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HIV/AIDS and Sexual Health

rose to call attention to the Government’s policy on HIV/AIDS and sexual health; and to move for Papers. The noble Lord said: My Lords, we very much look forward to the maiden speech of the noble Baroness, Lady Paisley of St George’s. I also understand that last night it was announced that today may see the swansong speech of the noble Lord, Lord Warner, who I gather is retiring at the end of this year. I will make no jokes about him spending more time with his family but I would like to thank him for all the work that he has done in this House on health. In moving for Papers, I should mention that I am a trustee of the Terrence Higgins Trust and am connected with the National Aids Trust, which I set up. When we speak of HIV/AIDS we almost automatically think of the global position—the position in Africa, India and south-east Asia. We think of the 25 million people who have already died, the 40 million people who are now infected, the millions who are infected and will die over the next few years for lack of drugs, and the millions who will be infected in the near future because there are no sensible prevention measures. We think of the orphans, the widows and the suffering that has been created. In short, we think of a global crisis, which in one way or another has affected virtually every country in the world. Perhaps the magnitude of the international figures takes away the focus from the deteriorating position in the United Kingdom. This debate allows both the national and the international positions to be raised. If I were to say one thing on the international position, I would wish to pay tribute to the efforts of the Global Fund and Richard Feachem in tackling the situation worldwide. I want to concentrate on the national position, which I do for these reasons: too often, the sexual health crisis in this country is ignored and swept under the carpet; too often, over the past 20 years, politicians have been embarrassed to get properly involved; and too often, sexual health has come bottom in the priorities of health Ministers and health authorities. In this House a week or two ago, a speaker bemoaned the difficulty of getting the public involved in the issues of mental health; she should try to get support for sexual health clinics or better facilities for clean needle exchanges for drug users. What is the position in the UK? There are now 70,000 people living with HIV. On present trends, the figure will reach 100,000 in three years’ time. We have already seen a threefold increase in the number of people accessing HIV treatment and care services since 1997. Compared with other west European countries, our position was once the best, but we now rest at the bottom of the scale. The Health Protection Agency now identifies HIV as one of the most serious infectious diseases facing this country. On other sexual diseases, last year there were 110,000 new diagnoses of chlamydia, a 200 per cent increase since 1996; almost 20,000 new cases of gonorrhoea, a 50 per cent increase since 1996; and 2,800 new cases of syphilis, another big increase over the same period. Add to that the undoubted pressure that the GUM clinics—the sexual health clinics—are under and one can see why the professionals on the ground talk about a sexual health crisis in this country. Above all, they want serious and effective action to counter it. I speak in this debate with the following experience. Exactly 20 years ago, I was launching the then Government’s public health campaign on HIV/AIDS. Just before Christmas 1986, we put up posters around the country on the theme, "““AIDS: Don’t die of ignorance””." We followed that up with television and radio advertising using the tombstone theme and then the iceberg. We sent leaflets to every household in the country and, in spite of a great deal of opposition, we introduced clean needle exchanges for drug users. The results of that campaign were startling. Our follow-up campaign showed that, as a result, 98 per cent of the public understood how HIV was transmitted—the figures for today are not remotely as good as that—and 95 per cent of the public said that the Government were right to carry out a campaign of this kind, which should persuade the nervous in Whitehall to follow suit. Most of all, new diagnoses not only of HIV but of sexual diseases came down markedly as a result, while the free needle exchange undoubtedly saved lives, as it undoubtedly continues to do. Contrary to much advice that we received—at that time we received a great deal of advice on how the campaign should be conducted—we did not preach at the public. We gave them the best medical advice that we had. We also gave them this advice on every poster: the more partners, the greater the risk; protect yourself; use a condom. That remains very much the advice today. Using a condom is the most effective means of preventing disease. I am going to be critical of the Government’s policy in this area, but there is one comment that I applaud. The Prime Minister said in his interview on World AIDS Day that the Roman Catholic Church should change its attitude to the use of condoms and recognise it as a way of preventing disease and protecting lives. There is a curious contrast in attitude here. I remember going to New York during my campaign and visiting the Roman Catholic St Clare’s Hospital. There was some magnificent work being carried out there but, in those days, because AIDS was fatal, it was to ease AIDS patients into death. Surely it is possible to look at the use of condoms as a way of preserving life—which it is if you have no drugs—and of preventing disease and suffering. The good that could still be done by a change of stance by the church is considerable. So I welcome the Prime Minister’s lead here. I wish that I could say the same for all the other policies that have been followed since the Prime Minister came to power. Incidentally, I do not in any way absolve my own Government from blame in this area, but it is obviously this Government who are in charge of policy now and who can change that policy. It took this Government four years from 1997 to publish a strategy, while all the time the position was getting worse. Then it took another three years for them to publish the White Paper Choosing Health. For the first time, it seemed as though the Government were getting serious and putting serious new resources—£300 million in all—into sexual health. Caroline Flint, the Minister for Public Health, said in July 2005 that, "““we remain committed to improving the sexual health of the nation and continue to make it a government priority. We have already invested £300m as part of our Public Health Paper—the largest amount ever for this area””." Of course, the trouble was that they had not already invested £300 million. They had said that they would invest that money. They had said that they would allocate £130 million for modernising the clinics, £80 million for accelerated implementation of chlamydia screening, £40 million for contraceptive services, and £50 million for a new national advertising campaign. Take that £50 million for a national advertising campaign: a campaign was indeed launched last month, but it did not cost £50 million, £40 million or even £10 million. It cost £3.6 million. So far there has been absolutely no guarantee that the remaining £46 million will be spent, although we know how effective such spending can be. Whatever may be the case elsewhere, this is a direct Department of Health responsibility. This is not down to the primary care trusts; it is down to the department and the Ministers. What of the other money? Much of that has not been spent either. The Independent Advisory Group on Sexual Health and HIV, under the chairmanship of the noble Baroness, Lady Gould—to whom I pay tribute in the hope that it will not do her too much harm—carried out a survey of primary care trusts. I quote directly from the group’s report, which for some reason has not been published in full by the Government: "““Almost two-thirds of PCTs from whom we have received evidence have withheld some or all of their Choosing Health allocation for sexual health, primarily to address their financial deficits. This has affected all aspects of sexual health covered in Choosing Health: contraception, chlamydia screening, and GUM services. Not even the high priority public service agreement (PSA) targets for chlamydia screening and 48 hour GUM access have protected these funding allocations, and contraception remains the ‘Cinderella’ service””." The independent advisory group is not alone in making such comments. I have also received a joint letter from the presidents of the British Association for Sexual Health and HIV and the Faculty of Family Planning & Reproductive Health Care. They have been pressing the Government on this, and said: "““The result of this disinvestment is poor access to services, increases in waiting times and in some cases the closure of clinics, which will ultimately lead to further increases in sexually transmitted diseases, unplanned pregnancies and abortions””." Similar points have been made by other organisations, such as the Terrence Higgins Trust, the National AIDS Trust and, again today, the independent advisory group. Part of the tragedy is that no one can seriously argue that extravagance in sexual services provision has led to the financial problems of the health service. All too often, the clinics are housed in poor, almost rundown accommodation where the pressure of demand is constant and unremitting, yet precisely those services are being penalised. Doubtless, the hope is that economies here will not produce the same public outcry as they would in some obviously more popular medical services. We should be under no illusion about the impact of the diversion of resources. It means not just that expansion money has been cut back locally, but also that regular budgets have been cut in some areas. The Wandsworth PCT issued a press release saying that, due to financial pressures, none of the new funding intended for sexual health was going to be committed during the 2006-07 financial year. In some way—ring-fencing, if necessary—we must ensure that money allocated for sexual health actually reaches these services. It is not enough to say that it is a local decision when the result is plainly unacceptable. The Government have a national responsibility for public health. What is happening today is clearly against the public interest. It means that there is even greater pressure on overstretched services, that infection spreads as patients waiting for appointments remain untreated and that the eventual cost to the health service will be not less, but substantially greater. Ultimately, this is not a financial question, but a moral issue. Just as we know what works internationally, we know what can be done to bring down our figures in the United Kingdom. We know that a major national advertising campaign can be effective in changing behaviour, but we have failed to mount one for20 years. We know that modern clinics provide the right environment for advice and treatment, but we struggle on in outdated premises. We know that well staffed services can have a real impact in providing proper care, yet we are content to see cuts being made in the already inadequate. As things stand, there is not much here for your Lordships’ comfort. Political commitment will be necessary to change the position. I hope that such a commitment will be forthcoming. I beg to move for Papers.