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HIV/AIDS and Sexual Health

My Lords, I, too, thank the noble Lord, Lord Fowler, for securing this debate, for introducing it with such passion and for his continuing advocacy of sexual health issues. I add my congratulations to the noble Baroness, Lady Paisley, on her incisive maiden speech. I remember when the HIV/AIDS pandemic first became an issue in this country. I was at that time working for what is now the Health Development Agency, and the noble Lord, Lord Fowler, bravely and consistently spoke about this issue as a health issue that demanded responses from health services and not just moral speculations. I have remained eternally grateful to him for that. Speaking as a humanist, I call not on God but on Governments to act firmly on this issue. Today, I want to address sexual health and HIV from the standpoint of health education and promotion. I shall ask the Minister to respond to the suggestion that personal, social and health education should be a statutory part of the school curriculum. I recognise that that is an education matter rather than one in his field, but departments do talk to each other. I shall ask him to respond to the suggestion that sexual health services should have ring-fenced funding at a local level—my noble friend Lady Gould, whom I salute as the chair of the sexual health advisory group, has already raised that issue, as that group consistently does, for which we should be grateful. I shall also ask when the NICE guidelines on injecting-drug use will be available for consultation. I shall add a little about transmission through the route of injecting drugs. First, I turn to sexual health education’s importance within a planned programme of personal, social and health education. We have debated that issue before, pursuing it recently in relation to the Education and Inspections Bill, where we did not get very far. Sexual health education is not simply about biology, nor is it simply a clinical issue. For girls and boys—and I take the points raised by the noble Baroness, Lady Flather—health education is about fostering good, non-exploitative relationships. It is about learning to care about another’s feelings and about the risks to another of irresponsible sex, which may lead not only to emotional hurt but to infection or an unplanned pregnancy. Sexual health education is also about helping young people to make informed decisions about their behaviour, while encouraging them to avoid being exploited by others. That rests on building self-esteem in young people, not only about sexual behaviour but generally. Decision-making skills and self-esteem can transfer from one activity to another; school programmes can and do help, as I have witnessed first-hand. Schools can, of course, also encourage aspiration in young people—and those who have aspirations in life are less likely to get into difficulty with health behaviours. Aspiration and, indeed, self-esteem may be encouraged by parents, family members and communities, as well as by schools. So education and nurturing are important in enabling young people to be healthy—and sexually healthy. That all starts very early, and while I am not talking about giving explicit sex information to five year-olds, I am talking about helping and supporting very young children to make confident and informed decisions. I add a word about risk-taking behaviour, which was mentioned earlier: we all take risks, but people have first to know about a risk to decide whether to take it and whether they will mitigate that risk by some action—for example, wearing a rope when mountain climbing, or using a condom. There are protective factors related to risk-taking, including the encouragement of aspiration and family and community support, as I mentioned. Another is to have the right information at the right time—for example, telling young people where they can get help with health and sexual health issues. Some schools engage a nurse to talk about services; others have taken young people to visit a Brook Advisory Centre, which can, as evidence shows, help them to seek advice about sexual health more readily. I turn to behaviour change as encouraged by health promotion, which as part of public health can either help to change people’s behaviour or help them to reject unhealthy behaviour. The first component is through laws that are enforced and the appropriate implementation of policies. There are good examples here in laws on smoking and seat-belts. Another component is through changing what is socially acceptable, where again smoking is an example—as is diet, to a certain extent. Health promotion or behaviour change communication has been defined, and this applies to sexual health as much as to any other health area, as a set of interventions, activities and changes in the social environment which help to move people towards a healthier life by changing behaviours. Health promotion and sexual health promotion need to be targeted, consistent and repeatedly reinforced. Front-line staff, such as teachers, GPs and those in clinics, are crucial. They need support, funding and adequate resources of all kinds. Political will is, of course, an extremely important influence here. I give an example of this from my current professional activity. I chair a special health authority, the National Treatment Agency for Substance Misuse, which has been given political support and money to carry out activities to improve drug services at a local level. That includes ensuring that all drug action teams have plans to deliver and monitor drug treatment, and that funding is essentially ring-fenced. The approach has been successful, as the number of users in treatment has risen, waiting times for treatment have decreased and the workforce has grown dramatically. We have hit our PSA targets two years early. Focused and funded intervention works, which is why I am asking about ring-fenced funding for sexual health services. That is absolutely crucial if any strategy is to succeed. Strategy is not a one-off intervention, but must be a process that encourages this kind of model. Someone has pre-contemplation about health behaviour—for example, a young man hears about AIDS but does not think that it applies to him—before moving on to contemplation, believing that he and his friends are at risk and that he should do something. That is followed by a decision, to get and use condoms. Then comes the maintenance of that behaviour, where the buying and use of condoms becomes a regular habit. This approach needs policies, services, education, campaigns and advocacy. As I said, it must be targeted, consistent, reinforced and funded. HIV can of course be spread through drug use, and that has not been mentioned much today. Injecting drugs accounts for 5.6 per cent of reported HIV diagnosis. The overall prevalence of HIV among injecting drug users is relatively low, at one in 50 infected, but the prevalence in London is much higher, at one in 25. The recent increase in HIV among such users outside London is of great concern, as there has been a sixfold increase in two years—from one in 400 in 2003 to one in 65 in 2005. Those figures are extremely worrying, so when will the NICE guidelines be produced for consultation, and how can we improve that situation? Again, we need to bring about focused activity to tackle a specific problem. This will mean identifying those most at risk and those who can best help and giving them training, support and funding. Lessons learnt from international interventions and experience show that, in addition to the need for political will, targeted health promotion and behaviour change is the most effective approach. Services and facilities must be in place, while service providers must be geared to tackle real and expressed needs and be sensitive to local cultural norms. Multifaceted interventions are the most successful, which means combining health promotion techniques with education techniques in a variety of settings and using public health measures across agencies—for example, in housing, employment, transport and education—to effect change and maintain healthy behaviour. My noble friend the Minister is aware of these issues and much has been done to tackle them, but it is still the case that statutory personal, social and health education in schools and sufficient ring-fenced funding for services would have an enormous impact.