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Charlotte Nichols (Warrington North) (Lab)
I beg to move,
That this House has considered National HIV testing week.
I am the understudy today for the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), who secured this debate. It has been 42 years since the untimely death of Terrence Higgins, who was not only the first recorded British person to die of HIV/AIDS, but a Commons Hansard reporter. Since then, we have made huge progress in the testing, diagnosis and treatment of HIV. Today, people living with HIV can continue to live very normal lives. It is essential to remember, however, that HIV remains a critical global health issue, with millions of people living with the virus and many more at risk of infection.
Early diagnosis and treatment of HIV is essential in reducing the spread of the virus, improving health outcomes and reducing the stigma associated with the disease. I thank charities such as the Terrence Higgins Trust, the National AIDS Trust, the George House Trust and others that have worked tirelessly to lead the fight against HIV. They have done and continue to do phenomenal work to help those living with HIV and to achieve the goal of no new HIV transmissions by 2030. I take the time on behalf of all the members of the all-party parliamentary group on HIV and AIDS to thank the outgoing chief executive of the National AIDS Trust, Deborah Gold, for her hard work and dedication to the charity for the past 10 years, and for her immense contribution to the fight against HIV. I am sure that everyone will join me in wishing her the best of luck in her new chapter.
As Members will be aware, HIV weakens a person’s immune system and their ability to fight everyday infections and disease. HIV is passed from human to human and, if left untreated, can progress through a series of stages leading to acquired immune deficiency syndrome, or AIDS. Though there is currently no cure for HIV, treatments are available that enable a person to live a long and healthy life. A person living with HIV has a similar life expectancy to a HIV-negative person, provided that they are tested and diagnosed in good time. In 2022, the Government introduced the national HIV action plan. It had the clear aim of reducing new infections by 80% by 2025 and, crucially, ending infections and deaths from HIV by 2030. That goal can be achieved only if the plan is properly financed and implemented.
In November, at the event to honour Sir Elton John organised by the APPG on HIV and AIDS and hosted by Mr Speaker, the Secretary of State for Health and Social Care outlined that the UK Government would be expanding the hugely successful NHS opt-out virus testing programme for HIV and hepatitis to 46 new emergency departments across England. Expansion of the programme from the current 33 sites to every high-prevalence area could identify a significant proportion of the estimated 4,500 people living with undiagnosed HIV, prevent new transmissions and save more lives.
As hon. Members will know, we have been marking National HIV Testing Week with events across the country, including on the parliamentary estate, to raise awareness of HIV testing. This annual campaign aims to raise awareness of the importance of regular testing to reduce the number of people living with undiagnosed HIV and those diagnosed late, and the campaign’s strapline “I test” is in its second year. I urge everyone to take advantage of the services available during National HIV Testing Week and throughout the year to get tested and know their status.
Recent UK Health Security Agency data highlights that while HIV diagnoses among white gay and bisexual men are falling, inequalities are deepening. HIV transmissions have increased in the last year among heterosexual men and women, as well as gay and bisexual men of other ethnicities. Persistent inequalities must be overcome. At the same time, the experience of people living with HIV is not equal or equitable. Worrying numbers of people living with HIV are afraid to visit healthcare settings, with women and people of black African ethnicity more likely to be afraid than men or people of white ethnicity. Those inequalities are mirrored in the experience of people offered an HIV test: 40% of women eligible for a test were not offered one when attending a sexual health service. I urge the Minister to do everything she can to tackle the inequalities in the HIV response in order to deliver the Government’s action plan and end new transmissions by 2030.
Along with tackling inequalities, we need to tackle the growing number of people previously diagnosed with HIV who are not accessing the care they need. The UKHSA estimates that as many as 14,000 people living with HIV in England have not been seen by their HIV clinic for at least a year, often for complex social and stigma-related reasons. They are essentially lost from the health system. One in three of those testing positive for HIV through opt-out HIV testing in accident and emergency departments knew about their status but were not accessing care. Hospitals in London are now reporting that people lost to care have overtaken undiagnosed HIV as the leading cause of HIV-related hospitalisation and mortality. Those are entirely preventable incidents.
Pilot work in south London funded by the Elton John AIDS Foundation has shown that with case finding, focused follow-up and wraparound support, people can be successfully returned to care at an average cost of £3,000 a person. HIV clinics currently do not have the resources to do that work, but it is significantly cheaper than care costs when people develop serious illness. A national programme must be urgently introduced to find everyone lost to HIV care in England and ensure that they are getting the lifesaving treatment they need. Will the Minister confirm what action the Government are taking to find people living with HIV who have been lost to care?
Finally, we must tackle late diagnosis. Certain groups are more likely to be diagnosed late and therefore experience worse health outcomes. Last year, 44% of people diagnosed with HIV in England were diagnosed at a late stage, and late diagnosis rates are even higher for women, at 51%. The number of people living with HIV who know their status but are not in care could be higher than the number of people with undiagnosed HIV. That is a risk to their health, expensive for the NHS and threatens HIV elimination. People not in HIV care are disproportionately from underserved communities, including black communities, women and people who use drugs.
The impact of late diagnosis can be extremely damaging: as well as meaning that someone might unknowingly pass on the virus, if they receive a late diagnosis, their chance of dying in the first year after diagnosis is 10 times greater than if they had received an early diagnosis. Additionally, late diagnosis can have a detrimental impact on an effective response to treatment, which in turn leads to greater healthcare costs at a time when there are already financial strains on the NHS. Late diagnosis is particularly common among certain groups, with 54% of heterosexual British black Africans and 29% of gay and bisexual men diagnosed late. Opt-out testing has allowed us to identify that those are the groups most likely to be HIV-positive.
Although opt-out testing highlighted that those groups were most likely to have HIV, we need to encourage more people from them to get tested. A simple solution for that could be to use public message campaigns. Targeted messaging across radio, television and social media could be created to encourage people to come forward and get tested. It could also specify the importance of testing and tell people where their nearest local test centre is.
Ultimately, to address late diagnosis in both primary and secondary care services, HIV testing needs to become more prominent across the entire NHS primary and secondary estate. If we want to turn the UK into a science and health superpower, and if we want there to be no new cases of HIV transmission by 2030, it is essential that we address the issues that I am highlighting. In particular, it is vital that we rapidly increase testing levels in high and very high prevalence areas through opt-out testing. That will not only save the NHS money and reduce the backlog but enable patients to know quickly whether they have HIV.
My challenge to the Minister is to fight her corner and fight the inequalities in the HIV response, ensure that access to testing is increased and ensure that once testing has started in hospitals, funding for it will continue until we find the last person living with undiagnosed HIV in England. The opportunity to eliminate new cases of a long-term condition is rare, yet we have the tools to do just that now. We must grasp that opportunity and create a culture where failure to follow guidelines is considered wrong and HIV testing is considered routine.
I end on this note. It is crucial that HIV and AIDS remain firmly on the agenda of our Governments, both domestically and internationally. They must be held to their promise to reach zero new infections by 2030.
Sir Peter Bottomley (Worthing West) (Con)
At the conclusion of the debate, I am going to take an HIV test. I do not expect it to have a surprising result, but I think that unless people like me set an example, we cannot expect others to overcome what might be embarrassment or awkwardness. The same applies to things like giving blood, which I did again this morning, for over the 90th time. If people watched blood being taken, they would be less fearful about giving blood themselves, and if they knew that they could take HIV tests without embarrassment, they would do so.
Each year, about 3 million of us go to sexual health clinics, where there are a lot of acronyms—STIs, STDs, GUM, HIV and AIDS—that all follow from things like blood being given. The first person in my family to take an HIV test was my mother, who had had a number of blood units given to her after an operation and wondered whether she was infected and might infect others in the family. She was clear; many were not so fortunate.
On vectors—person-to-person transmissions—we ought to be far more open, because the only thing we cannot inherit from our parents is celibacy. Celibacy can be adopted or forced on someone, but sex is quite common for the rest of us. On that, I am glad that we now have a vaccination against genital warts, which is included in the cervical cancer vaccination and is now available to young men and boys as well. We will reach herd immunity much faster if both sexes are involved. That also gives protection to men who have sex with men.
I am not an expert on all these things, but we ought to be as careful about this as we are about ensuring that people’s teeth are protected, as we discussed yesterday in the dentistry statement. We should be concerned that the chances of being involved in a conception that ends in a formal termination are about 50% in this country. There is a birth cohort of just over 600,000, and there are over 200,000 abortions a year—the maths is not complicated.
It takes two to tango. As the hon. Member for Warrington North (Charlotte Nichols) said in her remarkable, positive and important speech, we can end HIV transmission if, when people know that they have been exposed to it, they can get treatment for it.
There is no reason for a long debate, or even a long speech from someone like me. I simply say, in solidarity with the people we can protect, that we ought to know our own status, encourage others to find ways of discovering their status and make sure that help is available and offered.
It is odd that, often, when people come into contact with clinical services, they are not encouraged to discover their status in all kinds of ways. Modern treatments are available and they are effective. If we can overcome the embarrassment, we can get to a situation where people can be themselves and live as they choose, without being a risk to themselves or to others. I thank the hon. Lady again for her speech, and I hope that the whole country will pay attention.
Andy Slaughter (Hammersmith) (Lab)
It is a pleasure to follow the Father of the House, and I thank my hon. Friend the Member for Warrington North (Charlotte Nichols) for so clearly setting out the issues. I do not need to repeat them, as I want to speak briefly.
I represent a constituency that has had a high incidence of HIV infection for many years. It has a young, mobile and diverse population, and a very busy sexual health clinic at 10 Hammersmith Broadway, which I visited last summer. I pay tribute to all the staff there and at the other clinics around the country. They offer a fantastic service and they are engineering testing and comprehensive treatment under very difficult circumstances and with very limited resources. I also pay tribute to the Terrence Higgins Trust and the National AIDS Trust, and all the other charitable organisations that have done so much over the past few decades.
We should pause in this debate to mark the successes and the transformation in both the prevention and the treatment of HIV and AIDS over the past few years. There has been great success. We know now that early diagnosis is important but, after diagnosis, those who are infected can live normal lives of normal duration. That would have been unthinkable even 20 years ago. There is very effective prevention through PrEP and other methods. To go from where the risk of infection was a few years ago to where we are now is extremely significant.
Given that testing and treatment are available—and prevention should be available—it is even more frustrating that we are in the situation that my hon. Friend outlined. First, the fact that 4,500 people are undiagnosed in the UK is entirely unnecessary. One of the solutions, which the Government are expanding, is opt-out testing in A&E and other locations. That needs to be embedded and extended. Until we get to the stage of preventing transmission altogether—for which there is an ambitious target—opt-out testing needs to be expanded and made more usual. In turn, that will help to eliminate the disparities in testing rates between different parts of the population—between men and women, and heterosexuals and men who have sex with men. This is not rocket science. This is about simply making sure that the proper remedies are available.
The other issue that has come up repeatedly over the past couple of years is the availability of PrEP and other preventive measures. That is partly down to the pressure on sexual health clinics, through an upsurge in other STIs such as gonorrhoea and syphilis, of which we have seen not quite epidemics but serious outbreaks. Last year we saw several episodes of monkeypox. Understandably, they have taken priority in sexual health clinics, but that means that less time is available for consultation, and there are fewer prescriptions of PrEP and other medications. The waiting times are still far too long, but at one stage they were being measured in months rather than weeks. It is clearly a missed opportunity if people are willing to be prescribed PrEP and understand its advantages, but are not receiving prescriptions because they simply cannot get an appointment at their local clinic, through no fault of the clinic or its staff.
These problems need to be tackled, and it would be relatively inexpensive to do so. The problems are relatively clear and straightforward. The drugs and products are safe and tried and tested, and the methods—whether postal testing or in A&E or outreach—are well known and proven to work. The only issue, which I hope the Minister will address, remains why it is not being done. Obviously, there were problems during covid, as there were in many health services, but that is no longer a good enough excuse. There is no reason why people should not be able to readily accept testing, medication and preventive measures.
I would like to hear a further commitment from the Minister today on opt-out testing, resources for sexual health clinics and the availability of PrEP. It has been suggested that, given the expansion in services now provided by pharmacies, PrEP could be added to them. I see no reason why that cannot be the case. It could be perfectly safe to prescribe it in that way. It would take the pressure off clinics and it would make the medication more accessible and easier for those who are not currently receiving prescriptions.
I ask the Minister and the Government to consider those points. They are not difficult and they will not take a long time, but they could have a significant effect on many hundreds and thousands of people who are unnecessarily at risk.
Jim Shannon (Strangford) (DUP)
It is a pleasure to follow the hon. Member for Hammersmith (Andy Slaughter). I thank him for his contribution and his knowledge of his constituency. I also thank the hon. Member for Warrington North (Charlotte Nichols). She led a debate yesterday on mindfulness, which I attended, and she led this debate on HIV testing exceptionally well.
I am the Democratic Unionist party’s health spokesperson, so it is a pleasure for me to be here to make a contribution. I always like speak in such debates if possible. Once or twice I have missed them, but I am very pleased to be here today. We celebrate the fact that HIV is now a disease that people can live with, and can enjoy a better life with. That is something to celebrate.
National HIV Testing Week lasts from 5 to 11 February, and special recognition is deserved for reaching a decade since it started. We should look at what has been done in the last 10 years—how we have progressed and done better, and how people have a better quality of life today. It is important to mark this week in Parliament, as testing is the only way for people to know if they have HIV. The Father of the House said that he would go and get a test, even though he does not need one. He said that people should recognise that testing is important. The latest figures show that rate of HIV diagnosis is falling, but people of a heterosexual orientation are getting more HIV diagnoses, so there is a lot of work still to do. Testing is free, quick and easy, so it is imperative that people of all ages are aware of the services available to them and take advantage of them to prevent passing it on to others.
I would point the Minister, for whom I have great respect—I understand her deep interest in this subject and very much look forward to her response today—to the issue of PrEP, which the hon. Member for Hammersmith referred to. In Northern Ireland, we have had a very successful campaign on that for some time, which seeks to raise awareness, reduce sexual diseases and then, by its very nature, give people longer lives.
Some 69,000 HIV tests were carried out in Northern Ireland in 2020; from those, there were 52 new diagnoses, bringing the total number of people diagnosed with the disease in Northern Ireland to 1,123. With a population the size of ours, we might say that those figures are not bad—I do not think they are. It illustrates that testing and the use of PrEP, among other policies in Northern Ireland, have enabled us to reduce diagnoses and keep them at a manageable figure. That is a decline of 49% from 2015, which is a massive success story. There has been a declining trend in the annual number of diagnoses in people born in the UK. There is no doubt that we are doing our best to encourage people to partake in testing.
It is important to recognise how far we have come since the ’70s and ’80s, when there was a huge stigma around HIV diagnosis, testing and treatment. As I have said, I am my party’s health spokesperson, so I try never to miss these debates. It is amazing to see how far we have advanced since then, both socially and medically, and it is important to say how wonderful our NHS is, being capable of transforming what was once a much-feared virus into something that is now easily treated. That does not mean we become nonchalant in relation to it; it means we have to recognise what we have done, and then recognise what our policy will be for the next period, because people are now able to live long, healthy lives through treatment.
I look to the Minister for a commitment that we will dedicate more resources to educating young people on HIV and other viruses that can be passed on through infected bodily fluids. Many young people will not remember, or even be aware of, the years when HIV was a massive concern to so many. It is crucial that we keep on raising that awareness today, and that young people are encouraged to test, if necessary, and to have those conversations with family and friends, to ensure they do not have the disease and that they are safe, well and healthy.
Where we can do that most effectively is in schools and universities, which have a role to play in ensuring that young people feel comfortable and have a safe place where they can speak to someone privately. The Father of the House was absolutely right: these subjects are sometimes difficult to deal with, and those conversations may need to be private. Many universities already have sexual health clinics, which are fantastic services to offer young people.
So many organisations do incredibly hard work to provide support for other nations with a high prevalence of HIV. In National HIV Testing Week, I want to make a plea to the Minister. Ards Elim church in Newtownards, in my constituency, operates aid and missions out of the church and is incredibly active with missionaries in Africa, especially in Swaziland and Zimbabwe. Every year, a group of young people come to our constituency, every one of whom is HIV-positive—their parents had it, and they have it—but they are living their life today because of the new medications that we have. I feel greatly encouraged when I see them and when I hear them singing in their heavenly voices. It reminds me that we in this great United Kingdom of Great Britain and Northern Ireland have done magnificent work out in Swaziland, Zimbabwe and across Africa. I know it is not the Minister’s responsibility, but could she perhaps give a hint or write a letter to myself and others on what can be done to continue the work on HIV in Swaziland and Zimbabwe? It is of great interest to my constituents who attend that church.
At one stage, 40% of the population of Swaziland were HIV-positive, but today, after receiving medications and doing testing campaigns, the rate there is manageable. If that is not a success story, I would like to know what is. As many will know, there is a high prevalence of HIV in certain parts of Africa, and the ministry is keen to secure help for young children and parents who are suffering. There is so much ambition to help others, as it has been proven that catching cases early through frequent testing hinders the spread and lessens the impact of HIV on an individual. Across the UK, we are successful with our figures. Can the Minister provide some clarity on whether we are able to help other countries in desperate need as well?
This week is another opportunity to encourage people to take advantage of services offered to combat HIV. There is fantastic potential to protect people from HIV and to prevent severe illness and even death. When I think of the royal family, I often think of Princess Diana and the work she did when she was alive. She reached out and was one of those great motivators who tried to make sure that people across the world knew that HIV should not and would not be a death sentence.
To conclude, I thank the local health trusts in Northern Ireland, and indeed across the whole United Kingdom of Great Britain and Northern Ireland, for providing these worthwhile facilities. I call on the Government and the Minister to ensure that we continue to provide sufficient testing services to all across the United Kingdom of Great Britain and Northern Ireland, as testing has proven instrumental in saving lives. Why would we not celebrate an occasion like this, when across this great United Kingdom, many more people are alive today because of what we have done?
Amy Callaghan (East Dunbartonshire) (SNP)
I congratulate the hon. Member for Warrington North (Charlotte Nichols) on opening this debate. She was an excellent stand-in for the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), approaching the subject with nuance and good grace. I thank my constituents in East Dunbartonshire and people right across Scotland who contacted me in advance of the debate, which has helped me to shape my remarks. I also thank the Terrence Higgins Trust for its very helpful briefing.
Just prior to Christmas, I popped into Charlotte Tilbury, where I purchased myself a nice new lipstick, which I am wearing today. The money from the sales of this lipstick goes to the Rocket Fund, powered by the Elton John AIDS Foundation, which seeks to end AIDS everywhere. I must say that I was delighted to be doing my bit just by treating myself to a new lipstick, even prior to this debate.
National HIV Testing Week serves as a reminder to us all of the importance of knowing our status, and provides amplified opportunities for people who would otherwise never test to do so. The scientific advances in HIV treatment and prevention are some of the biggest we have seen in modern medicine. An HIV diagnosis has gone from being a near death sentence for sadly too many people to being a manageable condition, with people living with HIV enjoying a normal life expectancy. Even more incredibly, we can now say with absolute confidence that someone on effective HIV treatment cannot pass on the virus to their sexual partner—undetectable equals untransmittable.
One of the key interventions and milestones that contributed to this progress was the implementation of the NHS-delivered national HIV PrEP programme in 2017. I am proud to recognise here today that Scotland was the first nation in the UK to make PrEP available, free to anyone at risk, on our precious NHS. There are now approximately 6,000 people using PrEP in Scotland at any one time. An estimated 500 people are living with undiagnosed HIV in Scotland, and a further 961 people have been diagnosed with HIV but are no longer considered to be receiving specialist HIV care. Reaching those people will be vital if we are to succeed in ending new cases of HIV by 2030.
Between 2010 and 2019, the most marked reductions in the annual number of first ever HIV diagnoses in Scotland were observed among gay, bisexual and other men who have sex with men. The reductions likely reflect a decline in the incidence and transmission of HIV infection in Scotland, associated with a range of public health measures over this period. However, that same progress is not happening across other groups, with slower reductions among women and minority communities. Other groups continue to be marginalised, such as sex workers and injecting drug users.
The number of people with undiagnosed HIV in Scotland is thought to be larger in heterosexual individuals, which emphasises the importance of considering HIV in people without identified current risk behaviours and the potential for greater impact of HIV-related stigma. Stigma still blights the lives of far too many. We must continue to fight the stigma still experienced by people living with HIV. Stigma and discrimination remain a reality for many people living with the condition. There is a need to increase awareness, fight prejudice and improve education about HIV.
That is why, on 1 December 2022, the Scottish Government published their report “Ending HIV transmission in Scotland by 2030”. To achieve the HIV transmission elimination goal in Scotland, a whole system and whole society approach will be required. The high-level activities required are primary prevention, detection and treatment. Indeed, National HIV Testing Week holds the opportunity to get tested. It can even be done at home, with a result in as little as 15 minutes. I am pleased to confirm to everyone here that I, as a heterosexual woman, have taken an HIV test. It is an important step that we as Members of Parliament can take for our constituents to show how important this matter is. The only HIV test to fear is the one you did not take. It is a privilege that so many in the ’80s and ’90s were never afforded.
Globally, thanks to the investment of countries such as the UK in aid through the UN Global Fund and research into vaccines through International AIDS Vaccine Initiative, millions more are receiving antiretroviral treatment and testing. In November 2020, the UK Government announced aid spending would fall from 0.7% to 0.5% of GNI as a “temporary measure”, in response to the effects of the covid-19 pandemic on the UK’s public finances and economy. I would like to express my concern to the Government on their lack of recommitting to 0.7% GNI spending on overseas development aid. I echo the comments of the Chair of the International Development Committee, the hon. Member for Rotherham (Sarah Champion), and reiterate her point on how the UK is failing on funding commitments and its ability to set or achieve meaningful targets on sexual and reproductive health. We have the tools to end HIV transmissions; we just need to use them, backed up by political will.
While advancements in medical science have transformed HIV, the persistent stigma, discrimination and lack of awareness surrounding HIV testing remain formidable barriers in our fight against it. National HIV Testing Week serves as a crucial reminder of the importance of early detection and diagnosis. So, as we commemorate National HIV Testing Week, let us reaffirm our commitment to ending the silence surrounding HIV, and to dismantling barriers to testing and saving lives. I would like to see a recommitment by the UK Government to ending HIV as a public health threat. By working together, we can achieve our goal of ending new HIV cases by 2030.
Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
It is a great pleasure to speak for the Opposition in this debate to mark National HIV Testing Week. We have heard great contributions today from Members on both sides of the House, and it gives me hope that we can continue to make progress on this issue in the years ahead. I thank my hon. Friend the Member for Warrington North (Charlotte Nichols), the hon. Member for Worthing West (Sir Peter Bottomley), the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Hammersmith (Andy Slaughter) for making powerful speeches on the enormous progress made on HIV.
Incredible advances mean that people living with HIV on effective treatment can now enjoy normal life expectancy and are no longer at risk of passing on the virus. The reality of living with HIV in the 2020s is a world away from the 1980s. As colleagues have remarked today, we might just have the chance to be the generation to make Britain the first country in the world to end new cases of HIV for good. It is an enormous credit to a generation of activists, fantastic organisations such as the Terrence Higgins Trust, many great campaigning MPs across the House and the all-party parliamentary group on HIV and AIDS that we have got to this point. More treatments have become available. Thousands of people are now living with HIV at levels undetectable or intransmissible to others, and the stigma and misinformation that the LGBT+ community suffered through the ’80s is not what it was.
For Labour’s part, we are incredibly proud of our record on HIV. It was the last Labour Government who switched spending so people could get the new drugs as they became available after 1997. We passed the Equality Act in 2010 that gave legal protections to people living with HIV. Chris Smith became the first MP to talk about living with HIV in 2005, and in 2018 my hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) was the first MP to talk about living with HIV here in the Commons. But there is much more to be done.
There are around 4,500 people in the UK living with HIV who are undiagnosed. The earlier those people can be found and linked to care, the better their health outcomes will be and the closer we will be to stopping new transmissions. Some 44% of people diagnosed with HIV in England last year were diagnosed at a late stage. Late diagnosis rates are even higher for women, at 51%, and that means some women are diagnosed so late they are already on their death beds.
Sir Peter Bottomley
I am glad the hon. Lady is making the important point that women are particularly at risk of non-diagnosis. She rightly mentions some Labour people who made important contributions. We ought to remember Norman Fowler. I do not normally talk about my wife’s work, but if I may say so, when she was Secretary of State for Health, she got the insurance companies in and said, “Do not charge higher premiums, or refuse cover to, people who have taken an HIV test. That is not the way to move forward.”
Preet Kaur Gill
I thank the hon. Gentleman for his remarks, which he has now put on the record.
There were 13% fewer people tested for HIV in 2022 than in 2019. That is why we have seen cross-party support today for National HIV Testing Week. Testing is free, quick and easy. You can even test from home, and you can order a free test online; I urge colleagues to share that information with their constituents.
Turning to what the Government can do to help eradicate new transmissions of HIV, I was very pleased to see the Government finally commit to rolling out opt-out testing to all 32 areas of high HIV prevalence in England. The pilots have been a resounding success, and Labour has fully supported bringing them to other high-risk communities across England. The shadow Health Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), was on the HIV Commission that first made the recommendations. Will the Minister provide an update on progress towards rolling out the programme to the 47 new hospitals? Can she provide reassurance that in the long term, opt-out testing in emergency departments will be embedded as a cornerstone of the UK’s plan to end new HIV transmissions? Receiving an HIV diagnosis can be alarming, especially if you are not expecting it, so has she considered setting aside a portion of funding to ensure that people who are diagnosed through the scheme are given support to help them to come to terms with their diagnosis? Has she made an assessment of whether opt-out testing could be rolled out to other settings in primary care?
The Minister will know that the HIV action plan included several commitments on HIV testing, including the commitment that local authority commissioners would set the standard that sexual health services would achieve a 90% testing offer rate to first-time attendees. Two years on from the publication of the plan, there has been no reporting on its progress. Will the Minister say what progress the Government have made against commitments in the HIV action plan to increase the number of people tested in sexual health services?
Finally, I want to ask the Minister about the Government’s commitment to the prevention agenda. Under the Government, we have widening health inequalities, life expectancy stalling, and a record high of 2.8 million people out of the workforce due to ill health. Any Government interested in supporting the NHS would put prevention front and centre of their agenda, but for 14 years, there has been no joined-up plan for health, and services and institutions that promote good health have been run down. This week we heard that England’s national public health agency, the Office for Health Improvement and Disparities, has been “effectively dismantled”. OHID leads on sexual and reproductive health and HIV, as well as a wide range of public health issues, ranging from tobacco to obesity and children’s health. Will the Minister explain how the Government can be committed to the prevention agenda when they are dismantling our national public health function? Will she do us the courtesy of confirming how many full-time equivalent staff have been cut from OHID, and can she explain why the Government have not had the courtesy to make a statement to Parliament on what has been reported, which sounds like quite significant cuts?
The remarkable progress on HIV has been hard won, and it puts ending new cases of HIV within reach. We have only one Parliament left to do that by 2030. I want to put on record clearly that Labour is committed to getting us over the line. That is why we would immediately get to work publishing a refreshed HIV action plan. It will not be easy, but we know what it will take. We owe it to everyone we have lost to the virus, everyone who has faced that stigma, and everyone who is living with HIV today to end new transmissions once and for all.
The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)
I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) and the hon. Member for Warrington North (Charlotte Nichols) on securing this important debate. My right hon. Friend has been called away to his constituency today, but I am grateful to both him and the hon. Lady for their strong advocacy for National HIV Testing Week.
I pay tribute to all the other Members who have contributed today: my hon. Friend the Member for Worthing West (Sir Peter Bottomley), the hon. Members for Hammersmith (Andy Slaughter), for Strangford (Jim Shannon), and for East Dunbartonshire (Amy Callaghan), and the shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill). It is clear that there is cross-party consensus on the need to challenge ourselves to meet our ambition of no new HIV transmissions by 2030, and I am sure that we can do that if we stick together on this subject. I listened carefully to all Members’ speeches, and I will try to answer all the questions that were asked.
Let me begin by saying how grateful I am to everyone who has taken part in in National HIV Testing Week, especially all those who have been tested in Portcullis House thanks to the work of the excellent Terrence Higgins Trust. I also commend the work of other charities, including the National AIDS Trust, Tackle HIV, LGBT Foundation, George House Trust and many others supporting families up and down the country—and I salute the work of the all-party parliamentary group on HIV and AIDS.
We should remember the way in which heroic NHS staff stepped up to care for people living and dying with HIV and AIDS in the 1980s, at a time when AIDS was a terrifying new disease that spared no one. It was to honour their legacy, and to complete the work that our NHS began 40 years ago, that this Government made a bold and ambitious commitment in 2019 to end new transmissions in England by 2030. To that end, we published the first, groundbreaking national HIV action plan just over two years ago. Testing is one of the plan’s central pillars, and I am proud to say that we have been making huge strides, setting an example to the rest of the world to follow. Last year the UK ranked first in the European combined sexual and reproductive health rights ranking atlas 2020 to 2023, in front of 43 other countries, and the UK Health Security Agency has confirmed that for the third time in a row, England achieved or exceeded the UN’s 95-95-95 targets. That means that 95% of people with HIV are being diagnosed, 98% of those diagnosed are being treated, and 98% of those receiving treatment are unable to pass on the condition.
However, while we have made excellent progress, we are not complacent, and we will not be satisfied until the number of transmissions is brought to zero. We have therefore put National HIV Testing Week at the heart of our efforts, year on year. We know that tailored and targeted campaigns are the most effective, so we have increased the number of tests and widened the scope of our campaign, ensuring that our messaging reflects and appeals to the different groups whom we are trying to reach. We are undertaking ever greater efforts to reach those who have been missed before and have become disengaged from the process. Last year we introduced the option of self-testing, with near-instant results at home, to give people more choice and more control over their testing, and this year we are partnering with local businesses to offer tests in places that regularly serve people from, for example, the black African community, who we know are less likely to want to go for a test.
These efforts have brought results. Since we launched the HIV action plan, we have sent out nearly 100,000 tests and received more than 300 reactive results, allowing us to immediately begin the process of getting vital treatment to those who need it. So far this year, the figures show that more than 4,000 self-sampling and self-testing kits have been ordered and nearly 500 results have been reported, nine of them reactive. Our campaign’s message is simple: “I test”—not “eye test”! I am pleased to tell the House that, like the hon. Member for East Dunbartonshire, I tested this week, so I can say from experience that testing is quick, easy, confidential and free. I engaged in a good bit of banter with my fellow Health Ministers as we undertook our testing together, so ours was not very confidential, but it was done through choice, and we were demonstrating how easy it is to do. Everyone should test. It takes two minutes, so I say: please do it.
Our most recent figures show that although new HIV diagnosis rates are steadily decreasing, they sadly remain disproportionately higher among gay men, bisexual men and other men who have sex with men, as well as heterosexual people from the black African community. Similarly, disparity can be found in testing: despite huge progress and record testing rates among gay men, lower levels of testing persist among black African and hetero- sexual groups.
NHS England has invested £20 million to deliver opt-out HIV testing in emergency departments in areas of extremely high HIV prevalence to ensure that people who need it receive the right treatment as early as possible. Anyone having blood taken in A&E in those centres has been automatically—with the potential to opt out—tested for blood-borne viruses, which means that people who would not have been reached via any other testing route have been diagnosed. This saves the NHS millions of pounds, relieves pressure on the service, and helps to address inequalities in testing. In under two years, the programme has already proved value for money by diagnosing more than 4,000 people with blood-borne viruses including HIV, hepatitis B and hepatitis C. The National Institute for Health and Care Research is investing an additional £20 million to find out how we might go further, faster, in tackling HIV rates in the additional 47 sites of high HIV prevalence across England.
Andy Slaughter
That may be a good initiative, but it is limited by time, geography, and the type of institution offering the test. Are the Government committed to going further, and spreading opt-out testing to other health facilities and other parts of the country?
Dame Andrea Leadsom
As I just mentioned, there is an additional £20 million for the National Institute for Health and Care Research. As well as delivering the opt-out testing in 47 centres, it will deliver a live dashboard showing the effectiveness of this type of testing. That is in addition to self-testing, which people can do at home or at a testing centre. It is particularly important to note that the public health grant is used in local authority areas, so that authorities can make their own attempts to reach out and identify those who should be tested.
Jim Shannon
We in the House may want to reach out further and bring about more testing. Has the Minister been able to explore the possibility of extending this programme to Northern Ireland, Scotland and Wales? This is something that we should all pursue vigorously, and we can do that better if we do it collectively.
Dame Andrea Leadsom
I completely agree. We would like to see this being done around the world. The UK is, I believe, the third biggest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which seeks to eradicate those diseases and to which we have donated £5.5 billion, so our interest is in eradicating those diseases throughout the world. Closer to home, the hon. Gentleman is absolutely right: that crucial part of the United Kingdom, Northern Ireland, should also be supported and helped to roll out this testing, and that will be possible now that the Northern Ireland Assembly has been re-established, which I am delighted about.
Of course, there is still much more to be done to smash the stigma attached to HIV testing and treatment. I pay particular tribute to Becky from Sheffield and Akhona from Leeds for coming forward recently and telling their stories to the BBC. They are setting an example for people up and down the country who should come forward for testing or treatment, and we are backing their efforts to spread awareness by funding HIV Prevention England’s HIV stigma symposium in March at the International Convention Centre in Birmingham. The event will bring together community experts, activists, healthcare professionals and affected people to discuss the impact of HIV stigma and look at effective stigma-reduction strategies. I am sure that it will generate promising stigma-reduction solutions, and I will listen carefully to its recommendations. I am pleased that HIV Prevention England is focusing its efforts on giving a platform to speakers from underserved areas.
Of course, HIV prevention goes beyond testing. The use of pre-exposure prophylaxis, commonly known as PrEP, is an important part of combination HIV prevention. It has been called a “miracle drug” that prevents HIV-negative people from acquiring the virus, and it is a vital tool in our battle to end new HIV transmissions by 2030. Oral PrEP has been routinely available in specialist sexual health services since 2020.
However, we recognise that certain groups have challenges in accessing the PrEP they need. That is why we have developed a PrEP road map with colleagues from Government, local authorities, professional bodies and the voluntary and community sectors, and it will be published on 15 February.
Andy Slaughter
At the moment, because it can be accessed only through sexual health clinics, the average wait to access PrEP is more than 12 weeks. Sexual health clinics have seen about a 30% real-terms funding cut over the last few years, so will the Minister either increase the resources available to clinics or increase the number of outlets, such as pharmacies, from which PrEP can be obtained? That is where the logjam is occurring.
Dame Andrea Leadsom
As I have just said, we have developed a PrEP road map precisely to increase access to PrEP, and its report will be published in a few days’ time. I encourage the hon. Gentleman to look at that report. I thank everyone who played their part in drafting the road map, working tirelessly towards our 2030 goal of zero new transmissions.
I also thank all our partners for supporting the promotion of HIV testing through National HIV Testing Week, our sexual health summer campaigns, the roll-out of PrEP throughout the country, the introduction of opt-out testing, the development of a PrEP access and equity road map; and so much else besides.
These results would not have been possible without Kevin Fenton, the Government’s chief adviser on HIV and chair of the HIV action plan implementation steering group. His bold leadership has brought together partners across the health landscape towards our shared goals, and I pay particular tribute to him.
So many of us have a part to play as we reach the endgame of ending new HIV transmissions in England by 2030. I reiterate my sincere thanks to all colleagues who have shared their stories, advice and experiences to support our efforts for so long. I hope that today’s debate will inspire thousands of people to do the right thing and take an HIV test.
Charlotte Nichols
I thank all hon. and right hon. Members who have made such thoughtful contributions today. Again, I thank the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), who secured this debate, for giving us this opportunity.
The cross-party consensus on the importance of HIV testing and the tone in which today’s debate has taken place represent the very best traditions of this House. I hope all those listening will consider taking a test to know their status, and I look forward to continuing to work with members of the APPG on HIV and AIDS to hold the Government to account on their progress towards the 2030 target.
Question put and agreed to.
Resolved,
That this House has considered National HIV testing week.