true— of internal confidential papers, the Government are cutting by £4 million the funds for the Public Health Laboratory Service, which is the national agency monitoring the AIDS epidemic, with the result that six laboratories may have to close next year to meet the Government's cash limit. I do not know whether those reports are true — perhaps one of the Ministers will comment on them—but if they are, I hope that the Government will reconsider their decision.
Resource credibility is also the central issue in the drugs epidemic that is ravaging Edinburgh and Glasgow. So far there have been a relatively small number of cases of full-blown AIDS among drug misusers in those cities, but doctors are predicting a veritable explosion of full clinical AIDS cases next year, when the three-year latency period for many heroin addicts in Edinburgh will be up. From then on, if little or nothing is done, hundreds of young people can be expected to develop AIDS and die. The current Edinburgh figure of 1,500 to 2,000 virus carriers suggests that 700 or so will die over the next four years.
Most disturbing of all is the fact that researchers for Scottish Television, who have recently made comparisons with the New York experience, have found that, while the British figures are still far short of those in America, the explosive spread of the HIV virus is moving even faster here than in New York. In New York the number of AIDS victims is doubling every month.
It was against that background that the McClelland report to the Scottish Home and Health Department in September recommended the handing out of clean, disposable needles to addicts on a new-for-old basis at doctors' surgeries and hospitals, with the aim of reducing the spread of shared dirty needles, which are recognised as a major source of the transmission of AIDS. We listened to what the Secretary of State said on that matter and, while appreciating that careful consideration must be given to the suggestion, I had hoped for a more positive 813 response. It is an important recommendation and McClelland is the chair of the Scottish AIDS advisory committee.
I believe that the committee's recommendation was right. Some people have objected on the ground that it might lead to more drug use, but anything that can significantly reduce or slow down the transmission of a lethal virus must surely be supported. It is worth noting that that method of containment has been tried in Amsterdam, where a pilot project is under way, and it seems to be having some success. Of course, I readily agree with the advisory committee's proposal that the Government should also support the handing out of the heroin substitute Methadone as a means of weaning addicts off needles.
I wish to comment briefly on some other issues on which I believe that a clear view from Parliament would be helpful. The first issue is screening. Some take the view that, as there is no treatment available to offer patients who have been infected with the virus and who are free of symptoms, and that the advice, at least to a homosexual man, which is to avoid unsafe practices and to reduce the number of partners, is the same whether he has a positive or a negative test, there is no point in offering these tests on a routine basis in clinics for sexually transmitted diseases.
On the other hand, some doctors consider that the test for HIV antibodies should be promoted by a campaign directed at all who have been at risk. The aim would be to ensure that as many as possible of those who have been infected come forward and thus be available for counselling about their subsequent sexual behaviour, which, as the Secretary of State correctly said, is the whole point of the exercise.
I believe that it makes sense to offer the test at clinics for sexually transmitted diseases, or perhaps even at specialised AIDS centres that may be needed, certainly to homosexual men, where there is any question of bisexuality, to drug addicts and to women who are in high-risk groups.
The counselling consequences are crucial. Experience has shown that quite drastic changes in behaviour can take place swiftly in times of crisis. It would be wrong to assume that most people are incapable of making rapid changes in their lifestyles when they are convinced of the necessity of doing so and have alternative options available. That is already taking place among gay men in their response to the "safer sex" campaign initiated by the Terrence Higgins Trust to reduce the risks of AIDS infection.
However, changes in behaviour will come about only if increased screening facilities are made available. At present, tests to establish the presence of HTLV-3 are offered only to those who show symptoms of infection, and they are probably only a small proportion of those carrying the virus. There simply are not sufficient laboratory facilities to make the test available to all those in the high-risk groups, and clinics do not have enough staff to offer even those already tested the care, advice and support that are needed. The urgent remedying of that defect must be a priority for Government action.
On the other hand, I believe that mass screening would provide only an illusory protection for the general public and would involve a huge waste of public money. It would be impossible to enforce it effectively without dramatically 814 interfering with the civil liberties and personal privacy of the entire population. Indeed, the BMA has recently issued a statement to the effect that compulsory testing would be unethical as well as unworkable.
For all those reasons, it would be helpful— and I believe that the Secretary of State may be sympathetic to my suggestion—if the Government would make it clear in this debate that the alarmist proposals made in recent months, such as mass compulsory screening, screening at ports of entry or airports, the isolation of carriers and the compulsory carrying of cards by carriers, will not be implemented.
We should also consider the issue of confidentiality. AIDS is not highly infectious and making it a notifiable disease, which the Government have rightly resisted, would be counter-productive.
§ Sir Nicholas Bonsor (Upminster)
The hon. Gentleman said that AIDS is not a highly infectious disease. How does he explain the fact that in Senegal 90 per cent. of children under 16 and 50 per cent. of the children under eight have the disease?
§ Mr. Meacher
I am not absolutely sure that we know the answers to those questions. It is certainly true that AIDS is found in breast milk, and in Africa the disease is transmitted from men to women and from women to men in a way that does not entirely replicate the experience in Europe. However, I hope that the hon. Gentleman is not trying to deny the obvious fact that overwhelmingly in this country the disease is transmitted through sexual contact and drug misuse. If proper measures to reduce sexual contacts, to stick to one partner, to use condoms and not to share dirty needles were carried out, there is no reason why the patterns of transmission described by the hon. Gentlemman should be seen in this country.
Experience with other sexually transmitted diseases shows that if AIDS was to be made a notifiable disease it would deter people — I do not believe that the Government intend this — from seeking treatment or advice from their doctors. That would simply make HTLV-3 even more difficult to trace and contain. There are already widespread misgivings among homosexuals about seeking treatment or advice because breaches of medical confidentiality have occurred, with distressing and damaging consequences. Confidential details of several people with AIDS have been made public. Every effort must be made to stop that in order not to undermine the trust between doctor and patient.
Finally, there is the important issue of discrimination and employment rights. Those people who have HIV antibodies positively diagnosed can experience loss of family ties, of employment, of accommodation, of mortgage and insurance facilities and of easy access to medical and dental services. The occupational problems that they face can be instantaneous and crippling.
There are already reports of HIV carriers whose employment has been summarily terminated for that reason alone. However, as the British Medical Association said earlier this year:The low infectivity of the virus means there is no reason why patients with this virus should be prevented from returning to the community or their work".There is a real danger of creating a group of people who are very isolated. That would not only be wrong in principle—because they are entitled to health care as much as the rest of us—but would simply drive the 815 condition underground. For those reasons, I believe that the Government should take early action to protect the employment status of HIV positives who are fit and capable of working. The war against AIDS must not become the war against those who have AIDS.
§ Mr. Meacher
I would readily give way, but I have been speaking for some time and I am trying to finish. I should like to make my peroration and I hope that the hon. Gentleman will catch Mr. Speaker's eye later.
The struggle against AIDS is no longer merely a matter of morality or immorality, of public attitudes or political choices. It is a matter of life or death, potentially affecting millions of our people and especially our young people. Neither political sensitivity or expediency nor moral objections must be allowed to stand in the way of any step deemed likely to be effective in saving lives and preventing any additional individuals from contracting AIDS. That is the test by which the nation will judge both the Government and Parliament. We must not fail.
§ Sir David Price (Eastleigh)
I hope that the House and the nation will rally to the plea of my right hon. Friend the Secretary of State for Social Services for an all-party approach to this terrible disease. That is why we, the members of the Select Committee on Social Services, decided earlier this month that our next inquiry would be into AIDS. I can tell the House that we have had that subject on the back burner for a long time, but we felt that, in response to the growing concern of our colleagues, it would be proper to hold an inquiry. We shall carry on many of the questions that have been raised in today's debate.
One of the biggest problems that we face in trying to achieve an agreed national policy on dealing with AIDS is the present uncertain nature of our knowledge of this terrible disease. The full title of the disease — the acquired immune deficiency syndrome — as its name suggests, reveals that the disease is different in character from most other viral diseases, if not all. At the same time, we must acknowledge, as the hon. Member for Oldham, West (Mr. Meacher) acknowledged, that much has been learnt about the character and the epidemiology of AIDS since it was first identified in 1981. Let us pay tribute to those who made the discoveries. However, there are so many questions left unanswered that it is difficult for any of us to be over-certain—beyond certain agreed points —as to what direction the Government should take in this matter.
In my short speech I should like to pose some questions. My first question starts with the virus. The name of the virus has changed. We have known it for some time as HTLV-3, yet we now refer to it as HIV, although I understand that it is the same virus. Is it a stable virus? Or, as some people have suggested, does it have the capacity to mutate relatively easily and frequently and thereby change its structure so rapidly that the immune system cannot alter its antibodies fast enough to keep up? If that is so, our enemy is not a static target, but a moving one. That suggests to me that it will take a longer, rather than a shorter period before the virologists can get the total definition of the virus and then develop a vaccine.
§ Dr. M. S. Miller
Does the hon. Gentleman realise that the very nature of the virus—its ability to form mutants — is being used in genetic engineering? The hon. Gentleman's point about the mutations may not pose as big a barrier as we may have thought some years ago. Scientists can use the virus's capability against it.
§ Sir David Price
That is encouraging, but I am advised that that reduces the immediate prospects of a vaccine, which we all agree is the normal response to the disease.
My right hon. Friend the Secretary of State referred to my next question in his speech. How long is the virus's incubation period? Two years ago we heard that the period was as low as nine months to a year, and I have heard figures now of up to seven years. My right hon. Friend said today that the average is about five years. That is very important. If we compare the incubation period of the AIDS virus with that of syphilis, which has an average incubation period of one month, we have a problem of an entirely different order. The longer incubation period has a direct bearing on the problems of screening to which the hon. Member for Oldham, West referred.
My next question is even more relevant. How many of those who are found through a blood test to have the virus will go on to develop AIDS? Again, every time we consult the experts the figure rises. Two years ago it was as low as 10 per cent., and we have heard figures of as high as 75 per cent. My right hon. Friend the Secretary of State said today that his current advice is that the figure is 25 to 30 per cent. It is very important that we should know how many people will develop the disease. Even if we do not know that with absolute certainty—it is probably not possible to know definitely—we should at least know with reasonable certainty. That is essential information if we are to ask people voluntarily to submit to screening.
How is AIDS transmitted? It is now conventional wisdom that it is transmitted primarily through sexual intercourse and through some sexual practices more than others. It is transmitted through contaminated blood. However, we must ask whether it occurs at the lower levels of blood transmission between one person and another. Do small drops of blood transmit the disease or is it transmitted only on the larger scale of blood transfusions'? My right hon. Friend mentioned the sharing of needles by drug abusers.
There is also the congenital aspect. My right hon. Friend mentioned infected mothers and fathers. One must ask, at what point does the disease so get into the race that it becomes endemic in the normal monogamous population? The information from America suggests that that has already happened there. I do not believe, therefore, that AIDS is quite as restricted in its victims as we have assumed until now.
Then there is the question whether the disease can be transmitted, as more traditional contagious diseases are transmitted, through saliva and tears—the hon. Member for Oldham, West mentioned breast milk—and whether, hence, it may enter social activities such as kissing, hugging, crying and even shaking hands. Until now the answer has been a firm no, but I should like to k now whether it is really a firm no.
The entire House would agree that the development of an effective vaccine is the normal response to a viral epidemic. Is my right hon. Friend satisfied that we are doing enough to develop an effective vaccine? What is 817 happening in public laboratories, especially places such as Porton, in the pharmaceutical industry, in the universities and in private clinics?
We must also consider the world position. What attempts have been made to co-ordinate international research, or are we so far away from an agreed approach that it is better to allow each laboratory to do its own thing and to hope that, somewhere, a bright research scientist will come up with the answer? Sometimes that is a better way of doing it. Similar questions arise when we examine the need to develop more effective therapies for those who suffer from the full clinical symptoms of AIDS. At this stage in the history of AIDS it may be too optimistic to hope for a complete cure, but it may be possible to develop therapies that relieve suffering and delay the processes of the disease.
My right hon. Friend mentioned the work of the Wellcome Foundation in developing AZT, but is it effective only against secondary pneumonia, as one reads in the literature, and does it suffer from excessive toxicity, which some articles have suggested as an obstacle to its wider use? Can my right hon. Friend tell us about the Australian development of Isoprinosine? Can he confirm the encouraging rumours that one has heard about the work done with HIVA at Porton? What is the state of play? It is worth making a considerable effort in developing therapies that can delay the onset of the disease before we can obtain a cure.
The hon. Member for Oldham, West mentioned screening. How effective are the present methods of screening? All of us would do well to take on board the advice given by the British Medical Association in the brief that it sent to all hon. Members. It said:After a person becomes infected with the AIDS virus, it may take up to six months or more before they produce antibodies to the virus ie before `seroconversion' occurs. So-called tests for Aids detect only the antibodies, not the virus itself. Thus a person may carry the virus for several months before it becomes detectable. This means that it would not be possible to identify every person carrying the AIDS infection, even if the whole population was screened.That is very important.
To return to the questions that I asked about the nature of the virus, the BMA said later in its brief:Recently there have been reports that the AIDS virus is undergoing changes and that antibodies to the newer forms of the virus cannot be detected by existing tests.That adds a formidable set of objections to those made by the hon. Member for Oldham, West about compulsory screening, or even encouraging voluntary screening, except in those groups most at risk.
If someone discovers that he is seropositive, what can we tell him? What hope can we offer to him? The BMA said:Early detection of AIDS infection carries no advantages for the infected individual since no effective treatment is available.That puts the AIDS problem in an entirely different category from earlier public health campaigns on other diseases. All of us will remember the mass chest X-ray campaign, which was remarkably effective in identifying pulmonary tuberculosis. Even before modern drugs were developed, early detection increased enormously the hope of a cure. We cannot offer any such hope in relation to AIDS. Some deep and sensitive problems are involved 818 and, with the hon. Member for Oldham, West, I counsel the House strongly against any suggestion of compulsion in these matters.
What should we do? In our present state of knowledge, there is no solution to AIDS other than prevention. We can all agree on that. Therefore, I support strongly the campaign launched by my right hon. Friend to warn people about the danger of AIDS. The message is simple: AIDS kills. We should be blunt about it. Such a campaign should follow the general lines of the anti-drugs campaign, which has been much more successful than has been generally acknowledged. I give great credit for that to my right hon. Friend. The campaign should be run by professional communicators. As well as taking a general approach, it should be targeted upon those identifiable groups most at risk. "Just Say No" was the very successful advice against drug abuse targeted at young people. Similar advice should be given to those who are tempted, as the phrase goes, to sleep around.
We should treat those found seropositive as normal human beings and not ostracise them. There is no medical evidence to treat them as lepers, although some elementary precautions should be taken. Discrimination in employment and non-sexual social contact appears entirely unjustified and must be resisted. I agree entirely with the hon. Member for Oldham, West on this. For those who are unfortunate enough to develop the full AIDS symptoms we should provide—as indeed we are doing—the full range of medical and nursing support. We should offer them the love and care which the terminally ill always deserve and normally receive.
§ Mr. William Cash (Stafford)
Although I agree entirely with my hon. Friend that we should not treat people like lepers — everyone would agree with that — is it not extremely difficult to justify a position in which one would condone sexual behaviour by avoiding the fact that many of the figures show that AIDS has been generated because of sexual behaviour of one sort? Surely we should not only try to prevent it from happening, but should try to prevent it from spreading.
§ Sir David Price
If my hon. Friend is implying that we should once again advocate the merits of celibacy and monogamy, I am entirely with him. Some of us believe that there are strong medical reasons for not entirely liking a society in which sleeping around seems to be the prevailing trend.
We must take seriously the cry for help from the Royal College of Nursing for the terminally ill with AIDS. The college's brief to hon. Members states:The reaction of the hospice movement, most of whom exclude patients with AIDS from their care, adds to the burdens and problems of those caring in hospital. Many patients who would be suitable and respond to a hospice environment must remain in hospital blocking beds and obstructing the admission of acutely ill patients due to the inability/unwillingness of some hospices to meet this need.We must expand this, as unfortunately we anticipate increased numbers of AIDS victims.
I am entirely behind those who argue that within the Health Service we must do more to help those whose days are nearly over and to ensure a quiet, painless and loving end to their lives. I believe strongly in this, which leads me to make an urgent plea to my right hon. Friend to ensure that those hospitals that are in the front line of the battle against this terrible disease have sufficient resources. Like many of us involved in these issues, I have received urgent 819 cries for help from some of the STD clinics, only a mile or two from here. There is a desperate need for increased funding for these clinics, as the number of patients is likely to increase.
There seems to be general agreement among the experts that this terrible disease has a long way to go before it has run its course, and there will be more cases of AIDS in the United Kingdom, but there is as yet no cure for the disease, which is lethal. It is a chilling prognosis, but we must accept it. However, we must not lose our nerve. We must not treat those who are seropositive as lepers. Above all, we must nurse those who develop AIDS with proper love and care. It is no less than our duty. It is clearly laid out in the 25th chapter of St. Matthew's gospel— remember those cautionary words:Verily I say unto you, inasmuch as ye did it not to one of the least of these, ye did it not to me.
§ 11.2 am
§ Mr. Alan Williams (Swansea, West)
On a point of order, Mr. Deputy Speaker. As you have seen from today's press, there is profound concern at certain allegations that were made in this Chamber yesterday that, whereas the Government are trying to suppress publication in Australia of a book about MI5, the same Government have, for nearly four years, taken no proceedings on a series of actual security breaches, involving the security services of which the Prime Minister is the head, because the Attorney-General and the Prime Minister know that such action would necessitate prosecuting a Conservative parliamentary candidate. That is not a matter for you, Sir, but the background to my point of order.
I ask for your guidance, Mr. Deputy Speaker, on two matters. Have you received any sign from the Attorney-General, who is responsible for ensuring that justice is administered evenly and fairly, that he wishes to make a statement to the House today, as I have requested him to do? Secondly, in view of her alleged complicity in the subordination of national security interests for Conservative party interests, have you received any sign from the Prime Minister that she will make a statement on Monday, as I have asked her to do?
§ Mr. Deputy Speaker (Mr. Harold Walker)
The only matter for me is whether I have received a request from either the Attorney-General or the Prime Minister for permission to make a statement. I have to tell the right hon. Gentleman and the House that I have received no request for any statement to be made, nor has Mr. Speaker. However, the Leader of the House is present and what as been said will be conveyed to the appropriate quarters.
§ Mr. David Winnick (Walsall, North)
Further to that point of order, Mr. Deputy Speaker. I have no wish to interrupt the debate for more than a few minutes. However, as you will readily appreciate, there is growing concern over what appears to be a scandal and it is only right and proper that Ministers should come to the House and explain their position. Will you confirm that there is nothing in the sub judice rule, which is a matter for the Chair, as I understand it, which will prevent the Prime Minister or the Attorney-General from making a statement to the House? Secondly, is there any way in which we can get the Prime Minister or the Attorney-General to make a statement as quickly as possible, because the scandal is growing?
§ Mr. Deputy Speaker
I have dealt with the hon. Gentleman's second question, and the answer to the first had better lie until it arises—when, I hope, Mr. Speaker is in the Chair.
§ Mr. Tony Baldry (Banbury)
Further to that point of order, Mr. Deputy Speaker. Is it not the only scandal what is becoming the "Friday 11 o'clock spurious points of order", when every Friday, when we are debating important measures, Labour Front Bench spokesmen make a—
§ Mr. Deputy Speaker
Order. I understand the hon. Gentleman's point, but he is only indulging in the practice that he is denouncing.
§ Mr. Alex Fletcher (Edinburgh, Central)
Further to that point of order, Mr. Deputy Speaker. Is it not a fact that, under the guise of public interest, this point of order has been raised merely for Labour party interests?
§ 11.5 am
§ Mr. Leo Abse (Torfaen)
Perhaps we can return to the matters that are no less significant than the important point raised by my right hon. Friend the Member for Swansea, West (Mr. Williams).
A year or so ago, drawing on my experience in the United States during a parliamentary recess, I presumed to write an article on AIDS in a distinguished quarterly. It attracted the most severe criticism from a section of the homosexual community and, after a condemnatory editorial in the New Statesman, I was deluged with letters — some bitter, some bewildered — from homosexuals accusing me of deserting them when they were under attack. At the same time, I was, as I still am, constantly bombarded with other letters accusing me, as sponsor of the 1967 Act which ended the criminality of adult homosexuality in private, of responsibility for the near epidemic of AIDS. I regard that charge as absurd, for the Act, ending the most appalling discrimination against hundreds of thousands, if not millions of our fellow citizens, is no more responsible for AIDS than a death certificate is for death or a decree absolute for marriage breakdown.
However, as every experienced Member knows, there should be no expectation of gratitude in politics, least of all for those involved in the reform of the politics that impinge upon human relationships. That is why, repeatedly, Governments have shrunk unfailingly from the minefield and for generations have left it to a handful of those of us on the Back Benches to initiate reforms which consequently, lacking coercive power, lag behind national need.
On AIDS, the Government have acted, and are still acting to no small extent, within the same conventions that have affected many Governments in the nearly 30 years that I have been a Member of the House. In this case, the delayed Government action was prompted by a major miscalculation and a blundering gamble founded on the belief that all that was required was a holding operation. My hon. Friend the Member for Oldham, West (Mr. Meacher) has already said that the Government have been spending a piffling sum. I believe that that was because they knew that the federal budget in the United States for fighting AIDS was to be $227 million for the fiscal year 1986. Infected by dangerous American optimism, the Government chose to believe that with almost all that sum 821 —only 2 per cent. was intended to be devoted to social and educational research — directed into an aggressive pursuit of a so-called cure or vaccine, the Americans would soon be sending us a magic potion—a package solution —across the Atlantic.
Those of us on both sides of the Atlantic who express other views are dismissed as Cassandras. I regarded then, as I do now, that planned USA programme as a paradigm of the delusion of contemporary western man that technological and scientific progress enables him, by external manipulation, to conquer everything. Because of all that in the United States, and that attitude, no time was therefore to be wasted in finding the real source of the sickness in a high proportion of AIDS victims. A pill or an injection was to be discovered and the terrible symptoms would be suppressed. I have my doubts and my misgivings. Even if a wonder drug yet to be discovered could suppress the symptoms, what other exotic outbreaks will erupt as we evade attempting to deal with the cause?
I ask the House to pause for a moment and to think about the problem of not being able to reach those whom the Government now seek to exhort. The burden of my remarks is that exhortation is not the answer to the problem. It will reach many people, and the Government are to be commended for now endeavouring to reach them, but it will not reach many or those who are perhaps in the highest risk group of all. For, on examining the case histories of many though not, of course, all AIDS victims or on meeting those victims, as I have done in the United States, it is clear that only the purblind could deny that a significant source of their sickness lies, to use biblical language, in the soul, or perhaps, I would say, in the pysche.
The phenomenon of compulsively promiscuous heterosexual Don Juans or of the disturbed minority of homosexual men who fanatically and incessantly seek sex, always unassuaged, and who have hundreds of partners each year — their fumblings often only punctuated by heroin taking—is not to be dismissed moralistically as simply a lack of discipline. Those tragic men, actual or potential AIDS victims, making themselves victims and dangerous to the wider community, are literally sex mad and, like all mad people, they need help, not sententious moralising.
We have had plenty of that with ill-informed calls for compulsory screening from some sections of the Conservative party. The Minister asks for unity, but he should direct his attention to many of his own Back Benchers and to those in his own party who are being sententious and moralistic, and who prompt interventions like the ill-timed intervention that suggested that promiscuity was being deliberately encouraged by some sections of Labour councils. They have also been encouraged by the Chancellor of the Duchy of Lancaster, who attacks those of us who, by legislation, brought about what he calls the permissive—and what I call the more civilised—society. I do not want to dwell, as I could do, any more on that, but some restraint is required on their part.
I do not want to focus excessive attention on those elements in the Conservative party who are adopting such moralistic stances, but I ask the Minister to address his remarks to his own party, as they are not required by us. As the Bible has again been invoked, I should add in 822 passing that I read this week that the Bishop of Birmingham sought to demonstrate in the other place that only conduct that accorded with the Bible would save us from the epidemic. But he demonstrated yet again the folly of injecting didactic morality into our debate, as clearly the safest protection from AIDS for women is for them to be committed lesbians—an injunction not to be found in my reading of the Bible.
It is, of course, easier, although profitless, to be morally sententious than to examine the human condition of those men who compulsively court death through sex. Delving into the complexities of depth psychology, exploring the psychopathology of these obsessional men, may be exceedingly uncongenial. Looking outwards is always less painful than looking in, but in the end a genuine prophylactic may ward off the dangers that AIDS presents to our society far more effectively than the search for what may prove to be a spurious physical antidote.
I do not wish to be misunderstood, although doubtless one always is in these matters: I am in no way minimising the need for all the preventive measures mentioned in the House today or the need for those announced by the Secretary of State as well as those forcefully advocated by my hon. Friend the Member for Oldham, West. Certainly the attempt to communicate must be made in the most explicit terms.
The lamentable fact must be faced that, after 11 years at school, some 40 per cent. of the population leave without an 0-level. It is no use, therefore, talking to many in parliamentary language, and if words like "f … " have to be used, and if we speak of "arseholes" and not anal intercourse, since that is the street language, we must be prepared to explode the taboos of those prissy people in the Conservative party as well as the Tunbridge Wells taboos, knowing that otherwise blameless women and children, among others, will be unnecessarily put at risk. But preventive measures mean more than advertisements or even subsidised French letters, enormously important though they may be.
I ask the House to consider the scenario of the life history of the highest risk group. That group will not be reached by all the advertising in the world. It is a tragic scenario. Born to an unresponsive mother who leaves the baby without her corroboration of his vigour and healthy narcissism, the child can indeed become bereft. If the child does not see himself as the gleam in her eye, for there is no gleam, if she leaves him deprived of stimulating responses, so unempathetic, so indifferent, so remote, such serious deprivation of joyful responses to the child's aliveness can deplete him of self esteem, and leave a residual disposition towards severe empty depression in adult life. If the baby's problems are compounded, as they are judging by what one hears of life histories, by an absent father, the child may not only lack the solid male model with whom he could have identified so as to become a potential father, but may for ever lack the capacity to reassure himself that he could gain from within himself, because he lacks the experience of participating by merger in the calmness of an idealised adult, whose protection would have banished the agonising anxieties that would otherwise fall on any helpless, innocent babe.
Those who mature within such a negative ambience grow up experiencing themselves as boring, prone to ward off their sometimes desperate feelings of deadness by creating pseudo excitement. As toddlers they may become headbangers, in later childhood compulsive masturbators, 823 in adolesence daredevil activators, and as adults they are seen—if people have eyes to see it—desperately seeking to feel alive by frenzied sexual or drug activities.
Those are the lifestyles of many of those afflicted by AIDS, for they are bereft of the psychic structure that can regulate inner need and excitement, and have become victims of the need to have the over-stimulation of constant, manic excitation. Without some such excitements, so precarious and fragile are their selves that they fear that they will dissolve. Constant, incessant skin contact reassures them that they are still whole and not disintegrating.
In this country there are, in unprecedented numbers, hundreds of thousands of unloved, destabilised children growing up in broken and one-parent families who consequently endure the sort of wounds that I have sought to describe. We are placing them at risk, as we have placed so many young men and women of today at risk, because the dominant goal, as preached in our society and as starkly preached by this Government, is to grab what we can from the cornucopia of the consumer society. It is with such single-mindedness that support is being denied to our crumbling family system.
One result is that this generation in Britain, as in America, has revealed its unique capacity to have wrested from homosexuality, which has always existed, a new phenomenon, the visitation of AIDS. The malaise which brings this curse will not be wholly cured by expensive anti-AIDS jabs, imported some years hence from American drug companies. The psyche is not so easily bypassed. If, in 19th century fashion, we delude ourselves—fear that there is a grave danger of our doing so— into thinking that physical science will resolve all, we shall pay dearly for our hubris. There is a desperate need to fear our own feelings less and to desist in the fashionable scorn of psychotherapy and counselling. The under-funded and ramshackle state of our psychiatric and psychotherapeutic services is spelt out today by every child psychiatrist, now overwhelmed by horrifying child abuse — itself a symptom of family breakdown, which has been opened up by Esther Rantzen's constructive programme.
Now AIDS is revealing how little help is available to support both AIDS carriers and sufferers and, as I am urging, to modify the behaviour of the most compulsively promiscuous who, to the danger of us all, certainly cannot be reached by exhortation. Ideally, psychotherapists and trained counsellors should be available at every STD clinic in the land. They should be available to support the desperately needed and presently unfunded community care, without which central London hospitals would certainly be overwhelmed.
How absurd it is that institutions with actual or potential training capacity — I do not speak, as the Minister did, about training given by a handful of clinical psychologists — such as the Maudsley, the Portman clinic, the St. George's department of psychotherapy, the Cassel hospital at Richmond, the centre for research at Brent—
§ Mr. Abse
In a moment. Those associations, together with the British Association of Counselling and the valuable Albany Society, consider themselves to be under financial threat or know that they are hopelessly underfunded. The Government should do more than deal with 824 education in the way that has been shown today—valuable as that clearly will be. The Government must coordinate and activate psychological and counselling services to embark upon funded crash training for such purposes.
§ Dr. Miller
I should like an assurance from my hon. Friend that the counselling services, the psycho-analytic treatment and various other aspects which he mentioned are not instead of but in addition to vaccines or medicines to cure the condition.
§ Mr. Abse
Of course. Although there was some admonition from my hon. Friend the Member for Oldham, West on the issue, I can well understand the Government believing that the main research into vaccines will come out of the United States of America. Since we must have some sense of priority in this country, one of the most urgent priorities, if we are to deal with AIDS —I hope I am not saying it excessively pejoratively—is to deal with centres of infection. If we do not do deal with that, we will find ourselves having expended £10 million, £20 million or £50 million on advertising and still not having reached the people whom we wish to reach.
We have a national emergency. There is a need for the Government to turn to all those with the skills to help ward off the epidemic. There should be something such as a Government-sponsored Standing Committee, including the Royal Society of Psychiatry, the Institute of Psychoanalysis, the St. George Psychotherapeutic Centre, the British Association of Counselling, and so on.
If we relegate psychotherapy and counselling to a mere appendage of the armoury which we create in our attempt to shield us from the epidemic, we will be doomed to failure before we start. There are no short cuts. Saatchi and Saatchi advertising will not cope with the problems, beneficial though they may be to the formerly-named London Rubber Company, which incidentally, given its murky, monopolistic past, could immediately overcome its expressed reparative quilt over its anticipated profits by funding voluntary counselling services and by promoting stronger prophylactic and self-sealing condoms and stop worrying about its product image.
If we are to move forward, for example, to voluntary testing, as has been canvassed, we will need real counsellors to cope with it. We do not have them. A large proportion of the dedicated people who are striving to help at the moment in hospitals and outside have very few skills open to them to deal with the difficult problems that I have been attempting to describe. Therefore, I hope that the Government will take a lurch to look at existing psychotherapeutic and counselling opportunities that exist. Otherwise we will find that advertising may go on for years, but we will not reach those who do not have the capacity or the freedom to respond to the pleas made by the Minister.
§ Mr. Deputy Speaker
Order. Nearly 20 right hon. and hon. Members wish to take part in the debate. Unless there is brevity in speech making, some of them will be disappointed.
§ Mr. David Crouch (Canterbury)
Whatever the outcome of this debate, one thing we can be sure of is that the lead given by my right hon. Friend the Secretary of 825 State for Social Services will be remembered not only for the content of his speech but for the manner and style of making this a co-operative national approach. The lead given by the hon. Member for Oldham, West (Mr. Meacher) will also be remembered for its degree of co-operation.
I speak today as a member of the Medical Research Council. We are talking about a problem that is new in our lives. Acquired immune deficiency syndrome was first described in the United States in 1981. Isolation of viruses from AIDS patients was reported for the first time barely two years ago, in 1984, by two teams of scientists working independently, in France and in the United States. It was only this year that we gave the name to this human immuno-deficiency virus—HIV. The HIV virus kills T-lymphocytes, a key part of the body's immune system, and progressively destroys the body's ability to fight infection.
What do we need to do, and what has been done to date in research into fighting this deadly disease? We need to develop vaccines against the virus, and specific anti-viral therapies. In 1983 the Medical Research Council set up a working party on AIDS when only a handful of cases had been reported in Britain. The aim of the working party was to review progress in research and to encourage cooperation among those working on the problem. That cooperation is important. We have succeeded in isolating the virus. Initially this was done in France and in the United States—Dr. Gallo in Washington and Dr. Montagnier in Paris.
We are learning about the evolution of the virus. We still have to learn how it arose and how it might be expected to change in future. Studies of the molecular virology of HIV are central to the efforts aimed at preparing a vaccine. Isolation of the viruses has led to the development of antibody tests. In the case of HIV, the antibodies produced are not very effective in fighting the disease, but they provide a marker for infection. They help us to find out whether a person has been affected, and that is how it is possible to identify such persons. This is an important breakthrough in the bare five years that we have known of this disease in human society.
We cannot yet reliably test for the virus in a person's blood, but we can reliably test for the antibody that the body produces when the virus is present. A person can be affected before the antibody appears, and hon. Members have touched on that point. Several months—we do not know the exact period — can elapse before even the testing can find out whether the antibody is there. This breakthrough in finding the antibody is being used to test blood donations. Such donations can be screened to ensure their safety and be treated afterwards in making blood products such as Factor VIII, which is essential in the treatment of haemophiliacs, so that any virus present can be absolutely destroyed. This is of immense importance in the treatment of haemophiliacs and to those of us who need blood donations. Safety has been achieved —a great achievement.
Many scientists are working on AIDS research in Britain. This work is concentrated in London at two of our teaching hospitals, the Middlesex and St. Mary's, and at St. Stephens hospital in Fulham. I shall mention the names of two scientists who have done great work in Britain and internationally — Dr. Richard Tedder, a distinguished virologist at Middlesex hospital medical school, and 826 Professor Robin Weiss, director of the Institute of Cancer Research. Two years ago they went to the Medical Research Council for funds to make progress in research into the antibodies. They did not ask for a lot. They wanted £230,000 spread over three years. They got it. Their work led to the successful antibody test. In this work, as had been mentioned by my right hon. Friend the Secretary of State, they worked in close collaboration with a major private sector pharmaceutical firm, Wellcome Diagnostics Ltd. I should declare an interest, as I am a director of the pharmaceutical firm. At St. Mary's hospital, MRC funds are provided to support clinical trials to find new methods of identifying the virus in blood and to assess the effects of any new treatment being tried. There are no good prospects on the horizon.
Drugs in the treatment of AIDS, even dangerous ones with serious toxic effects, have been tried on very ill patients in the United States. The federal Food and Drug Administration allows the use of otherwise non-proven drugs as safe in certain circumstances as a last resort. I believe, although I am not sure, that in this country such treatment is allowed with the DHSS and Committee on Safety of Medicines approval. There is so much we need to know and so much more to be done. The question I would ask as I digress on the research aspects is: are we doing enough?
§ Dr. M. S. Miller
The hon. Gentleman said that the drugs are used as a last resort. Does he realise that the situation was exactly the same with insulin when it was first discovered? It was a highly dangerous, highly toxic drug and was used only when it was expected that the patient would die within the next two or three days. We know what has happened to that substance since.
§ Mr. Crouch
I accept the hon. Gentleman's experienced medical opinion in this matter, on which he is an authority. He has made a helpful contribution. I would only emphasise that this must not be left to the individual practitioners on the spot. They must have approval from the centre if such dangerous drugs are to be tried in what is virtually an experiment on a person suffering from a deadly disease. Are we doing enough in research? We must ask the Government that question. We are facing a crisis of science. We must make another breakthrough to develop a vaccine. There should be much more research at Government level, at the Medical Research Council, in our medical research centres, in the teaching hospitals and in our universities.
We need to step up considerably our work in east Africa, where AIDS has spread widely. I must correct a point made in the House today that AIDS is found primarily among homosexual men and those who indulge in intravenous drug activity. That is not the position in east Africa. The proportion of men to women with AIDS in Africa is one to one. It is a terrifying prospect for the rest of us if the disease should develop in that way here.
The Medical Research Council has an important unit in the Gambia studying the AIDS problem, but there is not much AIDS in west Africa and in the Gambia. We need to increase our research activity in east Africa. The MRC is supporting important work in Lusaka at the university teaching hospital. People are desperate for help in that part of Africa and in Lusaka. They need not only research aid from the MRC, but another sort of aid — overseas aid. I understand that the Overseas Development 827 Administration is aware of this problem and is helping. I hope that my hon. Friend the Minister will say whether that is so. I understand also that the World Health Organisation has been alerted to the problem.
We are facing a crisis of frightening proportions. It is not an exaggeration to say that AIDS is a major disease which could engulf the nation and spread worldwide. It is only five years old. The average time needed to develop a new drug is usually 15 years. Normally about 1,500 products must be developed before one is thought to be successful. Such developments in the drug industry, and such success after perhaps 15 years, can come only when we know what we are trying to cure, but only in the last year have we found the virus. We have only just got to first base. We must intensify our research efforts. Huge figures have been mentioned today. Our expenditure in the MRC on AIDS research is £300,000 a year. A further £300,000 is provided by the health departments. That is just over £500,000 a year to fight a potential disaster.
Much more money is allocated by the health departments to programmes to control the progress of this epidemic. I very much welcome the statement by my right hon. Friend the Secretary of State about the greatly increased amount to combat the progress of the epidemic and to the control and cure of the disease. I want to confine my remarks solely to the research programme.
In October 1985, just over a year ago, the secretary of the MRC, Sir James Gowans, went to see the Secretary of State for Education and Science—my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph)—and asked for an additional £500,000 for research into AIDS to support our epidemiological research. The health departments agreed to provide £300,000 and the Advisory Board for the Research Councils advised my right hon. Friend that the balance — a mere £200,000—should be provided in addition to the existing science budget and grant-in-aid to the MRC. My right hon. Friend did not agree. He said that the money would have to come from our existing budget.
On 17 November Sir James Gowans went to see the new Secretary of State for Education and Science, and again asked for more money. In the MRC's view, the national emergency that we are facing is such that additional funds must be made available. It is now considered that in order to pursue the priorities identified by the working party of the MRC an additional £1 million a year is needed. The matter is urgent. I hope that the Government—I say the Government because this embraces more than one Department — will recognise that this is one decision that cannot be left to the Treasury.
§ Mr. Gary Waller (Keighley)
Does my hon. Friend agree that, because of the concentrated effort that is needed for research, the best help would be to give support to the considerable effort in the United States and other countries, such as France? Does he agree that our best prospect is to devote our resources to education? Bearing in mind the exponential growth of the disease and the long period over which it remains dormant, we could use the time to delay the onset of the disease and to prevent it spreading and growing. We could then save thousands of lives five years hence.
§ Mr. Crouch
I agree with my hon. Friend. That is the aspect of controlling the progress of an epidemic. My concern is the attempt, through research, to find a cure. 828 There is something to be said for both. Money is required for both areas. The greatest amount of money will be required in the education process, as my right hon. Friend the Secretary of State said.
I want to say something about collaboration with the pharmaceutical industry. I have emphasised the word "collaboration" already. The hon. Member for Oldham, West said that in this country that industry, of which I am a member, spends about £500 million a year on research. That is valuable work. I have already mentioned the valuable co-operation between the MRC and the Wellcome Foundation.
I must say in this important debate that the time has come for a great co-operative effort by scientists, whether they are working in the Government, the universities or the pharmaceutical industry. We have a wealth of knowledge and facilities in the private sector. This is not a time for secrecy between companies. It is not a time for secrecy between companies and the Government. We are at war with a new virus. We must get ourselves on to a war footing to tackle the great problem. We must get together and share our knowledge. We must draw on the best brains in the country. A national effort is needed, and it must be international as well. Those are some of the questions to which the committee of my right hon. arid noble Friend Lord Whitelaw must give its most urgent consideration.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I am privileged to follow the hon. Member for Canterbury (Mr. Crouch). We have been treated to a seminal contribution to today's debate and I am sure that the Hansard report of the hon. Member's speech will be carefully studied by us all. The hon. Gentleman's work in the Medical Research Council and pharmaceutical industry is well known and has brought a valuable insight to this morning's discussions. I extend those comments also to the contributions made by the Secretary of State and the hon. Member for Oldham, West (Mr. Meacher). Both made statesmanlike speeches and both recognised that there is a need for all-party consensus to confront and attack this infection. In so far as I am able, I shall subscribe to that view and try to seek to strengthen the Government's arm in any way possible in the coming weeks and months as the grim story of this infection unfolds.
It is certainly true to say that everybody involved in the medical profession, voluntary groups, charities, infected groups and the general public have, for some time, been waiting for a lead from the Government. I believe that the Government have taken the first step this morning. Obviously, some of us would like to see the momentum maintained and increased. However, I recognise that the first steps have been taken, and I welcome and endorse the Government's view and the announcements made this morning.
I have been frustrated and scraping away for the past six months tabling parliamentary questions on AIDS. I had come to the conclusion that not enough was being done and not enough money was being spent. I hope that we can set any such recriminations behind us and look forward positively to the future.
I certainly think that the infection of the 500 or 600 patients who have contracted the disease and the 30,000 who have been infected by the virus could have been both 829 predicted and prevented. Certainly, the disease is not curable, as we know. A life sentence of infection for carriers is a serious matter and the Government—any Government—should and must respond to it.
The tone of this morning's debate is heartening. It has been constructive. We have not only a medical problem but a social problem on our hands. The language and adjectives that we use are very important, not just to the at-risk groups but to the wider public as well. There is a great deal of confusion, ignorance and fear, and we must be careful about how we tackle the problem for that reason.
The popular press has dealt with this matter in a sensational way and it has done itself no credit. It will take us many months to try to redress some of the damage it may have done. The infected people with the full-blown symptoms and the at-risk groups are immediately exposed to tremendous social pressure. In some cases they are persecuted, threatened and abused. I fear that if that continues indefinitely they will tend to be driven underground. If one is a member of the homosexual community, the best way to obtain cover is to acquire a wife. If one acquires a wife and is carrying the virus there is another vicious screw —[Interruption.]— turn of the screw in the spiral of infection. One has to be careful about the language used in such debates in more ways than one.
I subscribe to the view put forward by the hon. Member for Oldham, West (Mr. Meacher) that infection of the general population is not necessarily inevitable if action is taken quickly. Indeed, one of the things that has come across in the past few weeks, since television interest has been stimulated, is that there are many people who may have had isolated, casual sex with prostitutes, or whatever, during the past 18 months and who are now suffering a great deal of fear because some of the stories in the press suggest that they may be infected. If I am right—I hope that somebody with more medical knowledge will put me right if I am wrong—the chance of people who are not in one of the at—risk groups but who have previously engaged in casual heterosexual sex catching the virus is very remote. That is not true today. It will never be safe again to indulge in casual, heterosexual sex. As the Secretary of State said, people have the answer in their own hands by changing their habits in future. It would be helpful for somebody in authority to say that, to date, people who may have had casual isolated sex in the past are unlikely to be at risk. Any thought of them rushing to flood STD clinics for testing is a waste of time and they should not worry.
§ Mr. Strang
There is one exception to that. If the incident was with an Edinburgh prostitute, sadly there is a high chance of infection.
§ Mr. Kirkwood
It is dangerous to make sweeping generalisations. I am grateful for that correction. I hope to deal with Edinburgh later.
The announcements made by the Government this morning are extremely welcome. As the Secretary of State said, information is the only vaccine that we have at the moment. I hope that his leaflets will be clear about the risks, the transmission routes and the preventive measures that are necessary. However, I hope that he will also carefully consider using some of the valuable space in the leaflets to dispel some of the myths that I have been 830 speaking about. I hope, too, that he will desist from any moralising because, if the leaflets are going to young people, the last thing that they want to hear is a dose of moralising, which could erect a barrier between them and getting the message.
I wonder how long the Secretary of State envisages the television campaign that he announced this morning lasting. I hope that it will not be of short duration. I believe that we need a five to 10-year span of advertising. The problem is with us, and, as has been said, even if no one else was infected from today on, we should still have a serious problem. The comparison with the Trustee Savings Bank and British Gas flotation advertising campaigns is entirely valid and is not exceptional.
The Secretary of State will probably be aware that the British Medical Association general practitioners committee, in an emergency resolution only last night, came out in favour of issuing rubber protective sheaths through surgeries and clinics. I would go further and make them available through retail chemists. That is a very important weapon in the Secretary of State's armoury to which he should have recourse at an early stage.
The work done by the Terrence Higgins Trust and, in Scotland, by the Scottish AIDS Monitor organisation, is crucial. Their counselling, education and training and particularly their influence within their own peer group to try to influence sexual behaviour and patterns is crucial. I hope that the Government will actively consider giving more support in that direction.
It is important that at an early stage the Government promote some sort of co-ordinated charity umbrella. We know of the experience in New York, where there are now nearly 90 different, separate, fragmented charities all over the place. They are trying to do their best in difficult situations because they are competing with one another. The Government have a duty in that regard. I know that it is difficult and that ordinarily it is not the work of Government, but it is important that we get a recognised umbrella organisation. There are funds to be raised for research, counselling and so on. That voluntary effort has a valuable role to play, but if it is fragmented it will be vitiated and be the less effective for it.
If we are embarking on a professional advertising campaign, the tendency will be for people to come to the STD clinics, the surgeries and other places in response to it. The facilities must be there to look after them when they come — screening and testing must be available. There must be adequate resources for staff and the clinics themselves must be adequately equipped with test equipment such as the so-called "System 3" equipment, which is necessary for modern testing. As a pharmacist, I believe that the antibody tests will give way eventually to much better antigen and viral isolation techniques. If we do that, the testing equipment must be kept nearer to the test place. The Government must not rule out the possibility of that development in the near future.
Staffing and counsellors and the Public Health Laboratory Service will play a vital role, too. I hope that the Government will respond to the story in The Guardian about a £4 million cut. If that cut had an impact on AIDS-related work, I should be very concerned indeed. I endorse the view, taken probably on both sides of the House now, that any screening must be on a voluntary basis. At this stage mass screening makes no practical sense. It would be regrettable to let the idea take hold that it is possible to screen immigrants, too.
831 I should now like to refer to those who suffer full-blown symptoms of the syndrome. I add my commendation to those working in places such as St. Mary's and Middlesex, not just the medical but the caring staff, because nurses have been infected during their work. Their work is for the whole of our present-day society and should not go unrecognised. We need social workers, too, and buildings. I underline the plea for help for the London Lighthouse hospice and similar organisations. Their work is invaluable. The Government could do much to stimulate and promote their efforts.
The hon. Member for Canterbury made an eloquent plea for more money for research. He can make that plea much more competently than me. I agree with everything that he said.
On the question of the money that is available, I should like to refer the Secretary of State to the work done by the College of Health. I am sure that he has seen the figures. It set out a sensible, short-term regime of expenditure embracing £20 million or £30 million for advertising, £10 million or £11 million for health authorities, £10 million for voluntary groups, £4 million for staffing, £5 million for London because there are special problems there, and about £10 million for research. From my perspective of the problem, I believe that those are the amounts of money required. It would involve a tenfold increase over what was being spent before this morning's announcements were made.
I now refer specifically to Scotland. The Scottish situation is different. Diseases such as AIDS have a different profile and incidence, depending on the host community in which they operate and take hold. The situation in Scotland is now unique. I am sure that the hon. Member for Edinburgh, East (Mr. Strang) will deploy the Edinburgh problem at greater length.
As the hon. Member for Edinburgh, East said in an intervention, the drug community in Edinburgh is now nearly more than 50 per cent. AIDS-carrying. That has real implications for the whole of Scotland. The evidence is that in Scotland as a whole we have had 19 or 20 syndrome patients and 13 of them have died. Almost 5,000 are virus victims. In Edinburgh, nearly 2,000 people are virus carriers, and at least one third—probably more, and maybe as many as 90 per cent.—will eventually die. That is at least 700 people. Heroin has traditionally been cheaper on the west coast and the drug addicts go on the blue trains from Edinburgh's Haymarket station to Queen Street station in Glasgow and they take their dirty needles with them. They sample the heroin before they take it back to their friends, and the result is that there are now roughly 154 virus carriers among the drug community in Glasgow.
I should like to congratulate Scottish Television on the work that it has been doing and the programmes it has been making. According to its figures, some 8,000 to 12,000 people in Glasgow use intravenous heroin. Glasgow is on the precipice of a disaster of immense proportions which will occur if the infected population from Edinburgh enable the virus to take hold in Glasgow. No other city in Britain is facing such a disaster. The problem in Scotland stems from Edinburgh and the virus infection is creeping up the east coast. In Fife there are about 40 virus carriers, there are 140 in Dundee and 35 in Aberdeen. They can all be traced back to Edinburgh. On the east coast of Scotland, 26 babies are now carrying the virus.
832 I was pleased to see that the Secretary of State for Scotland was added to the Minister's Cabinet Committee. That is a useful step. The Cabinet Committee must urgently turn its attention to Glasgow. I understand the difficulties that the Minister will face in issuing new needles for old and in considering Methadone substitution and other measures—all the sensible recommendations made in the McClelland report. Implementing those measures will give rise to all sorts of problems and the Minister will receive criticism from all quarters. At the very least, will he consider using Glasgow as a pilot project? He could say to his critics from the Right—if that is the direction from which criticisms come—-that this is to be tried in Glasgow and that it has been tried in Amsterdam. I know that there are problems in Amsterdam, but the Minister could try it in Glasgow for two years to see whether it works. If crime increases and Glasgow becomes a magnet for drug abuse for the whole of Europe, the project could be stopped. In the immediate future, the Minister could isolate Glasgow and use it: as a pilot project for the McClelland committee recommendations.
The Minister does not have much time if he decides to do that. If he leaves it beyond the spring he will be too late, because in Edinburgh the problem is beyond control. Drug addiction in Scotland is not the same sort of Hampstead suburb activity that it is in London. In the main, hard line intravenous heroin is being used, and the down and outs do not have letter boxes for leaflets or electrical plugs for television sets and there is little chance of getting through to people like that in any other way. I make an earnest plea to the Minister to look at the special circumstances in Glasgow.
I think that it was Napoleon who said that battles can be won or lost in moments. In terms of the battle for Glasgow and the impact of AIDS on that city, the moment is now, and if the Government do not seize the opportunity they will never have it again.
§ Mr. Deputy Speaker
Order. The only short speech that we have had all day was on a point of order. I hope that hon. Members will try harder.
§ 12.3 pm
§ Sir Ian Percival (Southport)
I agree with the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), who said that we have a social as well as a medical problem. He expressed one view about that on which my thinking leads me to the opposite conclusion from him, but I shall develop that point later.
I am sorry that I missed part of the debate, both because of the apparent discourtesy to hon. Members who spoke and because I missed what they said. However, I have heard most of the debate and all hon. Members that I heard stressed the dire straits of those who suffer from this disease. We can but be desperately sorry for anybody who contracts it, however he contracted it and whatever our feelings about how he did so. All hon. Members have also stressed the dire straits to which Britain might be reduced if we do not succeed in our efforts to stop the predicted growth of the disease. I agree and am thinking not just in medical terms, but in terms of the misery to the ever-increasing numbers who may be subjected to the disease.
I totally accept all that the Minister said. This is a public health challenge and is of a size, urgency and 833 importance that cannot be exaggerated. I should like to introduce an additional factor. What I propose to say is not in place of anything that has been said, but in addition to it. In addition to a public health challenge, we have at least as important and as urgent a challenge to the nation's morals. Of course we must do what we have to do to meet the public health challenge, and we must all co-operate in every way that we can to find an answer to that challenge.
Hon. Members need also to ask themselves, and to ask everybody else who cares about it to ask themselves, at least two other questions. Why do we have this dreaded danger? Why do we have to face the undoubted need to direct to this cause resources that are sorely needed to help others to improve or recover their health?
Part of the answer to those questions must lie in the questions to which my hon. Friend the Member for Canterbury (Mr. Crouch) addressed himself—what he called the crisis of science. So be it. Of course we must do all that we can to find the answers, in so far as those answers lie in scientific matters, but I beg the House and the people of this country not to overlook one other factor. A very material factor in the spreading of this disease and of the misery that it causes is that so many have strayed so far and so often from what were taught as the normal moral values until the 1960s and from what are still taught, thank heaven, by a great many people.
I stress that I said the "normal" moral values. I do not want to moralise. I used the word "normal" deliberately. Very few people are ever good enough or clever enough to live up to the strictest sets of morals all their lives, but at least until the early 1960s there was always some sort of guide. We were led to believe that it was good to live up to what was regarded as normal. However, since the early 1960s I am afraid that by so many, especially perhaps those who have h0ad the use of the means of communications, that has been described as "old hat". With other right hon. and hon. Members, I have seen hon. Members sneering at any suggestion that some importance is to be placed upon moral values. I hope that they are starting to think again carefully about that.
Whatever the discussion may be about how the disease is spread, the two words that crop up over and over again are "sex" and "drugs". I do not need to be more explicit than that to make my point. It would not be very difficult to make it even more forcefully, but the fact is that any discussion—never mind about the purely scientific basis — on how the disease is spread from one person to another automatically introduces sex or drugs, or both.
I do not think that anybody could gainsay that this change in our habits—I choose to call them values—has happened for a variety of identifiable reasons. There are some who have set out deliberately to destabilise society by corrupting the young with sex and drugs. If we are not willing to recognise that fact, we shall continue to turn a blind eye. Not many people are involved in that, but we should be examining all the causes. I just hope that those who have been involved will, if they have any decency, quake at the thought of the devil that they have unleashed.
Others have used both sex and drugs for the purpose of making money. Although I earn my living as a lawyer and have spent 27 years as a Member of Parliament, I find it difficult to find words that preserve the kind of moderation that I am trying to preserve and yet adequately describe what I am talking about. But they are not the only 834 ones who are guilty. Among the guilty are those who, since the early 1960s, have actively promoted what they choose to call "the permissive society." In this Chamber I have even heard it called "the civilised society". They have actively promoted every form of deviation from those normal values until the mystery and the beauty of sex have been dragged down to the levels of what we have to talk about in this debate, and in the combating of this fearful social problem.
§ Mr. Abse
As the right hon. and learned Gentleman is addressing his remarks to those of us who put into effect this legislation, does he not think, as a distinguished Conservative Member of Parliament, that at a time when the Opposition note that both unemployment and interest rates have increased since 1979, he should tell us, since he is echoing the chairman of the Conservative party, that the only perception that the people of this country have is that the only people who cannot keep their trousers up are those who are either in the vicinity of the Conservative party or right at the heart of the Conservative party? Perhaps he will address his remarks to them and not to those of us on this side of the House who sponsored the legislation.
§ Sir Ian Percival
When the hon. Gentleman reads the Official Report he will realise that I was making a perfectly general observation, but if he feels that it applies to him, so be it—if the cap fits, he must wear it.
My right hon. Friend the Secretary of State said that there had been encouraging noises from the Independent Broadcasting Authority. I am glad to hear that, but we need rather more than encouraging noises. A week ago today I was watching the late night tennis highlights on the television. When that finished, instead of switching off I made the mistake of turning the dial. Although I spent five years in the Army, I was aghast at what I saw. There was a yellow triangle or something in the corner, but that would merely attract some viewers. It was neither funny nor clever and could not by any stretch of the imagination be described as having anything artistic about it. It was salacious, it was filthy and it was deplorable. That is the kind of thing that the IBA allows to be shown. People talk solemnly about intellectual and artistic freedom and then wonder why rape has increased by 29 per cent. in the past year. They should start looking at the facts and stop all this airy-fairy nonsense about artistic licence. When there is an element of art that is fine, but when it is just salacious filth we should face up to it, and let the IBA, which can do far more about it than we can, put a stop to it and put the people who foist this stuff on the public in their place.
We must all do all the things that my right hon. Friend the Secretary of State has said that we must do, but we must do more as well. My plea to and through the House is that we should strike at the very roots of the evil, not just the scientific causes but the social causes. By "we", I mean all of us. I have mentioned a few who I believe have contributed to the evil, but we must all try to help solve this social problem. There is a wonderful opportunity for the churches to take the lead in helping the country back to some moral values, but I do not resile from what I have said. I am not pointing the finger at other people and saying that they should do it. We must all do what we can, but the first necessity is to recognise the causes. Those who try to set aside or rule out the argument for moral values not only fail to look the facts in the face. They will never 835 find the answers to the problem, although I accept that they seek those answers as fervently as I do. None of us will get anywhere in seeking answers until we face this aspect of the matter.
The immediate purpose and gain of a return to what I have described as normal standards would be to reduce the number of people who contract or pass on the disease, but the long-term gain will be to make ours not only a more healthy nation, but a happier and a better one.
§ Mr. Willie W. Hamilton (Fife, Central)
The speech of the right hon. and learned Member for Southport (Sir I. Percival) gives me a very good lead in. Whenever the Conservative party starts talking about moral values, we can be sure that a general election is imminent. I shall have more to say about that later in my speech.
The Secretary of State, both in opening the debate and on earlier occasions, has appealed for an all-party approach to these matters. I agree with a good deal of what he said. There is indeed a limit to what Governments can do to contain, organise and control people's behaviour, especially their sexual behaviour.
Ministers should beware of certain Conservative Members adopting the posture that was put into words by the right hon. and learned Member for Southport, who attempted to lecture people on their sexual behaviour and morals. They need no such lectures from Conservative Members in particular. I should like to ask the Minister about an early-day motion which has been signed by a considerable number of Conservative Members. It concerns the desirability of repealing the Sexual Offences Act 1967, which allows certain behaviour between consenting adults in private. I want public schools to be abolished, which would go some way towards solving the problem that we are discussing. If we get into that kind of posture, two can play at that game.
Yesterday I had the great privilege of seeing what Scottish Television has done to reveal the facts about the great scourge that we face. I had the privilege, if it can be called a privilege, of seeing what it has done to expose the great dangers of the disease. I was almost physically sick as a result of what I saw, and I am a pretty hardened operator in these matters, but that is just the type of propaganda that is required.
I had not realised until yesterday how rapidly this incurable disease is spreading in Scotland, where it is spreading no less quickly than in other parts of the world. It is a certain killer and, at the moment, incurable. It has rightly been described as the greatest threat to public health this century, yet the public remain woefully ignorant about its causes and symptoms and what they can do to avoid its deadly clutches. One common misconception is that it is almost entirely restricted to homosexuals and drug addicts. Scottish Television has gone some way towards educating the British people that it is a heterosexual menace as well.
Researchers have told us that the circumstances in Scotland are special in many ways. I understand why the hon. Member for Eastleigh (Sir D. Price) is absent, but if he had stayed I would have asked him whether his all-party Select Committee, which is to consider the problem of AIDS, has a remit which extends to Scotland.
§ Mr. Hamilton
I hope that the hon. Gentleman will understand if I do not give way.
If the Select Committee's remit does not extend to Scotland, I hope that we in Scotland will exercise initiative and set up an ad hoc Select Committee, as consideration of the matter is desperately urgent.
My hon. Friend the Member for Edinburgh, East (Mr. Strang) mentioned, in an intervention, the provision of clean needles. The Government must make an urgent decision in that respect. The same applies to the provision of free, stronger condoms. We must not be squeamish about the use of language. If necessary, four-letter words must be used to show the dangers arising from this problem.
The Scottish Television researchers tell us that the AIDS virus came to Edinburgh in 1983 via a United States sailor who shared infected needles with a large group of addicts. New York has everything—just name it and it has it, and it sends it over here. That is how we got the problem in Edinburgh. It is spreading like a forest fire. There are 40 cases in Fife, 140 in Dundee and 35 in Aberdeen, and those figures are probably already underestimates. Glasgow has a drug-taking population of between 8,000 and 12,000. The city faces a terrifying problem, which is worsening rapidly. We are told that there are about 1,500 to 2,000 virus carriers in Edinburgh, about 700 of whom will die over the next four years.
What action is being taken to fight the menace? The Scottish AIDS advisory committee recommended that clean needles should be provided for addicts and that new money should be found to tackle the problem. No decision has been made about the needles and we have had little sign that the Government view the problem with sufficient seriousness.
Whenever we ask for increased public expenditure the Government reply, almost immediately and mechanically, "You cannot solve a problem by throwing money at it." As a generalisation that is true, but ever since 1979 the Government have thrown money indiscriminately at the police and the law and order services and, despite the enormous sums spent in that area, the crime figures have rocketed remorselessly year after year. The latest figures published yesterday show that the position is getting no better. The Government should not use the old excuse about throwing money at problems. Much more money must be spent on this extremely serious matter. If it is not spent now, we shall have to spend fortunes in the decades to come.
When we faced the threat of a war over the Falkland Islands the Prime Minister said that she would solve the problem "no matter what the cost." We had the war and hundreds of men on both sides died, but the problem is still unresolved. Hundreds of millions of pounds—perhaps thousands of millions of pounds—of public money were spent on that endeavour. All right, it won the Prime Minister a general election, though the British people probably regret that now. The point is that the Government can find the money when the will is there and when they see a danger as a paramount threat to national survival.
The spread of AIDS is as serious as, if not more serious than, what faced us in the Falkland Islands. The Prime Minister should go on television now and say, "We shall solve this problem, no matter what the cost." That would be a measure of the Government's seriousness. They should not appeal too much for an all-party approach to 837 the matter. With the imminence of an election, everything —but everything—is seen by the Government as a party political matter, whether that be Brent council, Mr. Grant in Islington, the BBC or even the Church of England. All those matters are in the political arena.
The Opposition reserve their judgment on this point. The Government's seriousness on this matter will be tested by the amount of resources that they are prepared to commit. The public understand, and will increasingly understand, the enormous seriousness of the disease. The Government's sincerity in their approach to the disease will be tested by the Prime Minister's edict, "We shall tackle it, no matter what the cost."
§ Mr. Patrick Cormack (Staffordshire, South)
The hon. Member for Fife, Central (Mr. Hamilton) has had a very long and distinguished parliamentary career. I am sorry that he is leaving the House at the end of this Parliament, but I am equally sorry that he sometimes leaves his charm outside and injects rather more bitterness into his remarks than becomes him. He was especially unfair when he attacked my right hon. and learned Friend the Member for Southport (Sir I. Percival) for what was essentially a sensible, moderate and reasonable speech.
I do not pretend to the medical knowledge of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), who is a pharmacist, or that of my hon. Friend the Member for Canterbury (Mr. Crouch), who spoke from the standpoint of the Medical Research Council. I want to make my remarks along the same lines as my right hon. and learned Friend the Member for Southport.
The hon. Member for Fife, Central was entirely correct to remind us—albeit with a little force—that no party has a monopoly on chastity or on moral values. It would be preposterous to suggest that. However, there is nothing wrong in recognising that the majority of the people in this country attest to or subscribe to some sort of faith — Moslem, Christian or Jewish. All the great faiths teach certain moral lessons. To face those lessons in such a debate is not attempting to be holier-than-thou or to be pious. Most of us have fallen by the wayside from time to time, but that does not mean that we do not recognise the fact that it is a good thing — as my right hon. and learned Friend the Member for Southport said—to have standards and aims to which we can aspire.
Although I believe that only a proper sense of compassion motivated the hon. Member for Torfaen (Mr. Abse) in his reforming zeal—much good has come of it—it behoves him to recognise that all has not been good and that those who have made money from titillating the baser sensibilities of people over the past 20 years or more, the evidence of which is in every bookshop and bookstall in the land and frequently on our television screens, have done small service to the community, even though they may have lined their own pockets. We must recognise that those people bear much responsibility for the terrible dilemma which the nation faces today and which the House is debating.
We must also recognise that to have a proper and burning concern for those who are suffering from this terrible disease and to have—if I can put it in the Christian context—a total sympathy and desire to help the sinner does not mean that we do not recognise that 838 there is such a thing as sin. We must also recognise that the two words which have cropped up time and time again in the debate, and which crop up whenever this subject is discussed, are sex and drugs. What are we talking about? We are considering a problem which has been exacerbated by certain homosexual practices and promiscuity. I agree with the hon. Member for Oldham, West (Mr. Meacher), who said that the latter—promiscuity—is probably the greater scourge. It does no service to put that to one side and not to debate it when we are discussing this disease. It must be recognised.
I am sorry that neither my right hon. Friend the Secretary of State nor my hon. Friend the Minister for Health is here, but I should tell my hon. Friend the Under-Secretary of State, who is no doubt taking copious notes to pass on to senior Ministers, that some aspects of the orchestration of the Government's campaign give cause for anxiety, although there is universal approval for the general drift of the Secretary of State's remarks in his positive and sensible speech this morning. I do not contemplate lightly the fact that many of my constituents of advanced years will suddenly have fairly alarming literature thrust through their letter boxes, and I hope that some thought will be given to exempting some aged sections of the population, who live in identifiable areas, from receiving the sort of material that will be put out. We must also recognise that some of the literature will have a disturbing effect on young children. It is especially important to have close consultation with the education authorities about precisely what is said and how it is said.
I said that most people subscribe to a faith. I hope that the Government will talk to the leaders of all religious faiths and give them the opportunity to contribute to the literature produced so that it can be seen that there is a recognisable and perfectly acceptable moral dimension.
Although I understand why the Government and everyone else say, "If people cannot desist from certain practices they should take precautions," there is a slight danger that it could be equated with the Government's saying, "It is bad to steal, but if you must, please wear gloves." We must get the message across much more carefully than that. We can talk about using condoms, but I hope that the Government will ensure that every contraceptive device carries a health warning on the packet. I see no reason why it should not say, "Promiscuity can kill." There is no reason why we should not adopt a warning similar to the Government health warnings on packets of cigarettes.
The hon. Member for Oldham, West might take issue with me on the moral dimension, but he said that codes of behavious must be changed. He made a fair point when he said that we shall overcome this terrible scourge that threatens to engulf the planet only if people change their behaviour—
§ Mr. Cormack
I am glad to see the hon. Gentleman nodding. He does not think that I have distorted his words. As we are at one across the Chamber on this—I think that few hon. Members would disagree—let us say to those who wish to take the easier way out that risks are still involved. The only way of being sure of avoiding this terrible disease is to practise monogomy or celibacy. It is difficult for everyone, but it can and should be done.
§ Dr. Norman A. Godman (Greenock and Port Glasgow)
Is not the major problem of an educational programme for drug misusers the fact that we are dealing mostly with youngsters aged between 16 and 24, who are enormously difficult to educate? Does the hon. Gentleman agree that much more is required above and beyond education?
§ Mr. Cormack
As the father of two children who are within or just approaching that age range, I agree entirely with the hon. Gentleman. That is why it is important, if a family subscribes to a faith, to say, "The tenets of our faith teach this," and to point out clearly and unequivocally that that is the case.
§ Mr. Cormack
The hon. Gentleman points out that many of the youngsters about whom he is concerned live on their own and do not have parents to care for them. We all accept that, as we accept that the sort of people of whom the hon. Member for Torfaen gave such a graphic description are the most difficult to reach. However, because we accept and seek to grapple with that problem, a problem on which no money should be spared, as it should not be spared in trying to find a cure, it does not mean that we should forget that the vast range of the population, most of whom live what one would call a "normal life", are at risk. Everybody is at risk, and to most we can take a more orthodox approach.
I hope that my remarks will be conveyed to the Ministers with responsibility for this matter, and that there will be consultations with those who have a moral responsibility in the life of the nation.
§ Dr. M. S. Miller (East Kilbride)
There have been moments in the debate when I have become aware of echoes of the past. While the moralising aspect is important and has to be mentioned, we should be much more concerned about trying to find a cure or prevention method for this awful disease, rather than exhorting people completely to change their way of life. It is a good thing to do in many instances, but that is looking at it from an extremely dangerous and long-term point of view, and we cannot wait that long. We cannot wait for several lifetimes before there is a cure or a vaccine.
I am reminded, from the dim and distant past, of when Paul Ehrlich, trying to find a cure for trypanolsomiasis, found something that produced an excellent effect on syphilis but was rather a dangerous drug, Salvarsan. It sometimes killed, but those who were not killed were cured of the disease. There was a terrible outcry against him or any doctor who wanted to use Salvarsan against syphilis, because one got syphilis only if one were promiscuous, and promiscuous people should not be saved. As a doctor, I did not adopt that attitude, although some might have done so. That seems to be one of the tendencies being indulged in today.
§ Dr. Miller
I cannot give way, as I wish to get on with my speech.
The hon. Member for Canterbury (Mr. Crouch), in an excellent speech, showed clearly what the problem is about. My hon. Friend the Member for Torfaen (Mr. Abse) seemed at one point to be about to blame the 840 profession for producing the disease. It reminded me of the General Practitioner of March this year, which talked about the problem and said:Part of the problem with AIDS is that it is a new disease first prescribed in 1981".Of course it meant described. That was a Freudian slip. The article showed the nature of the disease and gave some statistics. It said:A few naive moments with a calculator working out exponentially doubling rates"—because it is estimated to double every six to eight months—showed that in the year 2000 the disease would affect about 4 × 101 7 people—in other words, all of us. The article pointed out, however, that the calculation is fallacious, as the number and behaviour of susceptible people and risk groups will inevitably alter. 1 think that that is true.
The article described how AIDS started. In September 1981 there were 2,259 patients, of whom 917 had died. Of them, 71 per cent. were homosexual or bisexual, 17 per cent. were intravenous drug abusers, with equal numbers of males and females affected, 1 per cent. were haemophiliacs, 1 per cent. were sex partners of high risk groups, and 6 per cent. apparently had no risk factors, but by the end of 1984 there were almost 7,000 patients, with almost 4,000 deaths.
We know that the disease could well reach epidemic proportions. Hon. Members have been inundated with leaflets and booklets about the disease. The virus is about one sixteen thousandth the size of a pin head. It operates by using its ribonucleic acid. When it enters the bloodstream it makes straight for the "T" cells and converts its RNA into DNA, which is a double spiral instead of one. It then enters the chromosomes, which determine what the cell will do. The whole system is invaded by the virus.
Many hon. Members have made excellent speeches today. Incidentally, I still call it the human "T" cell lymphotropic virus type 3 the HTLV 3. I am glad that a special Cabinet Committee has been established, and that there is international co-operation with a team, but more money is needed, and I agree with my hon. Friend the Member for Fife, Central (Mr. Hamilton) that no money should be spared. This disease should be given at least as much priority as that accorded to the Falklands.
Some hon. Members have said that they are not sure about certain aspects of social communication and behaviour. For example, can the virus be carried in tears, kissing, shaking hands, and so on? The answer is probably not, but too little is known as yet. Hon. Members ask other telling questions. For example, the hon. Member for Eastleigh (Sir D. Price) asked how long it was before an antibody could be detected in the blood. It takes several months. There is also the question of the very toxic nature of the limited number of anti-AIDS drugs. Moreover, I completely agree with the strictures made of screening. It would be a hopeless course to embark upon.
I say, "For God's sake, do not allow extraneous considerations to cloud the main point." That point is that we must work for a vaccine and a cure for this awful disease. I have lived through the era when a search was being made for a safe cure for tuberculosis, syphilis, gonorrhoea and pneumonia. There are now safe cures for those conditions. There has also been a search for better treatment for diabetes, cancer and cardiovascular disease, and many dramatic improvements have been made.
841 I said earlier, by way of intervention, that we have a problem, the like of which we have not seen before—certainly during the era I am talking about, the past 50 or 60 years. There is a proliferation of drugs which sometimes cure and, in other instances, help. There has never been such a plethora of information as there is in this case. It took a long time to determine the casual organisms of many of the diseases that I have mentioned. This time, in a short period, the organism and the antibodies have been identified. Previously, it took years and years —generations—before that knowledge was available.
On a number of occasions I have spoken about my youngest son while attacking the Government for making it difficult to obtain posts in colleges and hospitals. I am pleased to tell the Minister that he is now the senior lecturer in biochemistry, molecular biology and recombinant DNA engineering at the Liverpool polytechnic. I hope that he will be one of those who work in this area and that, before it is too late, we will get a vaccine and a cure for this awful disease.
§ Mrs. Anna McCurley (Renfrew, West and Inverclyde)
I welcome my right hon. Friend's encouraging statement. We do not face just an epidemic in this country. The AIDS virus is now endemic in the United Kingdom. Rabies is not an epidemic in Europe but it is endemic there. The AIDS virus is endemic in Africa, and it has been for many years. The disease may be new, but the virus is not.
I was pleased to hear the hon. Member for East Kilbride (Dr. Miller) say that there was hope in this ghastly business. He talked about the great strides that had been made in research. I add that there is hope in the research carried on in my home city of Glasgow, where Professor Jarrett has experimented on cat viruses. These experiments have been viewed with great interest in the United States. Cats suffer from immuno-deficiency, too. The virus has been isolated. We hope that the experiments will lead to some way of combating HIV. The HIV virus was graphically described to me by Dr. Madhok of the Glasgow royal infirmary as a pirate of the cells. I think that the hon. Member for East Kilbride will concur with that description.
I have watched Government action on this problem develop from a rather gracious walk to a fast trot. In 1985 I was grateful when they took swift action to ensure the cleansing of blood so that there could be no fear associated with having an operation, or of haemophiliacs being any more at risk.
The House has been asked to consider several measures. Mass screening would be a grave mistake. The consequences would raise the spectres which I believe the second world war was fought to prevent. However, there may be room for selective screening in high risk groups. In some professions and jobs, individuals are at risk and may cause risk to others. I include surgeons, dentists and food processors who may be homosexual. We must consider in the future some way in which people in those types of high-risk professions who are identified as having the disease are at least compensated if they have to withdraw from their jobs.
Screening of immigrants has been mentioned, but it would not be foolproof. We know how long it takes for the virus to incubate. Although we could encourage some 842 high-risk groups to be screened, obviously we would have to make international bilateral arrangements. We must remember that, when we condemn those who might come out of Africa, in Canada AIDS is just as bad as it is in the United States.
Reference has been made to the McClelland report, a Scottish report. We have discussed the issuing of clean sharps to drug addicts. That has been done too late in Edinburgh. I believe deep in my heart that issuing sharps encourages drug taking. I would not be averse, however, to endorsing the idea of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) that we try an experiment in Glasgow and see whether it works. If one gives five sharps to a drug taker, he may go into a "shooting gallery", as it is euphemistically called, where there are seven people. At least two people will then use contaminated sharps, so that is not a foolproof method.
I congratulate my right hon. Friend the Secretary of State on the new health and educational measures. I hope that Scotland will benefit from the financial help. There are other swift and realistic counter-measures which are more immediate. We can produce good posters and educational leaflets, and place good advertisements on radio and television. However, some examples must not be given too much prominence. In this debate, some of those examples have been given far too much prominence.
I mention in particular the Terrence Higgins Trust material. The trust may be expatiating some kind of guilt, but I believe that its view of life is distorted. I do not think that, on the whole, the hetrosexual community indulges in bizarre sexual practices the like of which are described in the trust's leaflets. I much prefer the approach of the Scottish AIDS monitoring group, which is much more realistic and reasonable. Scottish Television must be congratulated on being the first to move strongly in this campaign with advertising and education on television. We should consider the deep need for the IBA to alter its advertising policy. "Better to offend than dead" seem to be the watchwords of the day. From what I have heard from my right hon. and learned Friend the Member for Southport (Sir I. Percival), the IBA seems to have double standards, which should be investigated.
We need a professional approach to advertising. If the Government can do it for Sid and British Gas, they can do it for AIDS. We must make better use of existing resources. We need to liberalise the STD clinics to make them more like walk-in centres, removing the stigma attached to them. The problem of ensuring confidentiality might rear its head, but counselling and free screening advice are the first line of defence. It might be slightly ridiculous to make this suggestion, but I believe that the Family Planning Association clinics should extend a welcome to homosexuals and give free condoms to them as well as to heterosexuals.
Mobile units, such as the blood transfusion service, which is already helping to educate people about the disease, may well develop their services with financial assistance. For example, they could use videos to educate the individuals who use their services. It may well be that the well-woman clinics and cervical screening clinics could be used, as well as the well-man clinic in Castlemilk in Glasgow, which must be mentioned as a new development. A total of 11,000 pharmaceutical outlets in this country have volunteered their resources. That must be taken up 843 and assisted with funding. We must also emphasise to general practitioners that they must help to improve their services as well as helping to fund hospital care units.
In the final analysis, the Government cannot account for private behaviour. The first thing I would suggest is that we should all be honest with our partners and ourselves, especially if we are in high-risk categories. If we are in high-risk categories, we should abstain. If we go abroad on business, let us remember the Canadian poll on business men, taken quite recently, which asked business men who visited central Africa what they would do if confronted with prostitutes who had the virus. They said that it would not make any difference to their activities. That is something that we should be exceptionally careful of and warn our business community about its travels abroad. Of course we must encourage people to give up drugs, and, especially, we must encourage them not to start in the first place.
Alas, we now have to think of that rich, red, life-giving liquid blood in the same terms as we have thought of urine and faeces. We do not handle them, so we do not handle blood; or at least we should handle it as little as possible. I am thinking particularly of guidance that must be given to those who deal with youngsters in playgrounds at school, where it is inevitable that accidents will take place and lesions will occur. We have to think of future generations. Frankly, this problem is more immediate than anything that the Campaign for Nuclear Disarmament can come up with.
There is still a great deal of ignorance about the disease, as the MORI poll in Scotland showed. However, at least we are getting through to people in Scotland, and 70 per cent. of those who were polled said that they felt that their families were in danger. At least they are alerted to the problem. A total of 85 per cent. of those polled said that they thought that advertising of condoms on television was fine.
The Scottish Television initiative of going to New York has been incredibly helpful in tracing the course of the disease. One person in 16 in New York now carries the virus, and we are only four years behind. The figures for Scotland are frightening, and they are changing for the worse from day to day. In the face of those statistics, the Government can do very little if we do not alter our behaviour. We will have to be sexually continent and responsible from now on or, for all of us, as the philosopher Hobbes once said in "Leviathan", life will be "nasty, brutish and short." Our leviathan is AIDS. I greet the Government's initiatives with a great deal of relief.
§ Mr. Laurie Pavitt (Brent, South)
After the intervention of the hon. Member for Renfrew, West and Inverclyde (Mrs. McCurley) earlier this morning, I was pleased with the speech she made. It was thoughtful, unlike the intervention, and I agree with a good deal of what she has told the House. Her opening sentence echoed the opening of the excellent speech made by the hon. Member for Canterbury (Mr. Crouch). The Secretary of State, as the House and he know, is not my favourite Minister. Perhaps he shares that honour with the Paymaster General, but the Secretary of State is certainly not very high in the league table.
The start of the debate, with the speeches by the Secretary of State and my hon. Friend the Member for Oldham, West (Mr. Meacher), was fantastically good. I 844 have attended practically every health debate for many years. They covered most of the material, and that gave the start to the nearest to a consensus debate that I have heard for a long time. Because so much has already been said, all that those who speak afterwards can do is to underline some of it.
I start with the fact that, in spite of the tremendous amount of public attention, we are still not seized of the enormity of the problem facing not just us but the whole of mankind. The clinical analogy with the bubonic plague, or with several other diseases, is not accurate, but, with the outbreak of the disease, the clock has gone back 300 years, to the possibility of a universal plague, because at present there is no cure. That is why the whole House is seeking desperately to find ways and means of dealing with the threat. Contract AIDS and inevitably one dies; that is one's death sentence.
Sometimes we make comparisons. This morning the hon. Member for Staffordshire, South (Mr. Cormack) talked about promiscuity, and I share his view. Of course, promiscuity is one of the basic elements that we have to deal with. I do not agree with much of the pontificating on moral attitudes, because the reality is moral behaviour and there is nothing that we can do by getting on our high horse and making statements about other people's behaviour.
There is no comparison with the other great killer, cancer. The House will have heard me say this many times. Viscount Tonypandy reminded me of it when he was ill. Cancer is a great killer, but more people recover from it than die from it. The House will have heard me say that I am one of the fortunate individuals who have recovered from it. Also, my wife's cancer was surgically removed 10 years ago. Mine was surgically removed six years ago. We both hope to emulate my late friend, Manny Shinwell, and to be around for many years more. [HON. MEMBERS: "Hear, hear.]
I was reminded by the hon. Member for Staffordshire, South of another analogy. The mortality figures have been bandied about. Some 20 years ago I introduced the first Bill to put a warning on the side of cigarette packets. The Chief Medical Officer of Health, on behalf of the Government, now tells us that there are 50,000 premature deaths a year as a result of smoking cigarettes— From chronic emphysema, carcinoma and chronic bronchitis, and 40,000 deaths from heart disease. If people gave up cigarette smoking, those deaths would not occur. If one wants to bandy about comparisons, there is no doubt that we have not been able to change social habits in that one area—we are now trying to do so in another—and those social habits amount to one death every three minutes. But that does not help us, because it is not comparable. We are in an entirely new situation.
Most of the time we are talking about containment, treatment and research. All Governments pay tribute to primary care by general practitioners—the first line of defence, we say —but the general practitioners are the "poor bloody infantry". They are in the front line. Unless something is done, the assault that we have seen over the past two or three years will overwhelm them. Patients show anxiety and make inquiries and a decision must be made about whether to refer them to a genito-urinary clinic. The patient may demand tests, but no tests can be given without counselling. That takes time.
The point has been made in the debate that there is a desperate shortage of training for counsellors. There is no 845 point in saying that we must have more counsellors unless we have the people trained to do the job. We shall return again and again to the problem of resources and here we are talking not only about the necessary money but about the people to use the resources effectively. Patients must be told the truth about the consequences. Who would like to be in the position of my hon. Friend the Member for East Kilbride (Dr. Miller), who has to say to his patients,I am sorry. There is no hope. You are going to die"?It is not always understood that there is a basic difference between clinics for AIDS and clinics for syphilis. There is no treatment for AIDS and, as my hon. Friend the Member for East Kilbride said in his learned medical speech, we have known about Salvarsan for donkey's years—almost generations.
The final stage for AIDS is hospital. I agree with those hon. Members who have spoken about the importance of the Lighthouse project. It is desperately needed and should receive full support.
Perhaps I could make a plea for the borough of Brent. As hon. Members know, that is an excellent constituency near London. Because the Government are closing a second hospital in my area, there is an admirable place at the Neasden site for a hospice similar to the Lighthouse. I hope that the Minister, when he makes a decision about what is to happen to that site, will bear that in mind. Two beds were recently refurbished in the Central Middlesex hospital and there is a possibility of AIDS treatment there. The refurbished new ward would be ideal for dealing with the problem for the whole of north-west London.
Doctors are in the front line, but of course so are nurses, because they are always in the front line. I should like to pay tribute to the brief from the Royal College of Nursing about which hon. Members have already spoken and to quote what the oncology adviser to the Royal College of Nursing has said:In view of the fact that medicine has so little to offer to patients … at this present time, nursing is central to care and prolonged survival and we would wish to see a greater investment of resources in this area.Nursing research at this present time in the United Kingdom is desperately underfunded and we would wish to see this situation remedied as we feel it has a great deal to offer in planning the future care for this population group.That is, the people with AIDS.
The fact that patients are ambulant for a long time places two new demands on training and the need for adequate funding. First, community nurses must be given top-up training required for dealing with AIDS, and that must be in addition to their training in basic nursing skills and experience. Secondly, it is vital that training and information should be given to home helps. Because of the fear attached to this disease, unless home helps are fully informed and know all about what is happening there will be a crisis about the care of people still living in the community and in need of support.
I was interested to hear the report by the hon. Member for Canterbury, who serves on the Medical Research Council, on which I had the honour to serve some years ago. Inevitably, we have talked a lot about pharmacology, but insufficient thought has been given to microbiology, biophysics and biochemistry, because in some of those fields we may find the answers that we need. The Medical Research Council has suffered cuts which it did not deserve, and I find it difficult to understand why it still has 846 to use its funds to give grants to the Public Health Laboratory Service for work on AIDS. Therefore, the transfer of funds from one place to another represents a cut.
There are four sources of funding: the Medical Research Council, the Wellcome Foundation, the pharmaceutical industry and private individuals. One individual has provided £108,000 for diagnostic equipment at St. Mary's hospital, to which reference has already been made in this debate. Funding is co-ordinated in America. We need a national body to monitor the raising and distribution of funds. Hospital front line clinical research should not have to be diverted to treatment and academics should be able to deal with this problem within their own field. However, I understand that academics are being converted to treatment because of the prevailing pressures.
Much has been said about the use of condoms, but insufficient has been said about advice regarding their use. People must be taught how to use them effectively. A condom can be used either correctly or incorrectly. If it is incorrectly used, it is ineffective. Furthermore, it does not provide the required security. It may be possible to persuade people to use condoms, but if they do not know how to use them correctly there will be a false dawn. The biggest nonsense is that the only free issue of condoms is by family planning clinics. I hope that the Minister will announce that a statutory instrument is to be introduced which will enable general practitioners to provide condoms on the National Health Service, in the same way as family doctors can provide both the pill and the diaphragm. We have the opportunity to remedy that anomaly.
I hope that the Department is discussing co-ordination with the Royal College of General Practitioners and the general medical services committee of the BMA. As has been said time and time again on both sides of the House, a combined operation involves co-operative effort.
A number of my hon. Friends have used the analogy of the Falklands war. This disease has resulted in an international, universal, cosmopolitan crisis which will be with us for the next 50 years. Something must be done about it now. We found £3 billion from the contingency fund at the drop of a hat for the Falklands war. I see that the Secretary of State has returned to the Treasury Bench. I am sorry that he was not here earlier; for the first time since his appointment I had a few kind words to say about him and he knows that that is very unusual. I hope that the Secretary of State or the Minister for Health will tell the House that the Prime Minister and the Government have said that the contingency fund will be bottomless. The greatest drawback to the effective conquering of this disease would be to make it just one more element in the distribution of National Health Service resources.
I welcomed the Secretary of State's announcement about the increased funds that are to be made available, but it is no use giving just this amount or just that amount. If the Secretary of State's policy is effective, it will have a snowball effect on research, treatment, care and, in particular, training. Those who are already qualified will need to attend a crash course to top up their training. In this case, the sky should be the limit.
§ Mr. Deputy Speaker (Mr. Ernest Armstrong)
Order. I should like to help the House by calling those hon. 847 Members who have sat through the debate, particularly as it is a Friday. However, the Front Bench speakers hope to catch my eye not later than 2 o'clock. As seven hon. Members are trying to catch my eye—we can all do the arithmetic — speeches of more than six and a half minutes duration will prevent me from calling all of them.
§ Sir Nicholas Bonsor (Upminster)
In the circumstances, Mr. Deputy Speaker, I shall try to take considerably less than six and a half minutes.
I welcome the return of my right hon. Friend the Secretary of State to the Front Bench, as my comments will be directly related to the way in which he opened the debate. First, I congratulate my right hon. Friend and the Government on the steps that they are taking to alert the public to the dangers of the sexual behaviour prevalent among the young and the dangers of promiscuity and homosexuality. I must, however, take issue with my right hon. Friend's statement that at this stage there is no risk in ordinary social contact. Although, fortunately, the disease has not yet reached the stage in this country that it has reached in the United States, Africa, Canada and many other countries in the world, context transmission of the disease cannot be limited to sexual contacts, drug addicts and blood transfusions.
In an affidavit to an inquiry in the United States in July this year Dr. John Seale said:Once a critical mass of people have been infected rapidly by a highly efficient means of transmitting the virus, then transmission by a far less efficient means will inevitably occur increasingly often. These include blood transfusions, perinatal transmission, biologically normal sexual intercourse, needle-stick industries, sharp contact of sores or abrasions with contaminated blood, saliva, or sputum, mechanical transmission by blood-sucking insects and flies, and routine dental procedures.At present this country is suffering only the very beginnings of the disease, and although it is likely that we can contain the explosion of the virus among our population better than has been the case in the United States, because we have had that example to avoid and more time to prepare ourselves, it would be overoptimistic to believe that the guidelines currently laid down by the Government and the public relations exercise on which we are embarking will do more than delay the time when the full force of this appalling disease falls upon our community.
One of the difficulties of public education is that those attempting to educate the public have only a very limited knowledge of the dangers. I shall, therefore, briefly run through a few facts which have been established and which point to the full danger that we now face.
First, over a period of five years it is estimated that between 25 and 30 per cent. of known carriers of the disease will die. We have known about the disease itself for only six years and it is mathematically probable—as well as, I am advised, medically probable — that the number of carrier deaths will continue to rise inexorably in the next six years. The chances are that between 60 and 70 per cent. of carriers will die of the disease less than 10 years after acquiring the virus, and no one can say whether any or all of the remainder will survive much longer. Given that we have known about the disease for only six years and that the number of carriers in the United States is estimated at best at 1.5 million and at worst at more than 4 million, the full horror facing the human race, and not just sections of it, is apparent.
848 Secondly, all body fluids are known to hold and carry the AIDS virus—not just blood and semen, but tears and saliva. That clearly constitutes a grave danger, as people carrying the disease may be infectious for up to 20 years and will be in daily contact with the rest of the population.
Thirdly, in the world context AIDS is not primarily a sexually transmitted disease. It is a blood-transmitted disease of the same retro-virus group as three well-known animal diseases — maedi-visna in sheep, bovine leukaemia in cattle and equine anaemia in horses—all of which are highly infectious, and all of which can be carried by insects as well as subject to blood transmission by other means. I see no reason, and no medical expert has yet given any, to assume that the AIDS virus will be transmitted in any way other than the way in which those known related viruses are transmitted.
As for Africa, I take issue with what my hon. Friend the Member for Renfrew, West and Inverclyde (Mrs. McCurley) said. She maintained that it has been endemic in Africa for many years. My understanding is that medical evidence suggests that the first known case of AIDS in human beings occurred in 1978.
§ Sir Nicholas Bonsor
I do not believe that there is any evidence of the virus before 1978, but we can argue about that another time.
The rate of expansion in Africa is horrifying. It reads like a science fiction novel for those of us who face the terrific horror of the reality, which is that about 80 per cent. of the population in central Africa are likely to be condemned to die from the disease, that at least 30 per cent. already carry it and that 20 per cent. of the carriers are children under 16. That is the crucial point which I mentioned earlier—it is now being carried extensively by children. It is transmitted not only by sexual intercourse —I submit that it is transmitted not primarily by sexual intercourse—but also by blood.
It follows from the facts that I have outlined that we must look much wider than public relations and persuading people to alter their sexual habits if we are to contain the disease for long enough to find a vaccine or a cure.
We must consider spending far more on research. We should consider building special hospital facilities and training special medical staff to look after AIDS cases. We should consider how we can contain the entry of AIDS-bearing visitors to Britain and identify the risks.
What almost everybody who has spoken has said about rejecting mass screening is wrong. Perhaps we are al too early a stage to have mass screening, but it would be criminally irresponsible if the Government failed to take such steps if the disease reached the level that is to be found in the United States.
We must be ready to have screening of the entire population, because AIDS carriers will be highly infectious and will be giving their disease to others in normal daily contact. Although we need to know who is carrying the disease, it is vital that we maintain ordinary contact with them and that they are not isolated or separated from the community. Nevertheless, it must be known whether people who are involved in a car crash and are bleeding, for example, are a danger to health. It is not fair to ask the police and ambulance services to come into 849 contact with an accident victim who is covered in blood without knowing what safety measures they should take to avoid the risk of dying from AIDS themselves.
§ Mr. Gavin Strang (Edinburgh, East)
I am sure that the hon. Member for Upminster (Sir N. Bonsor) understands that time does not allow me to respond to some of the interesting points that he made.
I welcome the fact that we are having this important debate in the first full week of the new Session. Like other right hon. and hon. Members, I welcomed the Secretary of State's speech, and I welcome the fact that he has taken the trouble to spend quite a bit of time listening to the debate.
As a number of hon. Members have acknowledged, we face a tragic situation in Edinburgh. The proportion of our population carrying the AIDS virus is higher than anywhere else in the United Kingdom. More than half the AIDS babies born in the United Kingdom are from Edinburgh. A total of 22 babies in the city have been born with AIDS.
It is well understood why Edinburgh has reached this position. It is accepted that the virus started among our injecting drug misuser — IDM — population in about 1983 and about 50 per cent. of that population are now HIV carriers.
The reason for Edinburgh's unique situation — it is different from the position in London, where the virus is found predominantly in the homosexual population—is that we have a substantial drug abuse problem and a high proportion of our drug misusers inject heroin. There is a pattern of sharing needles; reference has been made to the "shooting galleries" where the first user mixes heroin with his blood and passes the needle around, thereby ensuring that most of the other addicts will become carriers of the virus.
We have only 15 AIDS cases in Scotland, and nine of them are in the Lothian region. However, Edinburgh is on the brink of an outbreak of indigenous AIDS cases. So far, most cases have come in from outside the city. It is expected that we could have up to 100 cases in the first year, and we are probably approaching the end of the lull before the storm.
It is important to recognise that Edinburgh needs special help. Much has been said about the need for education. That is obviously crucial and it is the most important requirement, but the lack of time prevents me from examining that issue in detail.
I was glad that my hon. Friend the Member for Oldham, West (Mr. Meacher) paid tribute to the Scottish Television material. If the Secretary of State and his colleagues have not seen the leaflet prepared by STV—about 100,000 copies are to be distributed to young people of 16 and over in Scotland — I commend it to them, because STV has done much useful work and that sort of leaflet could be most helpful.
I wish to concentrate on the need for more intensive action among the high-risk groups. I leave aside the homosexual community, because in Scotland we must concentrate on our injecting drug misuser population. The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said that we have about 10,000 IDMs in Scotland, including 3,000 in the east of Scotland, 50 per 850 cent. of whom are carrying the virus. The comparative figure in the west of Scotland is only 5 per cent. and it is crucial to recognise that there are many more drug misusers in west central Scotland, so we could be on the verge of a terrifying explosion in the transmission of the AIDS virus in the Glasgow area.
That is why I welcome the fact that the Secretary of State said that the Government would respond very soon to the important recommendations of the McClelland committee—the Government have had the report now since September. I hope that the hon. Member for Roxburgh and Berwickshire will reconsider his suggestion that there might be a pilot project in Glasgow. The McClelland report is a cautious document and it considers the issues very carefully. We must balance the enormous risk to the human population from AIDS against the tragic incidence of drug abuse.
In his response to my intervention, the Secretary of State acknowledged that the McClelland report mentions control through general practitioners and the exchange of existing syringes and needles for new ones. The recommendations include advice and how a valid, counselling relationship should exist between the GP and the individual drug user.
Although no evidence is available in the United Kingdom on that point, there have been useful experiences in Amsterdam and southern Italy, and the case is overwhelming for biting the bullet and implementing the recommendations of the McClelland committee. It is impossible to sustain the argument that such action should be taken in Glasgow but not in Edinburgh. There is the whole question of the movement of the virus from drug misusers into the general population. The drug-misusing population is changing all the time, with new people joining it and others leaving.
§ Mr. Kirkwood
I should like to take two seconds to explain that I was looking at the point from the Government's position. They are under pressure, but I entirely support the point made by the hon. Member for Edinburgh, East (Mr. Strang) that action should be taken universally. If the Government are under pressure, they should at least consider setting up the initial pilot project.
§ Mr. Strang
I am glad that I gave way to the hon. Gentleman and that he has had the opportunity to clarify his position.
The other group to which I must refer is prostitutes. The reality is that the drug misuser must find the money to meet his habit. My hon. Friend the Member for Oldham, West referred to prescriptions and attempts to wean drug misusers from drugs to substitutes. We must take that point seriously in the AIDS context.
A significant number of people—especially, but not only, females — obtain money for drugs from prostitution. Many people from Scotland will have seen the interview with an Edinburgh prostitute. She was an HIV carrier, and she said that she had had about 37 partners that week and there was no question of their taking the basic precautions. We must consider prostitutes very carefully. Just as I hope that the Government will respond positively to the McClelland report for Scotland in relation to the exchange of syringes and needles, so I hope that they will consider prostitutes. This calls for much counselling and work, and people will have to make 851 contact with prostitutes and perhaps provide spermicidal sponges and condoms through GPs. That is a suggestion that must be considered.
It is very important to reduce the rate of spread of AIDS. That is the crucial point. In New York, the doubling time reached six months at one stage. It is now estimated to be around 11 months here. If there is a six-month doubling time and there are 1,000 carriers, in five years there will be 500,000 carriers. However, with a 12-month doubling time there will be 16,000 carriers. There is a great difference between 16,000 and 500,000 carriers over a five-year period. The Government must extend the doubling time and, as quickly as possible, reach a point where the incidence no longer doubles and the number of carriers begins to decline.
I was encouraged by the Secretary of State's remarks about screening. He hit the nail on the head when he said that we must consider the purpose of screening. For the high-risk groups, the advice is the same whether or not someone has the virus. In this context, we should make it easier for those who wish to be screened to be screened. We should encourage those who are about to get married, or who are thinking of having a baby, to be screened, because many people would choose not to have a baby if they discovered that they had AIDS. That would be the right course, because there is a 50 per cent. chance of the baby contracting the disease if the mother is an HIV carrier. We should encourage people to be screened on a voluntary basis, but let us not assume that if someone discovers that he is a carrier it will lead him to behave more responsibly. Some people may behave irresponsibly after discovering that they are carriers.
I must return to the question of resources. Hon. Members have said that London is a special case. It is, but in a debate in the Scottish Grand Committee in July I asked for an additional £1 million for Lothian because it knows that it will have additional costly cases and that there will be many more in the future. We are in the front line of the disease in the context of drug misusers, and that is why we must obtain additional resources.
I hope that we can draw a veil over the remarks in The Scotsman on 3 September of the Under-Secretary of State for Scotland, the hon. Member for Argyll and Bute (Mr. MacKay), who used to be the Minister responsible for health in Scotland. He made remarks such as, "The Government do not believe that there is any public demand for extra resources". He said that he was opposed to the exchange of needles and that in Edinburgh the problem would have to be treated as only one of the problems of the Health Service.
I have no intention of turning this into a party political issue, but if it is not to become a party political issue we must get additional resources on the scale which the public regard as appropriate. That means additional money for research, counselling and all the work that can be done before people contract the disease. I hope that the Government will respond quickly and positively to the McClelland recommendations, which are well considered, and that we can obtain the additional net resources which the Health Service in Scotland, and especially in Lothian, urgently requires.
§ Mr. Robert Key (Salisbury)
May I begin by making two declarations of interest, of both of which I am proud. First, I am a patron of Turning Point, which is the only 852 national voluntary organisation that provides rehabilitation, counselling and care for people with alcohol and drug-related problems, and increasingly with AIDS problems. Secondly, my constituency houses the Centre for Applied Microbiology Research, which is an arm of the Public Health Laboratory Service at Porton.
The Public Health Laboratory Service was set up all those years ago precisely to cope with crises such as AIDS. It has a statutory duty to work to control infectious and communicable diseases. AIDS work is now its highest priority, but how is it faring? The Public Health Laboratory Service is co-ordinated from Colindale, where a team of epidemiologists and statisticians works in the Communicable Disease Surveillance Centre and produces a weekly communicable disease report. The Central Public Health Laboratory evaluates blood testing technology. Its virologists have proved that the British blood testing kits produced by Wellcome are the best.
The Centre for Applied Microbiology Research in my constituency is responsible for the manufacture of inactivated AIDS virus. AIDS virus is a delicate organism, and thank goodness we have the equipment and the staff to manage the operation safely. But work is also done there on evaluating differences between AIDS virus strains in different parts of the world. In addition, the PHLS has about 50 local laboratories, including one at Odstock hospital in Salisbury.
I have to say that morale has been seriously affected by the PHLS accountability review which was heard al: the DHSS on 3 November. It makes no sense to close PHLS laboratories or to transfer them to the district health authorities by a financial sleight of hand. We need those laboratories and staff to stay as an integrated service for the whole nation, and I exhort my right hon. Friend the Secretary of State to note that.
The PHLS needs expanding, not contracting. It is desperately short of laboratory space. For instance, it cannot contribute effectively to international co-operation because it does not have enough laboratory space so it cannot take in and train either students or experts from countries that are facing truly terrible AIDS problems. The PHLS has AIDS as its first priority, but in so doing it has had to reorder its priorities and slow down other work on other subjects. To what extent is that acceptable?
CAMR has the unique opportunity to maintain its world lead. I pay tribute to the fact that, two years ago, the Government had the foresight to enter into a unique agreement with Porton International plc, the leading British biotechnology company, to cover the marketing and distribution of all products and processes of CAM R. This firm is the most fully, vertically and horizontally, integrated of all firms in AIDS diagnostics and treatment. It has achieved a great deal, is the leading company in the world, and also does leading work to help those suffering from haemophilia.
It is unfortunate that some headlines in the newspapers —I stress headlines—have been needlessly alarming. The report in The Times on 3 November had the headline:British tests on AIDS drug offer hope for cure".That was completly misleading, Had it said, "Hope for control" it would have been accurate, but that raised false hopes. I hope that we can get over to the media the message about the importance of getting these details, small as they are to a headline writer, absolutely correct.
Because PHLS and CAMR are world leaders, the Government have an international responsibility on 853 AIDS, and I urge them to greater enthusiasm. My hon. Friend the Minister for Health announced yesterday that the Government have pledged £250,000 to the World Health Organisation AIDS programme. That is a modest sum. I hope that it is not just conscience money and that the Government will not think that they need do no more. There are at least two reasons why they must do more.
The Government were represented at the recent AIDS conference in the Congo. It is now clear that, in the central African belt of countries, between 15 and 30 per cent. of people are infected and more people are dying of AIDS than are dying of hunger. Some of those countries will not even admit that they have AIDS, officially at least, although their doctors know exactly what is happening. The WHO cannot cope in these circumstances. It is simply not equipped to cope and we cannot expect it to.
Secondly, many of these African countries still look to Britain, often unofficially because of the problems, for help. The Government should urgently review our overseas aid programme and, as a practical and essential international contribution, should immediately establish bilateral programmes with countries requesting our help. We can offer two particular benefits. The first is blood screening and transfusion technology. Most of these countries do not have a national blood transfusion service and rely on the friends and relatives of the patients, or even someone who happens to be walking down the street. AIDS is spread quickly through the hospitals in such circumstances. Secondly, we can help with health education programmes with specific advice from the considerable experience of the Overseas Development Administration staff on the production of printed material, radio programmes, videos and so on. We have made a good start this week with Uganda, whose President was here.
Finally, every hon. Member has the responsibility to encourage health education in the community. We have to break through the barrier that says that if one tells young people about drugs, smoking, alcohol or AIDS they will be tempted to try it, to experiment and to succumb. As a former teacher, and having studied substance abuse in California, I am convinced that that attitude is not right. Likewise, we must come to terms with the need to exchange new needles for old for drug addicts.
In particular, we must encourage our district health authorities to take positive action, as mine is, I am glad to say. The district medical officer of health will shortly invite representatives from all organisations throughout the community and all local authorities and institutes, including the church, and a psychologist, and will establish a community control policy on AIDS.
We must face and achieve the hardest task of all, which is to change the attitudes of communities, nations, and indeed the world. The only approach that will work is one that is international and fully integrated. It must involve charities, Governments and pharmaceutical industries throughout the world.
Finally, I congratulate my right hon. Friend the Secretary of State on what he said. It is only the start, but he will certainly have my enthusiastic support as his strategy develops.
§ Dr. Norman A. Godman (Greenock and Port Glasgow)
Today we have heard some overlong speeches, but I shall follow the exemplary lead given by the hon. Member for Salisbury (Mr. Key). Several Scottish Members have rightly pointed to the magnitude of the problem in Scotland. We need more research and an expansion in laboratory facilities. Moreover, Scotland has an inadequate pathology service, which must be improved. I do not know what the situation is like south of the border, but in Scotland we have difficulties with post-mortem examinations.
Perhaps more important, we must improve in-patient facilities in Scottish hospitals. My hon. Friend the Member for East Kilbride (Dr. Miller), who is a general practitioner, may correct me, but I think that there is only one hospital in Scotland which is adequately geared up to dealing with the problem, and that is Ruchill hospital in Glasgow. As my hon. Friend the Member for East Kilbride suggested, we are dealing with an extraordinary disease and doctors are largely working in the dark.
The problem is pre-ordained. Unless there are dramatic developments in therapeutic facilities and treatments, this social problem will worsen. Even now it haunts many families in Scotland. The virus is spreading among those who misuse drugs in Glasgow and in the west of Scotland. Regrettably, there has been an astounding increase in its spread between 1983 and 1985. Most of those at risk from misusing drugs are aged between 16 and 24. We need a major campaign to persuade those young drug misusers that, if they do not stop experimenting with drugs, they must at least reduce the risk. We know that drug misusers change their habits because of the threat of AIDS, but the problem is, as I have said before, that we are attempting to educate a group who are difficult to educate.
There are at least 7,000 drug misusers in the west of Scotland, although some would claim that the figure is as high as 12,000. We do not know the level of infection in Glasgow and in the rest of Strathclyde. However, we know that in Scotland AIDS is not an infection that is experienced predominantly by homosexual males, as those most at risk are young, sexually active heterosexuals. Therefore, we need an injection of money and professionals into preventive measures. As others have argued, we must declare war on this social problem.
Those Old Testament prophets who constantly moralise from pulpits and political platforms may well have to accept an educational programme which they would normally condemn out of hand. For many young drug misusers things will get much worse. Indeed, for some drug misusers the hour is regrettably very late in terms of diagnosis and prognosis.
Do the Government have any plans to institute training courses for social workers and other non-medical professionals involved in the counselling of AIDS victims and their families? Some hon. Members have suggested that it is always the doctor who is in the front line. In counselling matters, it is often a social worker from an area team or from a psychiatric hospital who is in the front line. A much wider question should be asked: why do young people misuse drugs? One reason is that their lives are characterised by hopelessness. Many of them are unemployed. They live in large, ugly, peripheral council 855 schemes with little or nothing to look forward to. For these youngsters, using drugs can be an exciting, stimulating activity in forlorn, barren lives.
We must tackle these broad problems as a Government, as Her Majesty's Opposition and as a Parliament. If we tackle these major problems, drug misuse in my part of Scotland will decline. I, too, recommend the McClelland report to the Government, particularly the section that spells out the objectives of a campaign to prevent the spread of HIV. It is an excellent report, and the Government, in fairness and honesty, should take it on board.
§ Mr. Roger Sims (Chislehurst)
For the various reasons that have been put forward, I agree with the arguments against compulsory screening. I shall make two suggestions. First, there should be a legal requirement that those who are diagnosed as suffering from AIDS should be required to give information about their contacts. Secondly — it is not a small point—convicted rapists should be tested, in the interests not only of their victims but of society. If they are to be let loose on society again, their condition should be known.
Two suggestions that have been put forward are that free, clean needles should be provided for drug addicts, and free condoms for homosexuals. There are moral objections to both suggestions. I am bound to say to the hon. Member for Torfaen (Mr. Abse) that this is a moral issue. There are moral implications in what we are discussing. A case can be made for giving needles to drug addicts. It is part of the treatment for somebody suffering from a complaint of which he hopes to be cured. Homosexuality is different. It is not a complaint or a disease; it is an inclination or orientation.
Some people consider that homosexual practices are morally wrong. The Pope has made his view perfectly clear. Last week, 41 outspoken Roman Catholic bishops specifically ruled out sexual relations between homosexuals. They said:People must cut out sexual permissiveness and promiscuity if the epidemic is to be contained.We might have hoped that we would hear something from the leaders of the Anglican Church before now. All credit to the Archbishop of York for his interview yesterday, and to the Bishop of Birmingham for his remarks in another place in a debate earlier this week.
§ Mr. Sims
No. I am sorry.
In another place, the Bishop of Birmingham commented:The church has perhaps been too reticent in recent years about shouting loud for chastity."—[Official Report, House of Lords, 18 November 1986; Vol. 482, c. 158.]He can say that again. In the course of recent remarks, Cardinal Hume said:I think we have a lot of very hard thinking to do as a society, even if we have no religion.I am sure that that is so.
It is said that within our population approximately 10 per cent. are homosexuals. I do not know how accurate that figure is. It does not mean that they have to indulge in homosexual practices, any more than the other 90 per cent. of us are obliged to indulge in heterosexual practices. There is, after all, such a thing as self-control. The problem is, of course, that the climate nowadays is not conducive 856 to self-control. We cannot know exactly how much sexual activity takes place between males. I suspect that it is far greater now than it used to be.
It is one thing to recognise and counsel those who find that their sexual feelings are different and to try to help them and another to encourage them to indulge in homosexual practices. One aspect of that was highlighted by the Archbishop of York in his interview in the Daily Mail, which was reported today. He was reported as saying that hefirmly believed that young children's minds could be harmed by books which now present homosexuality as a viable alternative to heterosexual behaviour.He went on to say:At the school stage, it is extremely difficult for young people to be clear about their sexual orientation and this is probably not even fixed until young adulthood.Referring to some of the books used in schools—the so-called "gay studies"—he said:to have this too high on the agenda probably could lead many young people towards homosexuality who otherwise might have developed in a perfectly normal heterosexual fashion.He commented:While … homosexuals as a group should not feel themselves beleaguered, threatened and shunned by society, I do not think it is wise to go to the opposite extreme and actually promote this as an entirely acceptable alternative lifestyle.I suspect that many of my hon. Friends would say "Hear, hear" to that.
I suggest that there is a great responsibility on some people in show business who flaunt their homosexuality and other figures in public life who claim that they are proud to be "gay". They have corrupted what was once a fine English word. How many young people have been influenced by them — by clergymen who take an equivocal view, by local authorities which identify homosexuals as a special group, by the mayor of a London borough who advertises his homosexuality and has a male consort and even, alas, by Members of Parliament who publicise their inclinations? The media have played too large a part with specific programmes, such as those already mentioned, articles in newspapers and specific periodicals aimed at encouraging certain young people to "come out", as they say.
It has all gone much too far. It is time that the trend was reversed. There is a strong case for that reversal on religious and moral grounds, but, in the light of this debate, the public health grounds are overwhelming. If not only the Government but society as a whole fail to recognise that, they will do so at their peril.
§ Mr. Frank Dobson (Holborn and St. Pancras)
It would be idle to pretend that our country's response to the onset of AIDS has been prompt, rational or effective. To be fair to the Government, the whole developed world has had great difficulty in making the mental and other adjustments that have been needed to face up to an infectious disease which can kill and for which there is no known vaccine or cure.
Although most of us recognise that such scourges may wreak havoc in the Third world, we have believed until now that our prosperity and medical technology protected us here. This mental unpreparedness has been compounded by the fact that AIDS is a sexually transmitted disease. It has led to all sorts of hang-ups and an unwillingness by 857 some even to treat it as an illness, preferring instead to see it as a punishment visited on a society in moral decline. God knows how they explain why we deserve to get cancer or influenza. The position was made even worse by the fact that the first references in this country were to its appearing in the gay community and by the hysterical response of the cheap Tory tabloid press to that fact.
It is against that background that we need to look at the Government's performance. They have tried of late to respond rationally, but, until recently, Ministers have not been prepared to speak out authoritatively to counter the lying hysteria of some of the newspapers on which they depend for political support. They have tried to respond to the demands of patients and doctors, but without providing the additional funds as promptly or as generously as the situation clearly required.
The majority of AIDS sufferers in England have gone for counselling and treatment to just three hospitals — St. Mary's, St. Stephens and the Middlesex, all in London, one of them within the health authority area that serves my constituency. The three health authorities involved are desperately short of funds. They have all seen real cuts in their resources at the same time as they have been asked to make contributions to help people suffering from AIDS. Those authorities still need more funds.
In August last year I urged the Prime Minister to provide more resources for the central London health authorities, which face the bulk of the burden. Some additional funds have been provided, but, as I have said, they all still face further reductions in their funding. People served by those hospitals do not think that it is right that their cancer services or services for people with broken legs should be reduced to make up for the funding which is not coming from the Government towards doing something about AIDS.
The general restraints on Department of Health and Social Security expenditure have had all sorts of effects. In Bloomsbury there was a need to appoint another senior registrar for work on AIDS. That was encouraged by one part of the DHSS, only to be obstructed by the manpower objectives laid down by another part of the same Department.
The clinic at the Middlesex hospital faces shortages of staff and an uncertain future. The new ward at the Middlesex for AIDS patients cost more than was originally estimated. The clinic costs a lot to run. For example, the need for special sterilisation measures requires duplicates and triplicates of equipment which wear out more quickly in any case because of the rigours of the sterilisation process.
The funding has not reflected all those things. The heat treatment of blood to kill the virus has imposed additional cost on the National Blood Transfusion Service. There have been other false economies within the National Health Service. Of all the ludicrous changes, the present plan to contract the network of public health laboratories outside London is most absurd as we face the spread of the disease and an increased need for diagnostic services and monitoring.
The hon. Member for Canterbury (Mr. Crouch) referred to the plain, point-blank refusal of the previous Secretary of State for Education and Science to provide the extra funds which the MRC wanted for additional research on AIDS. Mention has been made by many hon. 858 Members of haemophiliacs who have been infected with HIV from contaminated supplies of Factor VIII bought from the United States. The chilling aspect of the infection of these 1,200 of our fellow citizens is that they placed themselves in the hands of the NHS to be helped, not to be hurt. Just think of the position of young, married haemophiliacs. There can be no moral objection to anything that they have done. They thought that they were receiving help from the NHS and, instead, their system was being poisoned. That is what happened. It would not have happened if the blood products laboratory at Elstree had been brought on stream in good time and we had not had to buy infected Factor VIII from the United States.
Subsequently, heat-treated Factor VIII has been obtained and supplied to haemophiliacs, but the additional cost of that has not been reimbursed in full by the Government, with the result that some of the 10 reference centres for haemophiliacs throughout the country have had to find enormous amounts of money from their own health authority to pay for it. St. Thomas' hospital, which is one of the two regional centres in London, will be faced with a bill next year approaching £1 million to pay for the additional cost of services for haemophiliacs arising from the onset of AIDS. That authority is having its funds cut next year, not extended.
A further example—of the Government's ham-fisted response to the problem of AIDS — I do not blame Ministers present today—was the raid carried out by Customs and Excise on the Gay's the Word bookshop in my constituency. Some of the books seized were the very ones which first spelt out the dangers of AIDS and the measures which could be taken to reduce the possibility of its spreading. The books even included the proceedings of a New York medical symposium on AIDS, and another which described the very plan for safer sex which Ministers will now commend to the British public. They were not obscene then, and they are not obscene now. They should not have been seized. For a long time the raid stemmed the flow of information which literally meant life or death to some members of the gay community.
I am not criticising the Government just for what happened in the past. There is a lack of resources now, and the uncertainties stretch into the future. For the past week or so the Secretary of State has been calling for national unity on the issue. If we are to be united with the Government, they must remember that they are part of the nation, and they must make a major contribution to resolving the problem.
Confidence that adequate provision will be made in future was not assisted by the incapacity of the DHSS recently to supply prompt answers to one page of questions from me. I asked the Secretary of State simple questions such as:what is his estimate of the likely extent of acquired immune deficiency syndrome over the next five years … which health authorities are providing resources for the treatment or study of acquired immune deficiency syndrome". — [Official Report, 17 November 1986; Vol. 105, c 78.]If Ministers cannot answer simple questions such as those, and if they do not have such basic facts, plans for effective action cannot be made, and still less can they be implemented.
What is needed? First, we must provide for people who are suffering from AIDS. We need adequate resources for counselling and diagnosis. We also need to provide for them to be treated for the opportunistic infections which 859 strike people affected by HIV. Hospitals at present scarcely have the out-patient or in-patient space to deal with people with AIDS. Even worse is the provision for home care for those not sick enough to need a hospital bed. In parallel with that must go a massive research effort into improved methods of treating AIDS sufferers, directed as much at the opportunistic afflictions as at the AIDS virus. Some of the opportunistic diseases which do the killing are themselves viruses against which vaccines may be developed, and equally research must go into the psycho-social aspects of the disease to improve the quality of counselling.
Next, we must try to stop the disease spreading. At present most people affected are still members of the gay community, but it is spreading among heterosexuals. Gay men have as much right to protection against the disease as anyone else, and they are most at risk. We must continue to provide counselling and screening for those who seek it. Nothing should be allowed to deter those who wish to know whether they have the disease.
§ Mr. Dobson
I do not have time. I am sorry.
Some insurance companies and money lenders have been reported as discriminating against people who have been tested for HIV even where that has proved negative. The Government should immediately change the law to stop that practice, which must be contrary to public policy.
Should there be compulsory screening of particular groups or of everyone? The answer is plainly no. It would consume vast resources and serve no useful purpose whatever in the circumstances. However, we cannot rule out universal screening if circumstances change. If a vaccine were developed which could prevent HIV but which would be harmful to people who already had it, it would be necessary to run a screening programme before a vaccination programme could be put into force.
Should people with AIDS be segregated? Frankly, the idea is quite ludicrous. Where would we segregate people for life? How would we find a place in which to segregate them, even if it was a sound idea? The idea is barmy.
Should people be discriminated against in employment? No, they should not. If a person is a work mate, he is no threat at all. If he is a sexual partner, he may become so. People should be treated for what they are—colleagues at work—and there should be no discrimination against them.
There is one bit of screening which I support. Semen can carry HIV. Therefore, it would be best to screen anyone who volunteered to donate semen for artificial insemination by donor. That would not be an invasion of liberty, because if a person did not want to be screened he need not volunteer for the service.
A number of hon. Members, including some of my hon. Friends, have spoken about the problems of intravenous drug users and the threat that they pose, especially in Scotland. I should like to reiterate what my hon. Friend the Member for Oldham, West (Mr. Meacher) said. The McClelland committee recommendations should be implemented. To some extent, that may be a recognition and a legitimising of drug use, but on balance it is the lesser of two evils.
How do we try to stop the spread of this disease? The simple answer is less and safer sex, but that is easier said than done. The sexual drive is one of the strongest urges 860 felt by humankind, at times even overcoming the drive to stay alive. Throughout history men and women have risked life and limb, fame and fortune, family and career for someone they loved or even merely fancied. We should not minimise the problems that face anyone seeking to abate or even change the course of sexual activity.
Among gay men, AIDS and the deaths from it have led to some modification of sexual habits, but not all gay men have modified their habits even though they are acutely aware of the dangers. Among heterosexuals there is still nothing like the same awareness of the threat. That is partly because of the early presentation by The Sun and other newspapers of AIDS as a gay plague. The people responsible for that sort of reporting must bear a great deal of the blame for helping heterosexuals to believe that AIDS was no threat to them.
We must try as much as we can to develop awareness in the young if we are to convince them that less and safer sex is to be their lot. The process will be helped if older people, including aging 46-year-olds like me, choose to remember what we did when we were young, with whom we did it and how keen we were on it. People with honest memories are more likely to be listened to by young people than those who, reversing Shakespeare, forget with advantages what deeds they did those days. Impossible demands will get no response and simple-minded suggestions that we should say to young people, "Do not" will only evoke the response, "Do not be bloody silly." That is an appropriate response.
Some pessimists fear that heterosexuals will not take much notice until a lot more of them die, and if we are realistic we must recognise that there is something in that fear. We support the Government's efforts to get people to reduce the number of their sexual partners, but the Government will need to employ better advertising than that which they indulged in before and which had such little impact. In the new campaign they will need to spend large sums of money, comparable with the amount that is being spent on persuading people to buy shares in British Gas. Up to now the Government have attached more importance to Sid buying shares than to Sid avoiding AIDS, and we must change the priorities.
In advance of the advertising campaign, additional facilities must be provided in hospitals and in sexually transmitted disease clinics, because advertising is bound to bring about an increase in the number of people going to such places for advice. It would be foolish to get things out of sequence, and we need additional resources before we go in for the publicity. In carrying out the publicity we must avoid being mealy-mouthed. No sooner does someone mention sex in public than people start using words with Latin roots or words taken straight from the French. As a result it is not clear to everyone what they are talking about.
If we are to get the message over to everybody, arc the words barrier contraceptive, condom or even sheath plain enough? I think not. We must use in public the words that are used in private and which everybody understands. It would be a good start to stop using the word condom and to use words like Durex or rubber Johnny instead. Those are the words that people use when they are talking in private. We must find slogans that are direct and that make an impact.If you can't be good, be careful861 is a bit of an old stager, but we must direct all our advertising and efforts at young people to restrain them from doing what they naturally wish to do. Another slogan might be:If you must have it off, put one on".Perhaps the copywriters will take that up; perhaps they will not. We must be serious about this. It is the only way to get the message over. A lot of French words will not do it for us.
Finally, I join those hon. Members who have said that we cannot deal with this problem in terms of Britain alone. It is a major global problem, and it will be solved only on a global scale. The Governments of all countries must batter the research-based drugs industries into adopting a fully collaborative research programme, with nobody holding back for the sake of cheap, short-term financial advantage.
The future of vast numbers of people throughout the world is at stake. We must ensure that our Government make a sensible and prompt contribution by providing funds to combat the disease here. They have not done so up to now. The Government must also provide vastly more funds and expertise so that our response to the horrible thing that is happening in Africa is not the squalid, petty-minded response of screening those people before they come here, but the proper, decent, charitable response of doing whatever we can to help those people in their desperate circumstances. As one of the world's developed countries, that is our obligation and it must be discharged.
§ The Minister for Health (Mr. Tony Newton)
At the outset of the speech of the hon. Member for Holborn and St. Pancras (Mr. Dobson) I had a small fear that he would disturb the tone of the debate, but by the end of his speech I am happy to say that not only had I been considerably entertained but I found myself in considerable agreement with some of the messages that he was seeking to give us, although I would not have clothed them in precisely the same language.
§ Mr. Newton
The hon. Gentleman has misunderstood what I said. Of course we all accept that it is necessary to use the terms that are required in order to communicate, although I suspect that one of the difficulties is that different groups of people use entirely different terminology. One of the serious points that the hon. Gentleman made will be reflected in the campaign that we are about to launch: the need to seek to address young people—one of the groups most at risk—in terms that are related to their attitudes. We must not assume that they have the attitudes that perhaps we adopted 20 or 30 years ago—still less the attitudes and views that we hold now.
For that very reason, as my right hon. Friend the Secretary of State for Social Services made clear earlier today, and as will have been made very clear to those members of the media who were at the launch of the Government's campaign material, the campaign will not be conducted simply through the general media, in the hope that some young people will read the national newspapers or watch the national television services. Part 862 of the campaign will be specifically directed at young people through the magazines that young people read and through the media, including the radio and cinema which are particularly powerful media for young people. Whatever differences of opinion there may be between hon. Members about the precise terms in which we should address both young and older people—
§ Mr. Newton
Yes, and in the schools. Whatever differences of opinion there may be, I hope that there will be agreement that we must address young people directly in terms tailored to their attitudes and needs and in ways which enable us to communicate effectively with them. That is one of the clearest messages that has come out of today's debate and I welcome it very much.
The debate has been constructive and important and I make no apology for not being able to add to the decisions announced by my right hon. Friend the Secretary of State when he opened the debate. I cannot say that we have suddenly reached a conclusion about needles, free condoms or the many other issues that have arisen in the debate. Indeed, the House would be entitled not to take me seriously if I suggested that we had. As the debate clearly showed, not least in the impressive speeches from Scotland, these are difficult matters requiring careful consideration, but they are also urgent and they are now being addressed by the Government. The views expressed in the debate, often in extremely impressive terms, can now be taken into account by the Government in the decision making process. Like my right hon. Friend the Secretary of State, I give a clear undertaking that what has been said today will be genuinely taken into account in the continuing work of the Government.
At the outset, lest it be squeezed out due to the brevity of my speech, I should pick up something said by the hon. Member for Oldham, West (Mr. Meacher) in his impressive opening speech for the Opposition. This was echoed by a number of hon. Members and it was repeated by the hon. Member for Holborn and St. Pancras in winding up for the Opposition. I refer to our view of the risks of ordinary social contact, including employment. It is extremely important to avoid a situation in which HIV carriers are treated as lepers and isolated from the community so that they lose their jobs and are no longer able to make a contribution to the community in a period when to all intents and purposes they are no threat to anyone in most normal activities. I suppose that I must accept that sex is a normal activity, but here I mean normal day to day social contact, including contact at the work place. It is important to make it clear that the Government's medical advice is that the AIDS virus cannot be contracted through normal social contact with an infected person. It cannot be transmitted by shaking hands and there is no record of anyone becoming infected through kissing. There is also no danger in sharing cups or cutlery, nor can it be caught in public toilets.
§ Sir Nicholas Bonsor
I am sorry to interrupt my hon. Friend. He was not present when I made my contribution, but I hope that he will read it. The medical advice that I have received is that it is not safe to make the comments that my hon. Friend has just made and that in the present state of medical knowledge it cannot be said conclusively that such activities are safe.
§ Mr. Newton
I apologise for not being present when my hon. Friend made his speech, but I am aware of what he said and I heard his intervention in a later speech. I can only say that my words are based on clear-cut expert medical advice to the Government from a wide variety of sources, focused through the Chief Medical Officer, and it is important that I should put them firmly on the record.
I have no means of validating or disproving the statistics given by my hon. Friend about Senegal, but one of the difficulties in some parts of Africa is that, quite apart from the possibility of infection as it exists in this country through the sharing of infected needles by drug abusers, the use of needles for normal health purposes cannot be guaranteed as safe in some areas. That may in itself be a potent source of infection, but it is quite different from ordinary social contact. I cannot speak authoritatively on this, but infected equipment may be a significant cause of the problem to which my hon. Friend adverted.
§ Dr. M. S. Miller
To answer the hon. Member for Upminster (Sir N. Bonsor), if an infected person has a bleeding gum or some other source of bleeding within the mouth and the person kissing him also has a sore or wound there is a possibility of transmission, but it is probable that the saliva would kill the organism as it is not easily viable outside its own environment.
§ Mr. Newton
I am grateful to the hon. Gentleman, who has special medical expertise, for that intervention. His view corresponds precisely with that of the Government's expert medical advisers.
It is important that people should understand that an AIDS carrier is not a routine, automatic, daily risk in ordinary daily contact. It is important that that should be understood if we are to have a chance of carrying through a rational policy in a civilised society.
I intended to say a little more on that front, but I should like to consider employment, which the hon. Member for Oldham, West mentioned. The House might know that my right hon. and learned Friend the Paymaster General has been considering employment issues that are involved in and arise from AIDS. On Monday, he will launch a booklet for employers which we believe will make a helpful contribution to the overall Government campaign. It will underline some of what I have said in the past few minutes and to which, I know, many hon. Members attach importance.
The public education campaign has general support. I should like to extend an apology to my hon. Friend the Member for Staffordshire, South (Mr. Cormack) for my absence and that of my right hon. Friend the Secretary of State during his speech. I know that he expressed some concern about that, but I hope that he is aware of the reason why we were unable to be here. He suggested that elderly people should be exempted from the leaflet delivery. I know that he feels that some elderly people might be upset if they are included, but some might be upset if they are excluded. In a country in which many 864 elderly people live in households with people who are not elderly, the practical problem of drawing such a distinction would be insuperable.
My hon. Friend the Member for Renfrew, West and Inverclyde (Mrs. McCurley) suggested that we should make use of pharmacists. We are arranging for free distribution of the very good and full Health Education Council booklet through pharmacists, and expect to use it as a secondary source of distribution for the leaflet that will be delivered throughout the country.
I have noted the several arguments that were advanced about resources. As the hon. Members for Oldham, West, for Holborn and St. Pancras and others have acknowledged, extra funds have been made available to the NHS, especially to the Thames regions, which have the worst problems in providing treatment.
Some extra funds were made available last year, and we expect to make further money available this year and next to take account of the increasing work load throughout the country. I ask the hon. Member for Holborn and St. Pancras to acknowledge that it is not so much the immediate size of the problem, although it is growing and we shall take account of that fact in our allocations, but the size of the problem in the future which will, or could, make really substantial demands on the NHS.
The principal need, but it is not the only one, is for districts to draw up plans on their projected provision for AIDS cases and the prevention of HIV infection and to get them back to the DHSS by the end of the year. We have commissioned a study on the cost of treating AIDS patients, and early next year we will sponsor a conference on the complex issue of predicting future trends. We hope, therefore, to be able to make a better assessment of NHS requirements in the longer term according to the best forecasts, rather than by plucking some figure out of the air.
None of that is an attempt to run away from the need to take account of the problem, especially for the Thames regions — though the problem will begin to spread beyond those regions; reference has already been made to Scotland—in distributing NHS money for next year. There have been substantial increases in total allocations and when considering the distribution of funds we shall have very much in mind what has been said in the debate.
A range of other matters have been raised, including important issues relating to the Public Health Laboratory Service. I assure my hon. Friend the Member for Salisbury (Mr. Key) and the House that we shall not allow to happen anything that, in our view, would jeopardise the provision of sensible testing arrangements for AIDS cases.
§ It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.