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HIV/AIDS and Sexual Health

My Lords, I was expecting to see the noble Lord, Lord Winston, rush in, tearing off mask and rubber gloves, fresh from yet another life-saving situation or media engagement, but I now assume that he has withdrawn from the debate, which has been so well introduced by my noble friend Lord Fowler. As Secretary of State when HIV/AIDS first came to our attention, he must take much of the credit for many of the preventive measures that were introduced. I know that he does not agree with me, and I suspect that no one else in the Chamber will agree with a word I have to say, but I shall take advantage of this short debate to air my views once again. One of the most important assumptions underlying our current understanding of AIDS is that it is a new disease caused by a new virus that appeared in Europe and America only during the later half of the 1970s. The recognition of AIDS as a distinct disease entity during the early 1980s supports that assumption. Yet hundreds of AIDS-like cases in people, some of whom have turned out to be infected with HIV, were documented in medical journals for decades before the recognition of AIDS. The public face of AIDS research that is meantto reassure still maintains that HIV—the human immunodeficiency virus—causes AIDS, and that when we can learn how to vaccinate against HIV or develop a medicine to treat HIV infection then AIDS will be cured. The best-kept secrets about AIDS are the questions unanswered, the puzzles unsolved, the contradictions unrecognised and the paradoxes unformulated. There is no doubt that AIDS itself, as distinctfrom HIV, is at least a century old, with many casesof Kaposi’s sarcoma, pneumocystis pneumonia, cytomegalovirus infections and other opportunistic diseases in patients matching the definition of AIDS being reported in North America and Europe in the 50-year period preceding the perceived arrival of AIDS in the 1970s. Those diseases in this period have not been accounted for in our current theories of AIDS. If HIV is new and a necessary cause of AIDS, as most researchers argue, what was the cause of these pre-1979 AIDS-like cases? Are there causes of acquired immune suppression other than HIV that may explain AIDS? What might those immunosuppressive agents be? Or is HIV much older than anyone has been willing to consider? If HIV is old, why has AIDS become epidemic only within the past 20 years? Have modes of transmission suddenly increased? No matter how one tries to examine these questions, the answers are disturbing. There was massive consternation during the 1990s caused by reports that HIV may be neither necessary nor sufficient to cause the syndrome. The key experiments had been performed in the laboratory of the discoverer of HIV himself, Luc Montagnier of the Institut Pasteur in Paris, and he announced that HIV alone is not sufficient to cause AIDS. Since then many clinicians have reported similar cases of HIV-free AIDS. Suddenly AIDS without HIV became big news because too many cases had surfaced to be ignored. There is no longer any doubt that HIV is not necessary to cause acquired immunodeficiency. The question is whether the causes of HIV-free AIDS are also at work in people with HIV, and therefore what role HIV plays in causing AIDS in anyone. Do we believe that everyone is equally susceptible to infection with the retrovirus and its consequences? If HIV is sufficient to cause AIDS, then everyone should be at equal risk and AIDS should develop at an equal rate among different risk groups once infection has become established. Clearly that is not the case. Researchers realised by 1987 that the threat of AIDS to non-risk groups was very small. Some calculations place the figure of contracting AIDS from a heterosexual without risk behaviours as low as one in 1 million—about the same risk as being struck by lightning. On the other hand, the high-risk groups are still high risk. The cumulative incidence of AIDS seven years after HIV infection in drug abusers is over 40 per cent, and about the same in homosexual men. The average latency period for the development of AIDS is about 10 years. In other words, one would expect that about half of all HIV-positive individuals should develop AIDS within 10 years, if drug abusers and homosexual men are typical of the entire population. But, of course, they are not. What am I trying to say? Some people are far more susceptible to AIDS than others and the reasons are clear: immunological exposure to semen, blood or other alloantigens; multiple, concurrent infections; prolonged medical or illicit drug use; malnutrition. Those are all serious factors that considerably weaken the immune system. Resistance to AIDS is about having an efficient, intact immune system. I believe that there should be a much broader approach to AIDS that includes specific remedies for malnutrition, elimination of all drug use, proper hygiene, safer sex measures and behavioural modification. These can all have profound effects on AIDS risk and the development of overt disease, even among people who are already seropositive. If, as I suggest, AIDS is not caused by a simple HIV infection but is a syndrome requiring multiple, concurrent causes of immune suppression, then the tremendous drop in the incidence of sexually-transmitted diseases associated with safer sex means that the risk of immune suppression due to multiple infections and allogenic exposure decreases drastically, the risk of autoimmunity decreases even more and the probability of developing an HIV infection concurrent with an appropriate cofactor infection diminishes. In other words, the same measures that are meant to control the spread of HIV are necessary to control the spread of allogenic and infectious cofactors in AIDS. I believe that the incidence of AIDS itself, as distinct from HIV seropositivity, will decrease much more quickly than the rate of HIV infection. More and more HIV-seropositive gay men will live longer and healthier lives. The fact that the latency period between HIV infection and AIDS has been increasing yearly indicates just such an effect. The latency period should continue to increase until many HIV-seropositive people are living healthy lives for several decades. Then we will finally recognise that HIV does not equal AIDS and that current treatment methods should be reassessed. In view of the Minister’s recent announcement, today is probably the last time I will have an opportunity to debate health matters with him. I am grateful for all he has done, particularly with the introduction and defence of the new dental contract, and I wish him well for the future.