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HIV/AIDS and Sexual Health

My Lords, what a privilege it is to take part in today’s debate. I pay tribute to the noble Baroness, Lady Paisley of St Georges, and thank her very much for her contribution. It was full of compassion, which many noble Lords really appreciated, and I wish her very well. I also want to take this opportunity to thank the noble Lord, Lord Warner. He and I have faced each other across the House for some time now. Very rarely have we agreed on things, but he has always been true to the issues and an exemplary Minister in how he has dealt with them. I wish him all the very best. I always like to take part in debates initiated by the noble Lord, Lord Fowler, not least because I always have to stop and think as I prepare for them. Thinking about today’s debate, I found myself wandering back over the past 25 years. Twenty-five years ago we did not even have a name for this disease, and it then went through a variety of different names. If I look back over those 25 years, when friends have been affected by this in many different ways, two things stand out for me. One is that advert. If he does not mind my saying so, the noble Lord, Lord Fowler, may become the only man in history—I hope in the very distant future—to have a tombstone on his tombstone. The advert stands out. The other thing that stands out is a book—it was also made into a film—called And the Band Played On: People, Politics and the AIDS Epidemic by Randy Shilts, an American who attempted to track the development of the disease in America from the first patient. The most important point in the book is when staff at the Centers for Disease Control and Prevention (CDC) in Atlanta have discovered that the disease is blood-borne but do not know what it is. They try to persuade the organisations involved in blood transfusions in America to take on board their messages, but they will not do so because they do not want to damage what is a big business for them. At one point, a man asks at a meeting, ““When doctors become businessmen, where does somebody who needs a doctor go?”” Throughout the past 25 years, that has focused my mind very much on the different parts that the health service, public opinion, journalists and so on have to play. Today’s debate is about the role of politicians in this campaign. Today many noble Lords have talked about the figures in the Health Protection Agency reportA Complex Picture—a very good title because the picture is complex. I do not want to repeat the figures that other noble Lords have set out but I will give just two. One is the rise in all STIs and how cross-infection makes the management of HIV, in particular, more difficult. That should concern us. The Health Protection Agency says that prevention makes good sense for individuals and public health. Some STIs are easily treated; others are lifelong and recurrent, with serious consequences, including infertility. The coincidence of HIV with other STIs makes managing that more difficult. The Health Protection Agency goes on to say: "““The continued rises in diagnoses of HIV [and] … acute STIs, attendance to sexual health services and sexual risk behaviours … suggest that a scaling up [of] our prevention responses to a level that will have an impact on the current trends is urgently needed””." I contrast that with the findings of a survey of sexual health clinic services, conducted recently by my honourable friend Sandra Gidley in another place. The survey shows that fewer than 33 per cent of clinics provide appointments within 48 hours, with over half of patients having to wait five days or more for an appointment, and that the average wait is more than seven days. Furthermore, many clinics reported restricted opening hours during the working day, often amounting to fewer than 20 hours a week, and many opened irregularly. That is hardly a strategy for encouraging people to come forward for testing. If you have plucked up the courage to go along for what may be a life-changing interview only to find that the place is closed, I dare say that that will put you off going back again. Most worryingly of all, as other noble Lords have said, those same clinics reported that funding is being cut to plug NHS deficits. Community, outreach and voluntary sector services designed to promote sexual health have been cut, even when they have been extremely effective in the populations whom they seek to serve. The noble Lord, Lord Fowler, will forever be associated with one of the most effective advertising campaigns in history—that first national campaign. Since then, there has been a huge amount of research about what works in public health campaigning. There is now a body of overwhelming evidence from across the world that what works in this field are short general messages to the public, repeated over and over again, coupled with specific messages to sub-populations who are at risk. I am afraid that at the moment we are not doing that. Out of the £50 million that they promised in 2003, the Government currently have in place one short £4 million campaign aimed at teenagers. It is very good but it is so short that it will be over before it has an effect. I strongly urge the Minister to take on board that there is a need for a consistent message, coupled with other messages for distinct populations. That will truly help us to make a difference with the group of people who do not remember the tombstone campaign because they were not old enough at the time to see it. I turn briefly to the international scene, which I do not get to talk about very often, and to one aspect in particular. I agreed with some of what the noble Lord, Lord Colwyn, said, although by no means all of it. I hope that we do not follow some of the conclusions of South African Health Ministers; however, I agree that, where there is a chronic shortage of doctors and nurses, particularly female health workers who can go into rural districts, it is inevitable that treatment, for women in particular, will be diminished. I should also like the Government to focus on the case being brought by Novartis against the Indian Government in relation to ARVs. If successful, the ongoing legal action against that Government could restrict the production of generic ARVs in India. The impact of that would be felt not only in that country but all across sub-Saharan Africa, because one-third of all ARVs used by people in developing countries are generic versions produced in India. I hope that we can support the Indian Government in resisting that action. If we do not, many of the things that my noble friend Lady Northover and the noble Baroness, Lady Flather, talked about will only get worse. Finally, I want to talk about one thing that has not been mentioned in this debate. The results and consequences of the mid-term election in the US brought a number of welcome changes. There is one that noble Lords may not yet have noticed and I bring it to their attention. The Democrats on the House Committee on International Relations have signalled that they wish to investigate funding for faith-based HIV/AIDS and abstinence-until-marriage initiatives, which receive funding under the President’s Emergency Plan for AIDS Relief. At the moment in the US, by law, one-third of HIV-prevention funding under PEPFAR must be used for abstinence-until-marriage programmes. Whatever the moral case may be for such an approach, the case against it is that it simply does not work. Two-thirds of 18 year-old girls in South Africa have HIV, but such messages do not, and never will, work in those cultures. The noble Baroness, Lady Flather, talked about that most tellingly. Given that the appropriateness and efficacy of such programmes has been challenged repeatedly, I hope that the Government will use their special relationship to support those within the US Administration who seek to challenge something which, when there are 14,000 new infections every day, cannot be right and cannot be sustained. The noble Lord, Lord Fowler, is absolutely right to have raised this issue again. He, perhaps more than anyone else, embodies the role of government in this. That role is to keep banging on with the messages that no one else wants to hear or to make, to keep doing it when everyone else has gone away and taken their attention elsewhere, and to persist with something which is unpopular and derided by the media but which could make a big difference. It was most important that he and his Government released that advertisement all those years ago; it could not be more important now for this Government to carry on that persistent message about HIV.