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HIV/AIDS and Sexual Health

My Lords, I, too, congratulate the noble Baroness, Lady Paisley of St Georges, on her splendid maiden speech, and we hope that we will hear many more. I also thank my noble friend Lord Fowler for initiating this debate, and I pay tribute to him, as have others, on his extraordinarily successful campaign in the 1980s. When you now speak to people who were teenagers at that time, they say that their overwhelming impression was the creation of fear. That, of course, has gone. The World Health Organisation defines sexual health promotion as, "““any intervention that improves a person’s physical or psychological wellbeing””." We agree with the Government in their stated aim in the first National Strategy for Sexual Health and HIV, published in July 2001, to, "““reduce the transmission of HIV and STIs””," with interventions that include increasing access to condoms, HIV education, needle exchanges for drug users, and a target of 48 hours for GUM clinic access. Unfortunately, five years later, the Government’s target of a 25 per cent reduction in HIV/AIDS has been quietly buried. The reality is that the increase in cases has been 10 per cent per year since 2000, with a doubling between 1997 and 2005. That is published in Communicable Disease and Public Health, 2002,vol. 5, page 97. In 1992, the then Conservative Government published Health of the Nation, a strategy for health in England, which identified HIV/AIDS as one of the five priority areas, with specific objectives set. Itwas accompanied by a high-profile public health television campaign warning people of the dangers. There was an initial drop in the rate of STIs but, since then, they have been rising exponentially, with the national strategy having no discernable effect. Between 1997 and 2005 the number of cases of syphilis increased by 1,653 per cent, gonorrhoea cases increased by 44 per cent, chlamydia cases by 147 per cent, herpes by 16 per cent, genital warts by 17 per cent, and HIV cases by 110 per cent. In contrast, between 1989 and 1997 the number of syphilis cases declined by 62 per cent and gonorrhoea cases declined by 29 per cent. Between 1991 and 1997, cases of HIV declined by 8 per cent. Expenditure on sexual health campaigns between 1997 and 2005 totalled £53 million, whereas in the eight years leading up to 1997, expenditure on sexual health campaigns totalled £122 million. Incidentally, we need to be cautious and use only Global Fund statistics on HIV, as some of the others can be somewhat dubious. In his 2002 report on the NHS for Gordon Brown, Sir Derek Wanless warned that the extra cost to the NHS of not engaging people in public health might reach £30 billion by 2022. In his annual report on21 July 2006, the Chief Medical Officer, Sir Liam Donaldson, served warning that the Government were following Wanless’s worst-case scenario. Two per cent of the health budget is devoted to health promotion, which is half that of Germany. Sir Liam Donaldson explained in the annual report that public health budgets are being raided to solve financial deficits in the acute sector. Only 36 per cent of primary care trusts—the bodies charged by government with overseeing the majority of public health interventions—believe that they have sufficient capacity and capability to deliver public health care effectively. The number of full-time equivalent doctors inthe public health, medicine and community health services sub-group of the NHS workforce has fallen from 312 in 2000 to 252 in 2005, a decline of 19 per cent. The Faculty of Public Health reported on29 March this year that four of England’s 13 medical deanery regions had cancelled their spending on public health training completely for 2006-07. As this is the noble Lord’s last appearance as Minister, he might like to take the opportunity to comment on his statement, reported at col. 1290 of the Official Report, that there are now 122,000 more doctors. Incidentally, we are sorry to hear that he is going. We wish him all the best and thank him for his hard work, for which we are very grateful. As my noble friend Lord Fowler pointed out,funding for sexual health services was to be£300 million. In August 2006 the Department of Health’s Independent Advisory Group on Sexual Health and HIV reported that much of the extra money earmarked for the Government for sexual health services had not reached the front line. To be precise, 33, or 17 per cent, of the 191 primary care trusts that it surveyed said they had withheld some or most of the funding, while 51, or 27 per cent, had absorbed the entire allocation into their general budget. As my noble friend Lady Flather emphasised, there have been successes with prevention in some countries—Uganda, Kenya and Botswana—with the ABC campaign. It has been criticised quite a bit in the House today, but there is no doubt that it has saved lives and substantially reduced the number of HIV/AIDS cases in pregnant women in Uganda, from 25 per cent to 6 per cent. Those are hard data. However, there are problems, as the noble Baronesses, Lady Northover and Lady Flather, mentioned. Condoms are not always successful in preventing pregnancy, let alone HIV, which is not surprising given that the virus is a fraction of the size of sperm. Also, many men refuse to wear condoms. Secondly, being faithful in marriage may fail because the wife may be faithful while the husband is not. Thirdly, as mentioned, in many societies women do not have the option of abstaining, especially when they are forced into marriage at an early age. As my noble friend Lady Flather mentioned, the United Kingdom Campaign for Microbicides (UKCM) may give women much more control over the situation, and it is to be hoped that that will continue to develop. Bill Gates said something very interesting in this sphere: "““No matter where she lives or what she does, a woman should never need her partner’s permission to save her own life””." Further to the subject of abstinence, politicians tarnish their reputation somewhat with rather ill-judged sound bites. The late and distinguished Baroness Young asked Her Majesty’s Government at Question Time why they did not present the whole picture, a comprehensive, preventative picture: condoms, be faithful in marriage, abstinence. The Minister at the time laughed and simply said, ““Abstinence does not work””. That is what psychiatrists call incongruity of affect. I presume the Minister meant to say that abstinence on its own does not work as a national policy. That is obvious. On another occasion, when the same question was put, another Minister said, with a laugh, that only old people recommended abstinence. He is wrong because young people are now taking the law into their own hands and devising their own policies. It will be interesting to see what happens. I was impressed with what the noble Baroness, Lady Massey of Darwen, said so sensitively and thoughtfully. An interesting article in the New Statesman pointed out: "““Reva Klein, a journalist who has done extensive research into progressive education in the US and UK, emphasises that the most effective sex education programmes aim to build young people’s self-esteem and ‘discourage them from seeking affirmation and escape through sexual relationships’. She tells of one example of a ‘social and emotional development curriculum’ … where teenagers have been trained as peer educators and sex education classes are run without adults present. Within seven years, teenage pregnancy rates plummeted in this deprived urban area””." We ought to give great credit to the young for taking the law into their own hands, and to give them all the support they need.