Oral answer (Lords) on Health: HIV - Mar 25

To ask Her Majesty’s Government what steps they are taking to bring an end to new transmission of HIV infection by 2030.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a trustee of the Bloomsbury Network.

My Lords, due to increased access to testing and other measures, there has been a welcome 28% decline in new HIV diagnoses since 2015. We are also one of the first countries in the world to meet the UNAIDS 90-90-90 HIV targets. To build on this progress, the Secretary of State for Health and Social Care has announced the Government’s commitment to end new transmissions of HIV in England by 2030. Work is under way to take this forward.

I thank my noble friend for that Answer. I know that noble Lords across the House who have long campaigned for this moment—I am hazarding a guess that I might include the Lord Speaker in view of his exceptional leadership in this area—will applaud the Secretary of State’s commitment to eliminating new HIV transmissions by 2030. In the certain knowledge that those with HIV on effective treatment cannot pass it on, it is now in our power to bring an end to this cruel illness. Does my noble friend agree that what is needed now is a comprehensive national HIV strategy, which brings together all of the steps that we need to take: prevention through both sustainable access to PrEP and effective treatment for those diagnosed; more testing to stop late diagnosis; greater investment in sexual health services; education about HIV in schools; an end to the fragmentation of HIV services; and a commitment to tackle stigma?

I thank my noble friend for that Question and pay tribute to the work of the Lord Speaker. I agree with the premise of his Question. Public Health England has attributed the success that we have had, with 92% of people with HIV now diagnosed, 98% of patients receiving treatment and 97% virally suppressed to a combination of HIV prevention, including expanded HIV testing, prompt initiation of antiretroviral therapy after diagnosis, condom provision and PrEP, all of which we will need to build on as we develop plans to achieve zero infections by 2030. He is absolutely right that these will all need to go into development of that plan.

My Lords, it is greatly to be welcomed that science is now leading us to end new transmissions by 2030. But is the Minister aware that women who are HIV-positive are four to five times more likely to develop cervical cancer? I agree with the noble Lord that there is a need for a new strategy. Will the forward plan and investment in public health recognise the need for investment in prevention and early intervention and a package of care for all women living with HIV, which includes going for regular smear tests?

I thank the noble Baroness for her question. She is absolutely right that the key to us making progress is prevention and early intervention and also understanding about any crossover consequences with other illnesses. She is also right that the key is closing the gaps now. In 2017, 43% of diagnoses were made at a late stage of HIV and, although there has been a decline, the largest group diagnosed at late stage were black African heterosexual men and women. It is important that we close those gaps. Some key projects have been working on that through the HIV Innovation Fund so when we bring forward plans for HIV 2030 it is important that we find out how we can close those gaps if we are indeed to get to zero by 2030.

My Lords, does the Minister agree that in order to end HIV by 2030 all children need to understand their own risks through comprehensive relationship and sex education and that schools that refuse to teach it are jeopardising the health of all pupils? Does she agree that that should not happen?

Knowledge about safer sex and sexual health is essential for young people. They must be equipped to understand and to make safe, informed and healthy choices. That is why we have brought in compulsory SRE for the first time, which all schools should be required to teach.

My Lords, as well as the very welcome national strategy that the Minister described, will she accept that this is a global problem? In other parts of the world, progress has not been as great as it has been here. We need to see that progress. In that respect, does she recognise the work that the Global Fund to Fight AIDS, Tuberculosis and Malaria has had on reducing incidence worldwide of these killer diseases? Will she commit for the Government to be active in their leadership in the replenishment of the Global Fund this year?

We can be incredibly proud that the UK is a world leader in efforts to end the AIDS epidemic, including through our huge investment in the Global Fund, which has provided 17.5 million people with treatment since 2017, and of course through DfID’s research on HIV prevention. That is exactly why DfID has committed to continuing its focus on HIV prevention technologies and I am happy to share that commitment with the noble Baroness.

My Lords, may I echo my noble friend Lord Black’s praise for the Secretary of State’s ambition and associate myself with his policy suggestions? My noble friend will be aware that there is a similarly infectious, life-limiting disease that affects similar people, called Hepatitis C. We now have a cure for that disease: we are able not just to eliminate it as a public health risk but actually to cure people. In drawing up any strategy, will the Minister ensure that the department also makes sure that curing Hep C and making that cure available to those people is as big a priority as eliminating HIV?

I thank my noble friend for his question and also for his leadership on this issue while he was in the department. He knows that the Government are committed to being a world leader in domestic eradication of Hepatitis C. He will know also that a legal challenge by AbbVie delayed the start of contracts on this issue by six months. I am pleased to be able to inform the House, however, that in January the High Court found in NHS England’s favour on all grounds in this matter. We can now go forward with those innovative contracts, which are worth about £1 billion over five years. That will be rapidly put in place over the coming months, which will allow us to make progress on this matter.

My Lords, although I congratulate the Government on the progress they have made in the diagnosis and treatment of HIV, does the Minister realise that women in this country have an ever-decreasing service for cervical cytology and, indeed, for having those smear tests read in laboratories, given that the number of laboratories is being decreased? Does she realise also that, because of cuts in local government funding, there are very few family planning clinics now, either for women or young girls? That means that the provision of contraception is very limited, because they have to go to their GPs.

I thank the noble Baroness for that probing question. The Government have mandated local authorities to commission comprehensive open access sexual services. We have continued the ring-fence around public health services in local authorities at £3 billion a year and they have maintained 3 million attendances in 2017, which is an increase since 2016. What is important is that the long-term plan has also identified sexual health services as an area for review going forward, which is one of the findings from PHE. This is therefore a cause for encouragement, and I hope that the noble Baroness will be reassured.