HIV Action Plan Annual Update 2022-23

I beg to move,

That this House has considered the HIV Action Plan annual update 2022-23.

It is a pleasure to serve under your chairmanship, Dr Huq. I was pleased to be successful in my application for this debate, and I thank colleagues from across the House for attending. I start by thanking the Government for fulfilling their commitment to update Parliament on the progress they have made on the HIV action plan—which I fully support—as it is crucial that Members are given the opportunity to scrutinise the progress that we are making on tackling HIV.

We are the generation that has the golden chance to end new cases of HIV by 2030. It is vital that we do all we can to ensure that that becomes a reality. Positive progress has been made to that end, as highlighted in the report. However, there remain further opportunities to stop new HIV transmissions in this country. That would certainly be a lasting legacy the Government could be proud of.

Two measures, in particular, will help to ensure that the Government fulfil their mission to turn the tide on HIV once and for all. First, opt-out testing is the hidden tool in our armoury that is waiting to be unleashed. Last December, I spoke in the House during the World AIDS Day debate about how effective opt-out testing was in those places that had already introduced it.

My hon. Friend will be aware of how health practitioners in Blackpool have led the way on opt-out testing to achieve great results. The focus on that in high-prevalence areas is of course particularly important, but does she agree that, although the NHS is making solid progress in this regard, it needs to up its game if it is to achieve its own targets by 2025?

I thank my hon. Friend for his intervention. I know that opt-out testing is already making improvements and that that will benefit his constituents in Blackpool. We have the blueprint for how to do this; we just need to roll it out further.

The numbers do not lie. The annual update revealed that more than 2,000 people have been diagnosed with HIV, hepatitis B and hepatitis C in 12 months alone. It is very likely that without opt-out testing many of these people would not have been diagnosed until a much later stage. That includes diagnoses in parts of London classed as having a “high” rather than a “very high” prevalence of HIV. Let us imagine what can be achieved if we now extend the roll-out to areas of high HIV prevalence, such as in my constituency of West Bromwich East.

The west midlands have several high-prevalence areas outside Sandwell, including Wolverhampton, Coventry and Birmingham. That is why, for World AIDS Day last year, West Midlands Mayor Andy Street joined the calls to fund this scheme in the west midlands. The way to end this virus is to find exactly these people—those who are unaware that they are carrying the disease but who are in fact passing it on to others—so that they can get the care they need and do not increase transmission further.

Opt-out testing in London, Blackpool, Brighton and Manchester has also revealed a quiet but growing crisis by identifying people who have previously been diagnosed with HIV but are not receiving the treatment they need. The UK Health Security Agency estimates the number of people who have fallen out of the HIV care system since 2015 to be an alarming 22,670. The Terrence Higgins Trust, which I take this opportunity to thank for all its excellent work, estimates the number of those who are alive and remain living in the UK as somewhere between 10,650 and 13,006. They are all at risk of becoming seriously ill and further transmitting the virus. In fact, hospitals in London are reporting that this has overtaken undiagnosed HIV as the primary cause of HIV-related hospital admissions.

This is totally preventable. Once someone living with HIV is on effective treatment, they can live a long, healthy life and do not pass on the virus. The annual update shows that more than a third of those found with HIV by opt-out testing were previously lost to care. That is another 473 people who can access treatment, prevent further serious illness and help to stop the spread of HIV. This is an important step forward, but we should not only be finding people when they need emergency care; we should be supporting them to stay in care in the first place. Without finding and providing treatment to those people, we cannot realise our ambition of ending new cases by 2030.

The hon. Lady highlights an important study from the Elton John AIDS Foundation, which found that, with a low amount of money, people can be returned to care. The problem is that sexual health and HIV services are under strain. That money needs to be ringfenced and provided by the Government so that we can spend now to save later.

The hon. Gentleman does a lot of work in this area and is a voice to be listened to.

I have shown that the key benefits of extending opt-out testing and further lost-to-care work are threefold: saving lives, saving money and reducing the pressure on the NHS at a time when every effort must be made to reduce waiting lists.

At the time of the World AIDS Day debate last December, I was assured that the Minister would look closely at the outcomes of the trial once 12 months of data was available. I hope that he agrees that the trial has been a success, as the annual report states, and that we should extend the roll-out without delay.

We already have an excellent programme in place, ready to support the expansion of combined blood-borne virus testing. After the Government initially invested £20 million in opt-out A&E testing through the HIV action plan, funding from the hepatitis C programme made it possible to add hep B and hep C to the programme. The success of that has been remarkable, and the hepatitis C elimination programme is already funding opt-out hep C testing in further areas. However, without specific funding for HIV we are missing an opportunity to save even more lives by testing for HIV at the same time.

For example, a pilot programme that took place in the Leeds Teaching Hospitals NHS Trust, where opt-out HIV testing was rolled out alongside hepatitis testing, found 25 people with HIV in just 17 months, along with a combined 297 people with hep B and C. After the end of that pilot, the hospital has been able to secure funding from NHS England to reinstate hepatitis C testing in the emergency department whenever blood is taken. However, it is disappointing that no funding has been provided for HIV testing to go alongside that, especially when the area is one in which there is a high prevalence of HIV. These opportunities to test are currently being wasted.

If we are to expand HIV testing further, it has to be combined with blood-borne virus testing—there is no hierarchy when it comes to the elimination of viruses, and it is important that we make progress against both. We are showing that combining testing is not just better; it is cheaper, more effective and de-stigmatising. I would therefore appreciate it if the Minister could confirm that a national expansion of opt-out hepatitis C testing would include HIV and hep B, as should be the case.

Another way in which we can stop the spread of the virus is by better utilising PrEP, which has been proven to be very effective at preventing the transmission of HIV. As part of the HIV action plan, we committed to an innovation in PrEP delivery to improve access for key groups, including provision in settings outside sexual and reproductive health services. However, we continue to await a date for when that will start, and I strongly urge the Department to outline when that will be as soon as possible.

The hon. Lady is dreadfully kind for giving way. I hope she will acknowledge to the Minister that many people end up buying PrEP online, anyway, so there is already a market for it where people access it outside of clinics. The Government are taking a cautious approach, and the people have already marched two miles ahead. The Government should take a more reactive approach, follow where the people are and allow them to buy it over the counter, with advisory blood tests rather than compulsory ones.

I thank the hon. Member again for his intervention, and I totally agree.

I would also like to raise the plight of those who are living with HIV but who feel unable to access healthcare for a variety of reasons—mainly as a result of the stigma surrounding the virus and concerns over their mental health. Engagement with this group is an important part of the action plan. Can the Minister please use this opportunity today to reassure colleagues that people living with HIV have the opportunity to seek support, and that tailored measures will be introduced to combat the issues I have raised?

Finally, all parts of the health system are responsible for delivering on the action plan. Shortly this will change, with adult HIV services moving from NHS England to integrated care systems in April 2024. As may be evident, the lines of responsibility are somewhat blurred. For that reason, it is key that we clarify as soon as possible the exact lines of authority, so that work can be accelerated to deal with the disparity in HIV support across different areas of the country. Again, I strongly encourage the Minister to provide the House with information on what the Government are doing to deal with this issue.

It is vital that we deliver on the HIV action plan, which gives us a genuine opportunity to be the first nation in the world to end this epidemic, which has both taken and harmed so many lives. By working together and implementing the reforms the action plan sets out, some of which I have mentioned today, we can stop the spread of the virus and, instead of allowing transmission to go undetected, we can stop the virus in its tracks. Many of these measures are non-burdensome but highly effective, so it is vital that we act before it is too late. We have a social responsibility to do all we can now and not to delay the implementation of the plan. I look forward to hearing the Government’s response.

I plan to call the Front Benchers at 5.13 pm, to be precise. I do not think there is any need to impose a time limit at the moment, but we are looking at roughly six and a half minutes per Member, if everybody could self-edit.

It is a pleasure to serve under your chairship this afternoon, Dame Caroline, in this really important and timely debate. I thank the hon. Member for West Bromwich East (Nicola Richards) for opening it so well and for outlining the importance of the action plan and what more the Government should do.

This issue is really important for me, because my constituency has one of the highest rates of HIV prevalence not just in London but in the whole UK. Forty years ago, the situation seemed hopeless, but we have seen life-changing improvements in treatment since then. With today’s medical advancements, someone on effective medical treatment cannot pass the virus on. That is vital, and we need to reiterate it loudly and clearly. What we have achieved is incredible and testament to the hard work of so many people in our life sciences industry and the NHS, and of the many charity and community groups that work behind and across the sector.

The HIV action plan, which was launched by the Government in 2021, is a comprehensive strategy aimed at tackling the HIV epidemic across the country. It focuses on four key areas: prevention; testing and diagnosis; treatment and care; and reducing stigma. However, the progress made in the last year is not equal across all areas—we have to be honest about that.

As part of the action plan, hospital emergency departments in London, Brighton, Blackpool and Manchester are testing people for HIV. I had the opportunity to visit Lewisham hospital a year and a half ago to see that work, to listen to the doctors and to see the results. The doctors told me that the oldest person tested for HIV in the A&E was an 85-year-old woman.

This programme has identified people living with HIV from groups who are less likely to test routinely, including women, heterosexuals and those of black ethnicities. That is crucial, as many people in those groups are currently experiencing poorer health outcomes due to late diagnoses.

It is a pleasure to serve under your chairmanship, Dame Caroline. I, too, would like to congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on securing the debate and on her comments. She has already said much of what I wanted to say, so that will spare us some time.

I apologise if anyone thinks I am about to drift out of order—I am not—but I want to focus on the women’s health strategy. We know that the HIV action plan has been incredibly effective in increasing the number of men diagnosed with HIV. We have seen a fantastic and sustained fall in HIV incidence for gay, bisexual and other men who have sex with men, but not for women. That is because there seems to be a lack of joined-up thinking when it comes to breaking down some of the stigmas and taboos that still exist for women, and we need to do more to ensure that they are tested.

This is where I drift off into the women’s health strategy, which is a comprehensive and excellent document, and I pay tribute to you, Dame Caroline, for ensuring we saw it get over the line. It clearly states:

“independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.”

The document contains some important and crucial points around tackling taboos and stigma and addressing disparities in outcome that might be affected by age, ethnicity or where the woman is from. It says clearly that those factors should not impact a woman’s ability to access services, but they do.

We know that women are less likely to have access to PrEP and that they are the least likely group to have their need for it identified—only 33% in 2021 had had their need identified. They are also the least likely to continue taking PrEP. The HIV action plan told us about making PrEP available from GPs, and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) commented on making medication more readily available from pharmacies. We have already done that for a range of conditions. Some contraception is readily available from pharmacies. For women, some forms of hormone replacement therapy are available from pharmacies. The morning-after pill is available from pharmacies. What we need to do, to break down the stigma and taboo, is to ensure that PrEP is more accessible from pharmacies. It seems to be a complete no-brainer.

The right hon. Lady makes some very good points about PrEP. But is this not also about a problem with sexual health and reproductive testing in clinics? In Britain, only one in 10 clinics offers online testing. That means that many people who cannot take time off work, or who cannot get away at the right time, are never able to get tested.

The hon. Gentleman makes an important point, and one that I had completely forgotten about but that I wanted to highlight. Online testing and receiving test packets through the post is incredibly discreet, quick, easy and efficient. I know that because even I have availed myself of those services—that will send the Twittersphere into an absolute frenzy. It is a really important point: to be in control of their own health, a person needs to know. Annually, I have an HIV test provided to me—I believe it is Terrence Higgins Trust that does that, because it is a brilliant charity that does fantastic work, not least in providing us with up-to-date information. It also promotes relentlessly the need to make sure that testing kits are readily and easily available through the post and online. It is absolutely critical that we have that. We learned during the pandemic, did we not, the importance of test, test, test?

That moves me on to tests, tests, tests of the opt-out variety. My constituency in Southampton does not benefit from opt-out testing at present. It is classified as having a high prevalence of HIV, with 2.4 adults per every 1,000 living with HIV in the area. We know that opt-out testing finds people living with HIV and brings about an earlier diagnosis in many cases. We all know that earlier treatment is the most effective and that once somebody on treatment has got to the point where their viral load is undetectable, it is untransmissible. Of course, we have to do the maths backwards; we know that if people are not diagnosed and not receiving treatment, they are more likely to be transmitting HIV.

We know that opt-out testing works. We know that it works in Blackpool and London, but we know that in Southampton, more than a third of HIV diagnoses are late, which puts people at much greater risk of ill health and death and increases the problem of onward transmission. We also know that women, black Africans and older people are more likely to be diagnosed late. My plea to the Minister is to ensure that we have an expansion of opt-out testing so that we can identify those people from groups who are less likely to be identified. We know that opt-out testing means that a higher proportion of women and older women are also likely to be identified.

It really is a great pleasure to serve under your chairmanship, Dame Caroline. I am grateful to my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing this timely debate and for her thoughtful contribution, which laid out the principal issues. I am also grateful to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for making sure that the full gamut of issues was covered, because sometimes it is possible for the perception to be that this is just an issue about gay men, and it is not. The hon. Member for Vauxhall (Florence Eshalomi), who, along with me and others, is a co-chair of the all-party parliamentary group on HIV and AIDS, made it absolutely clear that this is a wider issue than for just that one group.

As the HIV action plan has put in print, we have already reached the UN’s 95-95-95 target and are hopefully within touching distance of ending new transmissions by 2030. If that can be achieved, we should be clear that it is a milestone, equivalent to the eradication of polio in past years. I believe it is also a tangible example of British leadership in health and a testament to consistent and concerted efforts, which have produced incremental gains, giant leaps and, ultimately, a pathway that others have followed. As we have heard, however, we are not there yet.

The HIV action plan makes it clear that the goal will not be reached without PrEP. We know that PrEP works, with new transmissions of HIV dropping by over a third from 2019, but a recent survey by Prepster, the National AIDS Trust, the Terrence Higgins Trust, Sophia Forum and One Voice Network found that many people end up being diagnosed with HIV while waiting for PrEP. We need to close the gap between awareness of risk, accessing services and receiving PrEP, and I absolutely agree with the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) about the availability of PrEP. I could sit down after this speech, go on my phone and order PrEP to be delivered to me from India in the next few days, but I could not go to a pharmacy in the centre of London or, indeed, in my own constituency to receive that. Not only is that discriminatory, in the sense that people who can afford to buy it or access online services have an advantage; as the hon. Member suggested, it is putting the risk ahead of the reality that people are already accessing it. It is far better to get it from a pharmacy than from an Indian or other overseas supplier.