§ Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Kevin Hughes.]9.30 am
§ Sir Norman Fowler (Sutton Coldfield)
I am grateful for the opportunity of this short debate. I raised the prospect of such a debate in business questions two weeks ago and was told that Westminster Hall would provide me with the best opportunity. I am genuinely grateful for being allowed to hold this debate, but I hope that time can be found to hold such a debate on the Floor of the House.
AIDS is a subject of undoubted gravity—almost 19 million people throughout the world have died of it, of whom about 4 million were children. More than 34 million people are now living with HIV and, barring a miracle, most of them will die during the next decade. The most recent estimate shows that in 1999, almost 5.5 million were newly infected with HIV. To put the problem at its mildest, the disease will not go away—it is becoming worse. I hope sincerely that the House of Commons will find time to debate it in full.
In terms of human catastrophe, it is difficult to think of a problem that should cause us more concern. I intend to refer to what is happening in the United Kingdom, although it is impossible to do so and ignore the context of AIDS throughout the world. As each minute passes, four more young Africans are infected. As the Secretary-General of the United Nations said, when he came to London a few months ago, every day Africa buries 5,500 of its sons and daughters who have died of AIDS. A child born in Botswana should have an average life expectancy of 70 years, but thanks to AIDS he will have an even chance of dying by the time he is 41.
The epidemic is expanding in new directions. It has spread to eastern Europe, where even five years ago the virus was still almost unknown. In India, HIV is firmly embedded in the general population. In east Africa and the Pacific, new HIV infections rose by 70 per cent. between 1996 and 1998. This debate takes place against that dire background.
I shall concentrate on the United Kingdom for two reasons: first, we can do something directly about the position here. We have the responsibility to do so. It is no one else's responsibility. It is most important to note that it is not a case of our advising others; it is a challenge for us to act.
Secondly, it is all too easy to say that, because our problem is not on the same scale as that in Africa, for example, it is of no consequence. That way lies complacency and a bigger and ultimately more deadly problem than we have at the moment. It is true that our figures are better than those for many other countries, including many of our European neighbours, and thank God for that. We should only take limited comfort, however, from the figures The Public Health 62WH Laboratory Service estimates that about 35,000 people with HIV live in the United Kingdom. That equates to a prevalence among those aged 15 to 49 years of about one in 1,000. It also estimates that the number of people living with diagnosed HIV infection is increasing by at least 10 per cent. a year. That is one reason why the disease was the highest priority in the recent overview of communicable disease undertaken by the Public Health Laboratory Service. Although HIV is an entirely preventable infection—that needs to be repeated and repeated—in the past two years in particular there have been increases that give real cause for concern. In January, the Public Health Laboratory Service reported that, in 2000, there had been 2,868 new HIV diagnoses. That number is set to rise further as more reports of diagnoses made last year continue to come in. By the time all the reports are collected, it is expected that 2000 will have seen the highest ever number of new HIV diagnoses in the United Kingdom. That follows figures for 1999, which also showed an increase in HIV diagnosis. At that time, they were running at a 10-year high. Dr. Barry Evans, the head of the HIV division of the Communicable Disease Surveillance Centre, said that 1999 saw more diagnoses than any year since 1985, when HIV testing first became available.
As it happens, I was Health Secretary in 1985, when we conducted our high-profile health education campaign. The issue was how to respond. There was no cure and no vaccine. Today, the issue remains how to respond. There may be a perception among people at risk that HIV and AIDS are now curable, because of clinical advances. Despite the medical advances, there is still no cure and there is no vaccine.
When I was the Minister responsible, there were conflicting views about what the Government should do in the face of the challenge. Some said, "Don't do anything. People such as drug addicts have brought their sufferings on themselves and should be left to their own fate." Others appeared embarrassed by the whole subject. I remember going to the United States after we launched the health campaign in this country and politicians there who could not bring themselves to mention the word "AIDS". It was not only politicians—I recall journalists in this country who were content to cover wars but preferred not to cover the battle against AIDS. Even the churches tended to be schizophrenic. They wanted to help, but they did not want to give the impression that they were encouraging promiscuity, drug taking and the rest.
As you may imagine, Mr. Deputy Speaker, I received a lot of advice during that period. In 1997, I met the then Chief Rabbi. As I sat down, he handed me an aide memoire, which complimented me on the urgency and boldness of the campaign, but he went on to set out no fewer than 14 reasons why he was disturbed by the general thrust. He said:It tells people not what is right, but how to do wrong and get away with it. It is like sending people into a contaminated atmosphere but providing them with gas masks and protective clothing, or instructing thieves how to escape being caught…Say plainly: AIDS is the consequence of marital infidelity, pre-marital adventures, sexual deviation, social irresponsibility, and putting pleasure before duty and discipline.Although that was possibly an extreme example, there was a lot of that sort of criticism and advice at the time. Many people thought that we should have been conducting an entirely different sort of campaign.
63WH All those attitudes have echoes today. They explain in part, and only in part, why some countries respond with positive policies, while others, sadly and tragically, try to ignore what is happening all around them. My attitude was and is that antipathy towards AIDS sufferers is incomprehensible. Disease is disease, whether it is sexual or not. Suffering is suffering. One does not have to condone the conduct to help the casualties, many of whom—children, wives, haemophiliacs—are innocent victims of circumstance. Our first priority for a policy, as a country and Government, must be to prevent the disease from spreading further.
That leads me to one certain conclusion. In the campaign against AIDS, a particular responsibility lies with Governments. Voluntary organisations do heroic work, as I have witnessed in this country and the United States. They deserve enormous praise for the work that they do, especially when one considers the pressure that it puts on them. I pay tribute to the National AIDS Trust in this country and to the work of the all-party parliamentary group on AIDS. Particular tribute must be paid to the hon. Member for Walthamstow (Mr. Gerrard), the chairman of that group, who is taking evidence on the subject in another part of Westminster. The churches—in spite of some of the attitudes that they had when the problem was first recognised—also do invaluable work.
It is the Government's responsibility to lead in this area, however, by providing public education and the finance for it and for other necessary policies. If Governments do not do it, others will not be able to do it half as effectively; they may try, but they do not have the resources. If Governments fail to take up the challenge, the problem will not be tackled. That is a lesson for us—and it is a lesson internationally, too.
We should be in no doubt that public education remains the chief weapon at our disposal. Public education campaigns need to be more closely focused than they were in the 1980s; we cannot have the same campaign, 15 years on. We know more about the subject and about the groups at particular risk—homosexual and bisexual men, drug users, and heterosexuals who have visited areas of high HIV prevalence. We know a great deal more than we knew in 1986–87, but the lesson remains the same: public education is the only vaccine at our disposal.
§ Dr. Jenny Tonge (Richmond Park)
Does the right hon. Gentleman share a certain dismay and disappointment that the excellent television campaign that ran in 1986–87, during his time as a Minister, has not been repeated on an annual basis?
§ Sir Norman Fowler
I do—and the fact that that campaign has not been repeated is a comment not only on this Government but on the Governments that followed the period when I was Health Secretary. Television is undoubtedly one of the chief mediums for advertising—I am a newspaper man, so I will not say that it is the chief medium. There is no question about the impact that television has. A commercial company that had one big campaign, followed by nothing discernible in the next few years, would be regarded as following an eccentric policy.
64WH The campaign must be different, but the Government must use the resources at their disposal for health education and the message of prevention. That message is crucial, but it does not receive the attention that it might, and is not often enough the subject of public debate.
My short answer to the hon. Lady, therefore, is yes, we should do much more in the area to which she referred, and it is a pity that we have not done more in the intervening years.
I remember one important lesson from my experience: the public will accept sensible, objective advice given by the Government on the basis of the best medical advice from the chief medical officer—I was fortunate in Donald Acheson. Such advice is crucial. The Government are not condoning drug taking or promiscuity by issuing such advice; they are counselling against it. As was shown in the 1914–18 war, when there was an enormous problem not of AIDS but of sexual disease, and again in 1986–87, a campaign is much more likely to be effective if it offers practical advice rather than preaching—however well-intentioned that preaching may be. Frankly, I disagree with the Chief Rabbi on that matter. On balance, Ministers in any Government are not regarded as the fount of all moral guidance.
Ministers in non-health Departments are nervous about public education campaigns. I remember having a fascinating, but ultimately frustrating and delaying, debate about whether using the phrase "to have sex" was a proper description to be used in a newspaper advertisement.
It is also probably true that Margaret Thatcher's Government was not necessarily synonymous in most people's minds with a high-profile campaign on sex education, but that Government set up a special Cabinet Committee, chaired by the Deputy Prime Minister and consisting of a good third of the Cabinet, to oversee our campaign, then sent out leaflets to every house in the country pointing out the dangers of AIDS, put up posters on billboards to remind people of those dangers and, as the hon. Member for Richmond Park (Dr. Tonge) mentioned, promoted and paid for a television campaign on AIDS that meant, according to later research, that 90 per cent. of the public understood something of the dangers. Apart from public education initiatives, that Government organised free needle exchanges for drug addicts, so that at least they would not pass the virus from one to another. Again, that action was enormously controversial at the time, but proved to be literally a life saver.
In parenthesis, perhaps an international lesson from our experience is that if Governments take the issue seriously and act upon it, that can have a real impact on AIDS. If we compare infection rates in the United Kingdom with those in other European countries, let alone internationally, we see that the Government had an impact. Other countries, such as Uganda and Senegal, have also shown that Governments that get serious can have an impact. The nations that do worst are those where Governments, for one reason or another, brush the issue under the carpet.
To return to the United Kingdom, I do not suggest for one moment that the Government are brushing the issue under the carpet; I do not remotely regard this as a party 65WH political issue. Nevertheless, there is a serious question as to whether today's response is adequate to the challenge that we face. I say that for two reasons. First, there is a real danger that we have become complacent. The figures do not justify complacency and we should listen to people such as Dr. Barry Evans, when he says:This is the second consecutive year where we have reported record high levels of HIV diagnoses. We are now two decades into the HIV epidemic but we continue to see new cases of an infection which is largely preventable. We cannot afford to become complacent about safer sex. The basic prevention messages remain the same: use a condom when having sex with a new or casual sexual partner and in the case of injecting drug use never share injecting equipment. As health professionals we have to find new ways of making the risks of HIV clear to the public and in particular to young people.That is a challenge to health professionals, but it is a challenge to political professionals, too. It is a challenge to the Government—any Government. We must find ways of communicating the risk, and we must find and finance ways of warning people, especially young people, of the dangers, and influencing their behaviour.
The second reason that further action is required is that we have now been waiting a long time for the Government's promised strategy on sexual health and HIV. Perhaps the Minister will be able to say more about that this morning. On 6 February, the Minister for Public Health said in a written reply:We plan to issue the strategy for consultation shortly."—[Official Report, 6 February 2001: Vol. 362 c. 508W.]"Shortly" is certainly better than "in due course", but it is not as good as "very soon". We—at least, those of us who have been Ministers—have all used those words from time to time, but as the Government now seem to be in a mood to define what they mean by those generalised terms, I should be grateful for the Minister's guidance.
If we were dealing with any other matter, the excuses for delay might not be accepted as easily as they have been in this case. Given the problem, it is the Government's duty to publish now. To provide some encouragement, I need no instruction on how nervous a Government machine can become on entering into the area: I remember the debates. However, in my experience, when it came to publication and the campaign, the public were substantially more mature than all the so-called media experts pointing out the possible pitfalls. "Trust the people" is not a bad guiding policy, even in such an area.
The case for a new set of initiatives is overwhelming. The Government have the responsibility for detailing those initiatives, and I hope that any lead that we give here might have at least a persuasive effect on other Governments with bigger problems who are still strangely reluctant to act. Above all, however, an initiative in this country could help save lives and prevent unnecessary suffering. After 30 years in the House—I believe that you, Mr. Deputy Speaker, and I entered on the same day—and having experience of several Government Departments and shadow Departments, I can imagine no greater aim than that—the saving of lives and the prevention of disease.
§ Mr. Peter Brooke (Cities of London and Westminster)
I pay tribute to my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) for a 66WH characteristically magisterial introduction to the debate, and for having arranged it. Mine will be a much less substantial contribution, but I am delighted to speak in support of his interest.
I declare an interest myself. I have a natural constituency interest, given that my part of London is one of the areas in which AIDS has been most prevalent, and more specifically, I am a patron of the La Verna housing association in Paddington, in my constituency.
Apart from La Verna, in which my interest is continuous, I have a continuing interest in developments in Africa, having travelled widely as a young man in South Africa and central and east Africa. However, my direct involvement has been in the United Kingdom and in parliamentary terms had three brief stages. In the first instance, I was, like my right hon. Friend the Member for Sutton Coldfield, in at the beginning, in that I was the Civil Science Minister in 1985. By an extraordinary coincidence, my first wife died in March 1985, and in that same week, between her death and the funeral, Sir James Gowans, then the executive head of the Medical Research Council, visited Sir Keith Joseph, the Secretary of State. I remember the redemptive quality, from my point of view, of attending a meeting about so serious a matter at that moment in my life.
Sir David Phillips, later Lord Phillips, had advised us as chairman of the Advisory Board for the Research Councils that virology was one of the fields in which the United Kingdom had fallen behind—he said that no nation can keep up to date with every field of science simultaneously. When Sir James visited us, he said that one of the disadvantages that we would have in coping with the circumstances would be that inattention to virology in the previous decade. He told the late Sir Keith that it was extremely important from the point of view of those planning the campaign to cope with the epidemic to have the best possible statistical information about where the case load was occurring. However, the Medical Research Council could not fund that out of the resources then available to it, and he asked whether the Secretary of State might provide extra money for that purpose. We were heavily pressed at the time: we had had to introduce the idea of student tuition fees because the science budget was so stretched. Nevertheless, Sir Keith found £2 million for the MRC to set up a statistical database to show where the incidence was occurring.
My second stage was brief. I left the Government for a five-month sabbatical in 1992 and obviously needed to look for new interests. I identified AIDS, and had developed a programme of how to become more expert on the matter, but that was nipped in the bud by my return to the Government.
I subsequently left the Government permanently in 1994 and I have endeavoured to be a regular attender of the all-party group, although following the explosion of all-party groups in this Parliament, diary conflicts do not allow me to attend as many meetings as I would like. I join my right hon. Friend in paying the warmest possible tribute to the hon. Member for Walthamstow (Mr. Gerrard) for the way in which he chairs and leads that group, which is responsible for his absence today because of hearings elsewhere.
67WH On a series of mornings in the summer of 1998, the all-party group held hearings because it was anticipated that the Government were on the point of delivering their national strategy. Rather a long time has elapsed since then without our having seen that strategy. Like my right hon. Friend, I am looking forward to hearing the Minister's comments on that. The timing of 1998 related to a seminar that was due to take place involving experts in the field in the autumn—perhaps October—of 1998, and we wanted to have held our hearings. We held them in this Room and elsewhere for three or four hours on three or four mornings and we heard many witnesses.
The timetable required to complete or agree the report before the summer recess, in anticipation of the seminar in October, worked marginally to the disadvantage of the report. We were not a Select Committee; we were operating in necessarily rather improvised circumstances, and we did not pay as much attention as we might have done to what we said in the report. Tell it not in Gath nor in the streets of Askelon, Mr. Deputy Speaker, but I would not have signed up to absolutely everything that we put in the report, but we did not have the opportunity to explore such issues in detail.
Having gone to that trouble in 1998, we have obviously been listening carefully to the Government. We have heard noises at intervals since the summer of 1998 that the report was imminent, coming, on the way, or would be with us soon. Each of those dawns turned out to be false and we are still waiting. Rumours suggest that it may, as my right hon. Friend said, be with us in the next month, but after so many disappointments we shall, necessarily, believe it only when we see it.
It would be helpful if the Minister could explain why it has proved difficult to produce the report, given that many people are interested in it and waiting for it. If it does not appear before the end of March, I can only echo the dying words of General Braddock, who was ambushed by the Iroquois in 1763. While propped up against a tree to die, he uttered the memorable words,We shall know better how to deal with them next time.In the meantime, we get a cri de coeur. I received one this very week from the president of the Mildmay Mission hospital, which is to the east of my constituency. The president said:I expect you have seen in the press recently that Mildmay Mission Hospital has been forced to close one of its eleven bedded units due to the financial difficulties.Funding comes from many different Health Authorities, but regrettably due to the lack of resources this is having unfortunate repercussions on Mildmay. It is strange that, when more men, women and children have been treated in 2000, funds are becoming less available.I have just read in Hansard the debate on hospices"—on 6 February, the same day as the written answer—and how the funding is ad hoc throughout the service. I feel however that Mildmay does come within a different category. It's the only specialist hospice in London (where most of the patients come from) and we are the only place that care specifically for patients with brain impairment, as a result of AIDS.It is not generally understood that only about ⅓ of the patients can take the combination drugs and recently we have had more deaths than previously, though not as many as when we first opened.68WH She proceeds to invite me to the hospice, which I have visited in the past.
Finally, like my right hon. Friend I want to say a few brief words about Africa. It is commonplace to quote with praise the example of the Ugandan Government, and such a reference is a much happier one than the usual euphemism for Uganda of which we read in Private Eye. Last month, I visited South Africa with the Select Committee on Northern Ireland Affairs. The Foreign and Commonwealth Office briefing included the following ominous words:South Africa is one of the countries in the world most seriously affected by HIV/AIDS. Recent estimates suggest that, at the current rate of infection, 25% of the population will be HIV positive by 2005, the most affected group being women between the ages of 15 and 25. Four million South Africans are expected to have died by 2008.I shall not get involved in the controversy surrounding the way in which the South African Government are dealing with the problem. Of course, it is a further commonplace that the middle classes throughout Africa will be greatly affected by AIDS and that the leadership in Africa will thus be decimated.
We visited townships in East Rand and Natal, where 90 per cent. of children who were fortunate enough to have completed secondary schooling were nevertheless unable to get jobs. Such township areas consist of about 250,000 people, and in that climate of despair it is easy to see how the problems that we are describing could be exacerbated. It would be helpful if the Minister could comment on the work of the Department for International Development on AIDS. The figures that I quoted epitomise the African problem—a problem that the whole of mankind faces. I am most grateful to my right hon. Friend for giving me the opportunity to contribute to this debate.
§ 10.3 am
§ Mr. Russell Brown (Dumfries)
I congratulate the right hon. Member for Sutton Coldfield (Sir N. Fowler) on securing this debate and I offer my sincere apologies for missing the beginning.
Like others in this Chamber who are members of the all-party group on AIDS, I was torn between appearing at today's evidence-taking session, which is also taking place tomorrow and on 28 February, or contributing in some way, however small, to this debate. Compared with that of more experienced Members of the House, my contribution will be somewhat limited and will relate narrowly to certain aspects and issues, on which I seek a commitment from the Minister.
As I know from speaking to different organisations about health issues and from considering HIV and AIDS in global terms, people in this country are astounded that, without a shadow of a doubt, in 2001 the problem is not going away; if anything, it is escalating. It can even be put in terms of a missing generation in many African states and it is astonishing that such a thing can happen—it is almost unbearable.
One aspect is not talked about as much as it should be—gay men in this country. I am deeply concerned about what is not taking place rather than what is. The Government's approach to HIV and sexual health is at different stages throughout the country. The Welsh Assembly's sexual health strategy was published in draft 69WH form about 13 months ago, the Scottish Executive has prepared, but, according to the information that I have received, not published an HIV prevention strategy and, in England, a sexual health and HIV strategy was scheduled to appear late last year. The Northern Ireland Assembly has not produced a separate strategy. However, the HIV strategy of the London national health service is being produced.
Gay men remain the main group affected by HIV in the United Kingdom and make up the majority of deaths, the majority of those living with HIV and the majority of new transmissions. Paradoxically, concern for their needs and lives has often been low on any list of priorities and on occasions, I regret to say, has received scant attention in national and regional planning.
The level of diagnosed infections in gay men has remained remarkably constant at around 1,400 a year. Data show that the average age of those diagnosed has remained the same, showing that new generations of gay men continue to become infected. According to the answers to two recent parliamentary questions, about 70 per cent. of transmissions of HIV in the UK, as opposed to diagnoses that include people infected in Africa, are through sex between men. However, health authorities report that only 24 per cent. of HIV prevention money is targeted at gay men and even that figure is viewed with suspicion.
In October, the UK gay men's health network launched a document called "Ten Questions for UK HIV and Sexual Health Strategies", in which it argues that, although gay men make up the majority of those infected, paradoxically concern for their needs and lives has been a low priority. For instance, while Ministers have set up expert advisory groups for mother-child transmission, for which there is full justification, and also for infection among health care workers, the same attention has not been paid to the much higher rates of infection in gay men.
The network also argues that the social determinants of health are often ignored and that HIV bypasses the health inequalities debate. In many fields of health promotion, the myth that behaviour can be changed solely by the provision of information and/or medical treatment has been discarded, but that simplistic model has persisted for many years. To make real improvements, the true determinants of health inequalities need to be tackled. The continuing social exclusion, inequalities, prejudice and discrimination experienced by gay men must be challenged and legislative as well as long-term cultural changes are required. It is important to consider that seriously in society today.
Concern has been expressed that HIV in gay men has been marginalised as a voluntary sector issue. If the voluntary sector will not consider it, what real hope is there for it to be considered seriously elsewhere? The voluntary sector has an important role to play and can exert an influence through work in schools and so forth.
I seek some commitments from the Minister this morning. I hope that he will give an assurance, if not a guarantee, that the continuing high rate of HIV infection among gay men is at the top of the priority list and that the forthcoming strategy will reflect that. Furthermore, the report of the social exclusion unit on teenage pregnancy shows that a bold and imaginative 70WH approach is possible to tackle the social determinants of health inequalities. I hope that the Minister will extend that approach to HIV and gay men.
I again apologise to the right hon. Member for Sutton Coldfield for not having been present at the start of the debate and congratulate him on having secured it.
§ Dr. Jenny Tonge (Richmond Park)
I, too, congratulate the right hon. Member for Sutton Coldfield (Sir N. Fowler), who is a fellow member of the all-party group on AIDS, on securing this debate. It is long overdue and we are still awaiting the Government's strategy on sexual health—four years is a long time in the AIDS epidemic, which is sweeping the world.
Twenty years ago, or perhaps longer, an Australian medical colleague—a cardiologist—spent a weekend at my house. We were discussing heart transplants and so on, but he said that HIV would be the big news in medicine. He was right, but I did not think so at the time. As the right hon. Gentleman said, sexually transmitted disease was not much talked about 20 or 25 years ago. The clap clinics, as they were affectionately called, were up the back stairs by the mortuary in most hospitals and patients crept in wearing dark glasses and a wig. The terrors of the then known sexually transmitted diseases of syphilis and gonorrhoea had almost been eliminated. I remember whispering and giggling in a corner when I was a student because a grand and pompous old lady was suffering the effects of tertiary syphilis on one of the wards. She did not know that and the consultants would not have dreamt of telling her, nor would they have dared, but that was the way in which sexually transmitted disease was generally dealt with.
That attitude must and is changing and whole departments are now devoted to AIDS alone. A huge amount of time and money in many departments, including cardiology, neurology and immunology, is devoted to patients suffering from AIDS. The rise in tuberculosis, which is a serious public health problem, is largely attributable to the AIDS epidemic. We are discussing a serious business. As the right hon. Gentleman said, 19 million of the world's population are estimated to be HIV positive.
My first trip to Africa was to Uganda, where I naively wondered what type of business was done in the shops that sold different sized rectangular boxes. They were, of course, coffin shops. In the west we have coffee shops; in Africa they have coffin shops. It is a good trade because so many people are dying from AIDS. Furthermore, Uganda has had some success in controlling the number of patients suffering from AIDS because of their excellent education and basic health care programmes. We ignore their experience at our peril because travel is widespread and people go in and out of every country in the world. We are no longer confined to the so-called civilised developed world; people can go anywhere on holiday.
Human beings are, I regret to say, often indiscriminately sexually active, which means that they will pick up sexually transmitted diseases—especially AIDS. We do not know how far AIDS has spread in Asia, eastern Europe and Russia because many of those countries are in denial about the epidemic. AIDS affects the economically active members of the population, 71WH which makes it different from any other disease that has affected the world. It affects those people whom their country most needs. In the past, diseases have killed babies, the weak, the elderly and people with other diseases. AIDS kills economically active people, which means that it is a great threat not only to developing countries, but to the world.
We are discussing a public health problem, which is an old-fashioned concept. We used to have medical officers who looked after the public health. They were concerned whether water was clean, whether sewers were sound and whether there was evidence of disease spreading through their communities. However, we have lost that concept in Britain—we have become used to diseases being treated by antibiotics or operations. A major proportion of expenditure in the health service should be on public health and the prevention of diseases that affect the community and the economy of the community.
In the UK, we have concentrated on treatment. The drug firms have gone ballistic and have had a wonderful time inventing new drugs. They have done brilliant work inventing some fantastic combinations of drugs that can prolong fitness in a patient suffering from AIDS, so that he or she can go on working, which is important, and to prolong life. However, there is no cure. The great danger is that many people—especially young people—think, "Ah, there is a cure," or, "By the time I get it there will be a cure, so there is no need to worry." We are wrong if we think that there will be a complete cure in the next 10 or 20 years.
Therefore, we must push home the preventive message. When the right hon. Member for Sutton Coldfield was speaking, I mentioned television advertising. I am incensed by British television, which shows sex or sexual activity every evening. Whether it is teenagers grappling with one another in "Neighbours" or the full Monty after the watershed, one can watch sex. Human beings are sexually active; it is nothing to be ashamed of. We would not be here if we were not sexually active because we depend on it for our survival. Young people watch television and believe that to be sexually active is the norm, but where are the antidotes or warnings? There are no warnings about sexually transmitted diseases such as chlamydia, gonorrhoea and AIDS on television.
Where are the warnings about getting pregnant? If we want people to take sex seriously, we must be upfront about it and talk about the downside. Yes, sex is great, yes, sex gives us babies if we want them, but it also produces unwanted pregnancies and, dangerously, diseases that can kill. We should use television more to put over that message.
Oxfam recently launched a campaign against TRIPS—trade-related intellectual property rights. That is the convention that protects patents for the pharmaceutical industries that manufacture drugs so that, it is said, developing countries cannot manufacture them more cheaply at home. A test case is being heard in South Africa soon. Again that puts the emphasis on the treatment, and the real message in developing countries must be prevention. It would cost $2 a day to treat an AIDS patient in a developing country if the drugs were made locally and cheaply. The annual 72WH budget per person in most developing countries is about $8 a year. Hon. Members will correct me if I am wrong. Where will they get that sort of money? We also need drugs that will prevent vertical transmission from mother to child, but they will be expensive. Wherever one looks in the world, the preventive message is the most important. We must not rely on drugs to solve our problems for us all the time.
Even if the drugs were available in developing countries, where is the basic health structure to deliver them? Those of us on the AIDS group have heard about the complicated business of taking retroviral drugs. The right combination must be taken at the right time of day and then it must be repeated, and this drug cannot be taken with that one. How can we explain that to someone who has had no education, when the nearest health clinic may be 200 miles away? There is no way to deliver the treatment. Again, the preventive message is so important.
I am my party's spokesperson on international development and the Department for International Development is to be congratulated on its work in this area. It took the problem very seriously. I remember as a newly elected Member of Parliament going to talk to it, in 1997, about something that I felt passionate about—the rise of AIDS in developing countries. At that time there was, rightly, an emphasis on malaria: malaria kills millions of people and we had to do something about it. But I have noticed how well the Government have taken that message on board. For example, in 1998 they earmarked a small amount of money for AIDS vaccine research. Now they are putting an enormous amount of money into it, with the international AIDS vaccine initiative, and the Chancellor promised more concessions in his autumn statement last year. I congratulate them on that.
In conclusion, I repeat two messages. First, prevention and the ultimate development of a vaccine against this terrible disease are the only answer, but the vaccine could be 10 years away, which leaves us with prevention, education and the need to spread the message. That is why it is vital that the sexual health strategy is launched soon.
§ Mrs. Caroline Spelman (Meriden)
I add my congratulations to my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) on securing this debate on such an important topic. It is also good to hear from him because he brings his experience of government to the debate, and it is important that we hear how difficult it sometimes is in practical terms to persuade the Government machine to move in an area that might be regarded as controversial, but which it is dangerous to ignore. I commend all that my right hon. Friend did during his time in government to ensure that the matter was tackled and that resources were allocated to it. I also add my congratulations to my right hon. Friend the Member for Cities of London and Westminster (Mr. Brooke), who battled at a time when it was difficult economically to persuade the Treasury to spend money, but important to do so. It is important to nip an epidemic in the bud and to intervene early.
In common with many hon. Members, I have been greatly moved by the documentaries on the AIDS epidemic in east African states in particular, and the 73WH devastating impact on their society, especially on children. The documentary with the greatest impact showed children sleeping under cardboard at the side of a road because, not only had their parents died, but they had no living family of their parents' generation. The hon. Member for Richmond Park (Dr. Tonge) emphasised the seriousness of the problem for African society and its economy. The economically active cohort of society is being lost and the African continent is already suffering—it is not attracting the same amount of investment from international corporations and business. Added to that disadvantage comes the dreadful affliction of the AIDS epidemic.
The hon. Lady referred to the impracticality of those countries being able to afford the medication that could help the afflicted. A recent headline case in the newspapers concerned nurses from Kenya coming to work in the west midlands who were found to be infected with HIV. Regrettably, the media did not focus on the right issues. We are taking nurses and trained medical staff from Kenya and other countries that need them. We heard about the role of the Department for International Development and I urge the Department of Health to reconsider. Should we be draining the third world of qualified medical staff'? The Government have said that that is not their intention, but it is still happening.
What about some reverse traffic? Should we not provide more assistance to those countries when they are losing their trained professional help? People in their 30s and 40s are dying from this dreadful disease and their hospitals and medical services are being depleted. There must be something that we can do, as the world's fourth largest economy.
§ Mr. Brooke
Does my hon. Friend share my concern that the announcement last year that special arrangements would be made to provide entry visas for people with particular specialisations has also led to the removal of the condition that those who come here as students should return to their countries on completion of their studies? That also robs the third world of a valuable resource.
§ Mrs. Spelman
My right hon. Friend has a valid point. Most Members of Parliament meet qualified medical professionals in their surgeries who want to settle here permanently. Members ask themselves whether, by helping them to do so, they are removing a resource from countries that desperately need it. The moral argument should be examined.
The attention of hon. Members has turned from the plight of countries in Africa to the domestic situation. That is important and is doubtless what sparked my right hon. Friend the Member for Sutton Coldfield to secure this debate. Given the fact that the incidence of HIV and AIDS is again rising in the United Kingdom, we should all want to readdress that question. There is certainly no room for complacency. Although the rate of infection in this country has been contained below rates in other European countries—due, I suspect, in no small part to early intervention by the Government of the day—it is once again on the increase.
Like other hon. Members who have contributed to this debate, I want to know what has happened to the Government's integrated sexual health strategy, which 74WH was initially promised for spring 2000. After a period of consultation, we were told that it would be available in the autumn. A 1999 Department of Health press release states:The Department of Health will publish a short Emerging Findings report in January 2000. The report will set out key facts, principles and issues to be addressed. It will provide an opportunity for a wider audience to contribute informally to the development of the strategy. We will publish an HIV/AIDS Strategy Document setting out the action to be taken in spring 2000.There must be a good reason why that document has been delayed, given the increasing prevalence of the disease.
There are other problems with the existing programme. My right hon. Friend the Member for Cities of London and Westminster referred to the Mildmay Mission hospital, and I wish to discuss the practical reality for what is the UK's leading centre for HIV and AIDS. Funding from London health authorities has not been forthcoming, so the hospital has been forced to make 10 people redundant and it faces a year-end deficit of £650,000. On 3 November, the Department of Health announced an extra £41 million for the type of work that Mildmay undertakes. Why is that money not flowing through? Why is that specialist centre in such difficulties? Why is it forced to cut services at a time when the incidence of the disease is increasing? The hospital told me that it is difficult to apportion its limited budget between the high cost of combination drug therapies and the specialist supportive rehabilitative care that it offers. If the extra money has been made available, it should by now be flowing through to an establishment such as Mildmay.
The hon. Member for Richmond Park referred to the role of pharmaceutical companies. Surely the Government can put pressure on those companies to make life-saving drugs available—particularly for AIDS sufferers—at a more realistic price, regardless of wealth or nationality. Many such companies are sited in the developed world and some of the most successful are in the United Kingdom. Surely the Government can do something.
On speaking to professionals who work with these drug combinations, I was concerned to discover the difficulties associated with the delivery mechanism. If the drugs are not taken 95 per cent. of the time, they are dramatically less effective. If they are taken less than 80 per cent. of the time, resistance builds up and a patient can become immune and unable to take them. In the end, there is no other treatment for such patients. It is clear that an AIDS patient needs a great deal of support if drug therapy is to be effective. Given the cost of the drugs, ensuring that they are taken in the most effective way is surely a cost-effective use of medical support. I am sure that we can understand why those conditions will make it increasingly difficult to ensure that the drugs are taken appropriately, especially in the developing world, unless more professional help is on hand.
As hon. Members have said, this is a preventable infection. The most important reason for accelerating the delivery of the sexual health strategy must be the need to highlight what can be done to prevent disease. There is much evidence to suggest that the prevention of sexually transmitted diseases is deteriorating. Established diseases that we thought had been contained, such as syphilis and gonorrhoea, are back on the increase.
75WH Syphilis and gonorrhoea are reappearing throughout the country. There were 30 cases in Manchester in 1999 compared with two the previous year. Taken together, Rochdale health authority and Oldham health authority have seen 54 cases of gonorrhoea in the past year. There is a simple cultural reason to explain those increases—a new generation has begun to experience life. Perhaps younger people think that the predicted AIDS epidemic has not happened and so they have become complacent about the need to use preventive barrier methods of contraception. The rise in other sexually transmitted diseases provides ample evidence that barrier methods are not being used. The increasing use of oral contraception and the Government's recent support for the morning-after pill, which is another oral method, does nothing to stem the tide of sexually transmitted disease.
§ Dr. Tonge
I think that the hon. Lady will agree that when young people need the morning-after pill it is because they have already had unprotected sex and laid themselves open to the risk of catching a sexually transmitted disease. That is why it is important to attack on all fronts by providing another outlet where education can be made available and warnings can be given.
§ Mrs. Spelman
Absolutely. The hon. Lady is right to say that the morning after pill is after the event. Unfortunately, it gives the public a reason not to consider prevention before the event. Preventive methods thought through in advance are most likely to stem the tide of infection.
I want to finish by speaking up, as the hon. Member for Dumfries (Mr. Brown) did, for the plight of a generation of young men who, through the absence of a sufficiently vigorous public health campaign, are in danger of losing their lives. I am depressed by the analysis of the Public Health Laboratory Service of the dangers facing that particular group. It states:Perhaps most worryingly of all, a substantial number of HIV infections remain undiagnosed. Only about 63 per cent. of gay and bisexual men in 1999 who are HIV positive knew they were infected; among heterosexual men, this figure falls to just 48 per cent.That lack of information is one of the most worrying aspects of the rising incidence of HIV and AIDS. My right hon. Friend the Member for Sutton Coldfield is right to say that we should trust the public with information. As people do not have that information, they may unwittingly infect others simply because they are unaware that they are carriers. We must be grown up about that aspect of the disease, which is something that we have not been in the past.
There is a screening programme for pregnant women. When I was pregnant with the first of my three children. I was asked whether I would be prepared to undergo the test for HIV. Of course, I was glad to do so. I had had a blood transfusion, so I wanted to be sure that I had not contracted an infection that I was about to pass on to my child. I did not know that the test was anonymous, but, although I heard no more and was happy not to know more, women are not subsequently told its result. It is 76WH important to help the gay community, to whom the hon. Member for Dumfries referred, to prevent the spread of infection.
The nation has grown up with this debate, as a result of good health education campaigns. The Government must introduce their delayed sexual health strategy and reinvigorate this important aspect of the public health agenda.
§ Mr. Peter Bottomley (Worthing, West)
I am grateful to the Minister for making it possible for me to contribute briefly to this debate. I am sorry to have missed the speeches of two former Secretaries of State to whom I was Parliamentary Private Secretary. I had to meet a Minister about a vulnerable constituent.
I want to make three points. First, we should base the discussion on the grounds not only of sexual health but sexual activity. Celibacy is something that we cannot inherit from our parents; we can adopt it and it may be forced on us, but it is not an inherited characteristic. How can we reduce the adverse consequences of sexual activity? We must throw away the language of birth control, family planning and saying, "No" to people, although we may be able to find examples in which that policy has been worth while. We must understand that many people in future generations will do the things that we did in our time. For sexually transmitted diseases, including HIV, barrier methods matter more than contraceptive methods. We must be open about that.
Secondly, as my hon. Friend the Member for Meriden (Mrs. Spelman) said, HIV is caused not only by sexual activity. The blood route is what matters in various countries—some of my friends have been exposed to that danger as haemophiliacs or recipients of emergency blood transfusions.
Thirdly, the hon. Member for Richmond Park (Dr. Tonge) made a point about the media. Reasonably, it goes on a lot about sex, but it seldom shows people discussing contraception or the use of barriers during sex. It does not mention the embarrassment felt by people in their early years of sexual activity, when looking for contraception of whatever kind—for an act that is more intimate than sharing a toothbrush. Radio might be an important means by which to overcome embarrassment and on which people might be reasonably explicit. It is no good simply for Simon Bates to present chocolate box romances on Classic FM. People need to talk, not offensively but in detail, about how one can get past desire and embarrassment to safe sexual activity.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)
I congratulate the right hon. Member for Sutton Coldfield (Sir N. Fowler) on securing the debate, and join hon. Members in paying tribute to his contribution and the lead that he has taken in raising awareness about AIDS, especially in the early years of the epidemic. Some of the quotes that he included in his speech showed just how courageous a stand individuals had to take at that stage, because there was a tremendous amount of hypocrisy and ignorance and a simple unwillingness to face facts. It was easy, in those early days, not to acknowledge the potential scope 77WH of AIDS and HIV. I pay tribute, too, to my hon. Friend the Member for Walthamstow (Mr. Gerrard), who chairs the all-party parliamentary group on AIDS.
The national plan formulated by the right hon. Member for Sutton Coldfield to combat AIDS included public health measures, research and service development and very open public education. The campaign of public information was followed by more specific health education directed towards the groups most at risk. The first ever Government-funded campaign, in 1986, had the slogan, "Don't die of ignorance." I am sure that we all remember it, which shows its impact. It broke new ground in raising awareness and providing everyone with basic information on HIV.
The message of that campaign was powerful, as was the scale of media coverage. It included television and posters, and a leaflet containing facts on HIV and AIDS, which was sent to all 23 million households in the United Kingdom. It is widely acknowledged that the United Kingdom remains a low prevalence, low risk country for HIV infection as a result of the early and sustained investment in HIV prevention and health promotion campaigns.
The scale of the AIDS problem in other countries in the new millennium is staggering and of grave concern. The number of people estimated by the joint United Nations programme to be living with HIV and AIDS was more than 34 million at the end of 1999. The vast majority of infected people are in the developing world, which is least able to cope. Countries in sub-Saharan Africa are by far the worst hit, with an estimated 24 million infected. Several Members referred to that, in particular the right hon. Member for Cities of London and Westminster (Mr. Brooke), who referred to South Africa and the economic impact. When I attended a World Health Organisation meeting in Geneva last year and spoke to a South African Health Minister, I was struck by the economic impact of stripping out a whole generation. As the hon. Member for Richmond Park (Dr. Tonge) said, the economically active generation is being hit. As a result, we are left with the children, who are still growing up, and the older t generation.
The Department for International Development has made a considerable contribution by working not only with the South African Government—part of the development plan last year was an overall contribution of £11 million from the United Kingdom, and a specific project worth £7.5 million—but with India, where the United Kingdom has contributed £37 million to a project. HIV and AIDS remain one of that Department's key priorities. Last year, it spent £100 million on HIV and AIDS. In a written answer, my right hon. Friend the Secretary of State for International Development said that she expected that contribution to increase.
The right hon. Member for Cities of London and Westminster also referred to hospices, which play an important part. He is right to say that the previous funding structure was far too ad hoc and was not strategic. For that reason, an extra £55 million will be available for care by 2003–04. It is also expected that health authorities will enter not merely annual agreements for funding but three-year agreements, to ensure that support is provided where it is most needed.
78WH The hon. Member for Richmond Park was right to say that prevention is the most effective way to tackle the disease. She drew attention to other sexually transmitted diseases, because HIV and AIDS should not be seen in isolation. I fully agree with my hon. Friend the Member for Dumfries (Mr. Brown), who said that we should not ignore gay men, maternal transmission and the voluntary sector. I hope to be able to reassure him.
Before I outline the direction in which the Government are moving, I make it clear to the hon. Member for Meriden (Mrs. Spelman) that, in spite of what she said, the Department of Health does not actively recruit nurses from third-world countries. A strategy is in place, and she knows that in the case to which she referred in Wolverhampton, trained nurses were not being recruited. They were not trained when they came. I want to place on the record forcefully that that case should not be misrepresented. Guidelines are in place, of which we are acutely aware. Overseas recruitment by the Government is mainly from countries such as the Philippines. An agreement has also been reached with Spain. No one should get the wrong impression about that.
§ Mrs. Spelman
There is no misunderstanding. I understand the Department's guidelines, which are clear. The loophole is through nurse recruitment agencies that do not stick to those guidelines. That is where the weakness lies at present.
§ Ms Stuart
I do not wish to depress the right hon. Member for Sutton Coldfield. He is right when he says that in campaigns we should trust the people, but as a fellow Birmingham Member of Parliament—I know that the royal borough of Sutton Coldfield has still not come to terms with being part of Birmingham, but it is—he will know that we still face battles to convince the public, not least of the value of initiatives such as the Safe project in Birmingham, in which condoms are handed out to sex workers, which has been extremely effective although sections of the community deeply resent it. That is why it is important for politicians and Governments to stand up and say what is right and to be seen to do so.
On the overall situation and what the Government are doing, in western Europe, the scale of our problem is less than elsewhere, but that is no reason for complacency. We still have an estimated 500,000 people living with HIV. The United Kingdom has fared better than some other countries in Europe: Portugal has seven times our prevalence of HIV infection; Spain has five times; France four times; and Italy three times. Other European neighbours such as Germany and Sweden have managed, like us, to keep HIV infection at a lower level.
Developed countries are more able to afford to take advantage of the development of effective treatments for HIV. Those developments have been both exciting and challenging. Since the arrival of combination antiretroviral therapies in 1996, people with HIV have benefited from a reduction in debilitating infections and failing immunity, which previously characterised the disease. That may be one reason why public awareness has diminished: the number of people who die from HIV has been reduced. We still have a long way to go—the complexities of following the treatment have been mentioned.
79WH The effects of such treatment are evident also from the changing epidemiology of HIV and AIDS in this country, which shows a 60 per cent. decrease in the number of people progressing to AIDS last year compared to 1994. That decrease is a result of the fact that people with HIV are not progressing to an AIDS-defining illness as rapidly as before. The mortality figures also tell a story, with a 73 per cent. decrease in HIV-AIDS-related deaths recorded last year compared with 1994.
There are people living with HIV throughout the country, but 60 per cent. of them continue to be in the London area, and overall the gay community remains the largest single group affected. However, in 1999, for the first time the number of new HIV diagnoses among heterosexuals was higher than among gay and bisexual men, and that trend has continued. The majority of those infections were acquired abroad—again, the hon. Member for Richmond Park made this point powerfully—usually by people from, or who have visited, countries of high HIV prevalence or risk, such as those in sub-Saharan Africa. The increase in HIV diagnoses among heterosexuals is probably in part the result of initiatives in the past few years that have encouraged people to come forward for testing.
Into the second decade—I think that my speech should say the second millennium—of HIV-AIDS in this country, we cannot afford to drop our guard. We now need a comprehensive strategy that encompasses prevention and education, treatment and care. New generations of young people need a new approach to make them aware—not merely of HIV but of other sexually transmitted infections. That is one reason why we decided to merge the work undertaken in the sexual health and HIV strategies last year. As the hon. Member for Worthing, West (Mr. Bottomley) said, a combination of the two is needed. That joint approach obviously needs careful consultation with key groups, so that both HIV and other sexually transmitted infections receive the detailed and specific attention necessary if we are to make progress in combating the rise in transmissions.
There is disappointment that the strategy is taking longer than was hoped. I am sure that right hon. Members who have served in government will agree that sometimes Ministers share frustration when work does not progress as quickly as expected. I hope that the phrase "is nearing completion"—the "is" is written in italics—provides an escalated reassurance that we will issue the draft document shortly. We are determined to get the message right and ensure that strategy proposals can be implemented. To answer the question about why it has taken so long, on balance, we would prefer to get it right by bringing the two together in a wider consultation. We hope that it will be introduced shortly.
§ Sir Norman Fowler
Will the Minister be a little clearer? We have heard the word "shortly" before. Can we expect the strategy document to be published in the next few weeks? We have been waiting for it for a very long time.
§ Ms Stuart
The right hon. Gentleman is tempting me to put a figure on the time, but I say simply that it will come shortly.
80WH On the important role of HIV prevention activities, it is as important not to exaggerate the risks of HIV for the general population as it is to recognise that those risks have not gone away Sexually active young people have information and health promotion needs and we continue to deliver new campaigns in recognition of that fact.
The right hon. Gentleman said that the effective campaign of the 1980s was right for the time, but that a simple repetition would not be the answer. The new campaigns must be more focused. The recent "Clem and Lydia" television advertisements, which dealt with chlamydia, put the HIV safer sex messages into the wider context of other sexually transmitted diseases. Chlamydia is more common than HIV among young people and presents a more immediate risk.
The large increase in inquiries to the national AIDS helpline and to Health Promotion England's "Lovelife" website show that it is possible to engage young people with the safer sex message. The hon. Member for Richmond Park pointed out that the situation was different 20 years ago, and referred to dark glasses and wigs. Ten years ago, condoms could only be acquired in gents' toilets or through cryptic messages at the pharmacists; they are now to be found on the shelves in Tesco, next to Lemsip and aspirin.
Effective drug treatments have increased life expectancy and improved the quality of life for many with HIV. They have had an impact on HIV prevention work; for example, for some gay men, the duration of the epidemic may have bred a familiarity with the effects of HIV. There is a danger that prevention messages may lose their impact if they become familiar. The challenge for health promotion planners and providers is to develop and deliver sophisticated interventions that engage target audiences, whatever their experiences of HIV. Those must be relevant and based on research into people's behaviour that accurately identifies how people live their lives in relation to HIV.
We shall ask the health development agencies to review and publish evidence-based, effective HIV and sexually transmitted disease prevention and sexual health promotion. The response to those problems must be local. National health promotion work is designed to respond to the changing nature of the AIDS epidemic. For example, health promotion resources are now available for African communities and we are developing, in partnership with community-based groups, a strategic prevention framework that aims to reduce transmission among those communities.
The sustained financial investment in local HIV prevention since the start of the epidemic has undoubtedly contributed to England's low prevalence. We provide the national health service with some £55 million for local work, but need to ensure that prevention services take account of up-to-date information on successful strategies to identify and disseminate best practice.
We are making headway in the reduction of mother-to-baby transmission of HIV. In 1998, we introduced a policy that offers an HIV test to all pregnant women as a routine part of ante-natal care. Most HIV-infected pregnant women accept the offer of measures such as drug treatments and caesarean section to reduce the risk of their babies becoming infected. In 1999, about 76 per 81WH cent. of pregnant women with HIV in inner London had had their infection diagnosed before delivery, compared with 50 per cent. in 1998. We estimate that that will prevent about 45 infant HIV infections in 1999 alone. Although everyone wants to meet a target of zero children born with HIV, we do not believe that that is possible. However, our aim is to reduce the number of children with HIV by 80 per cent. by 2002.
We have not discarded HIV as one of our major priorities. We are building on the success of some of the campaigns of the past 20 years, particularly the work with mothers and children. I hope that the strategy to be published shortly will reassure hon. Members that there has been no reduction in capital investment or in the Government's commitment to combatting HIV.