HIV (Government Policy) (Hansard, 22 July 1993)

§ Miss Joan Lestor (Eccles)

I could not have picked a better night for the Adjournment debate. I raise the issue of AIDS and HIV in an attempt to discover the Government's current attitude towards the Day report and projections about the development of the disease in future.

It is a pity that leaks and speculations about the contents of the Day report took off well before its publication. Many who, prior to publication, claimed that the matter was being exaggerated, have not, to my knowledge, amended their comments in the light of the report. Andrew Neil frequently claims that there is little or no danger. He is quoted as saying, You have more chance of being run over by a car on the way to see your girl friend than you have of contracting AIDS from them. The use of the word "them" is interesting in that context, as is the absence of reference to protection and the reference to sex with them. The analogy is also interesting. We all try to make people, particularly the young, responsible in their attitude to traffic and I ask no more than that we extend the same principle to sexual activities.

I shall quote an extract from the paper by Professor Anderson and Robert May, in which they state: The degree to which infection will be constrained within a small core of highly sexually active people depends on who mixes with whom: the network of sexual contacts among those who are very active sexually and those who are not. To define such a network, one must ask questions not only about numbers of sexual partners but also about other matters in relation to their habits.

We must have a detailed answer from the Government on the Day report and matters related to it. In that connection, I congratulate the hon. Member for Stratford-on-Avon (Mr. Howarth) on his ingenuity in raising the subject of education on HIV and AIDS during the debate on the guillotine motion on the Education Bill on Monday. He made a forthright and sensible speech. As I agreed with it and as time is limited, I shall not repeat his case, except to say that the Lords amendment was never discussed here. The country has never heard the arguments for and against keeping the teaching of AIDS in the core curriculum.

We are depriving our children of the right to be educated about such matters. In the light of the knowledge that we possess, it is indefensible for us to make it easier for our children to die of ignorance, as the hon. Member for Stratford-on-Avon said. We all like to think that our children are innocent—they are until a certain age, but times have changed. We now know from the research that has been carried out that 35 per cent. of under-16s and 50 per cent. of under-18s have full sexual intercourse and one third use no protection—so we know that we have a problem. Some 20 per cent. of HIV infections in this country occur in the 15 to 25-year-old age group.

The Government have said—I support them in this—that they are anxious to reduce teenage pregnancies and other sexual problems and some sexual-related diseases. The Government should be seen to be effective. According to the reply given by the Minister on 12 July to my hon. friend the Member for Islington, South and Finsbury 614 (Mr. Smith), there are 500 reports of children in the United Kingdom born to women who are known to be infected with AIDS. Large numbers of those women were very young and many of them had had unprotected sex. Some 152 of those children are known to be uninfected, but the status of the rest is not yet known.

The worrying factor is that the results of unlinked, anonymous HIV surveys showed that there have been many pregnant women whose HIV infection was not known to the staff in the hospital. Therefore, there are an unknown number of children born to HIV infected women and their plight is yet to be known. Anyone who has looked at how AIDS has swept across certain continents and the effect that it is having on families and children, born only to die a few years later, knows that, although we do not have that problem here, we have no cause for complacency.

The Day report suggests that the number of AIDS cases will soon level off among homosexual men and that HIV infection is declining among drug users. The report, however, also predicts an increase in new cases of AIDS among heterosexuals and suggests that that increase will continue over the next few years.

I was also alarmed to read that, of men tested in Brighton—I stress, of those who came forward to be tested, because they were concerned—one in four homosexual men were infected and one in seven heterosexual men were infected. That figure may be due to the peculiar circumstances of that area, but we have to bear it in mind.

It is important also to bear in mind when we look at statistics that we cannot categorise people as belonging to one particular group: homosexual, heterosexual, drug takers, or whatever. In many instances, behaviour in one group can be found in another.

The Government's attitude is somewhat puzzling. That is why I applied for this Adjournment debate. The Government say that their policies have worked and that predictions about the spread of the AIDS virus have not been borne out by the facts. I am glad to hear it, as I am sure everybody is. If the policies that the Government have adopted are right, why on earth are they reducing the facilities that have contributed to keeping AIDS and HIV under control? It does not make sense.

The Government say that the figures in the Day report vindicate the policies that they have put into practice to fight the disease. Why, then, change those policies? When we look at the spread of any disease, we know that, if people grow careless about inoculation, the educative process has to start all over again.

Why are grants to voluntary organisations, such as the Terrence Higgins Trust, being cut? Why are the Government putting an end to the ring fencing of AIDS funds? Why is the Department of Health AIDS unit being integrated with the communicable diseases branch? Why is the Health Education Authority being reorganised? What are the implications of all this for education campaigns and the independence of such an authority? Ring fencing provided additional resources, for the significant care implications of AIDS and HIV could not be met by the national health service budget.

The George House Trust in Manchester has done excellent work in dealing with victims of AIDS and the HIV virus. Its work has been acknowledged by many 615 people. The trust has entered into correspondence with the Department of Health about the cut in funds. It makes very worrying reading.

When he asked for extra funding, John Nicholson, who runs the George House Trust, said: Nationally, the result of the F64 allocation is that direct Department funding continues to be restricted to the London national voluntary organisations. Regionally, the northwestern regional health authority continues to be unclear as to how it will organise funding for regional-wide voluntary organisations after the 1st April 1994 and continues not to fund them directly. Our core grant from the north-west regional health authority, through North Manchester health authority, ended on the 31st of March this year. Locally, all local authorities in the north-west, except Manchester, are in difficulty. Many have bid for contributions on our behalf, but"— he says, and I know this to be true— I understand they have now received a 20 per cent. cash cut for 1993–94, while Manchester itself has a cash standstill. John Nicholson said that they seem unlikely to be able to implement the guidelines which insisted on the same level of funding being provided next year to the voluntary sector. I am sure that that does not apply only to the George House Trust in my constituency. It has implications for all voluntary organisations and for funding which had been ring-fenced.

Those who deal with AIDS and HIV were at least able to believe that funds were specially allocated to them and they did not have to scrape around for money. Unfortunately, as is the case with other units—for example, those dealing with alcohol abuse—they now find that ring fencing no longer exists and that they have to compete with other demands.

I am not an alarmist; I want more preventive work to be undertaken. I believe that we can deal with AIDS and HIV if we are prepared to put ourselves out, make the resources available and acknowledge what has to be done.

It is sad that the necessary time is not allocated to debate such matters in the House. A report as important as the Day report should be discussed in detail. I want to allow the Minister plenty of time to comment, but I make a few observations on the report's summary. The working party concluded: after adjustment for under-reporting, there will be between 2,015 and 2,720 new AIDS cases in England and Wales in 1995, and between 1,945 and 3,215 new AIDS cases in 1997. It also gives the 1995 and 1997 planning projections for new AIDS cases among the main exposure categories. It continues: It is estimated that there were approximately 23,400 HIV infected individuals in England and Wales at the end of 1996 … The expected levelling off in the overall incidence of AIDS in 1996 and 1997 masks sharp underlying differences in the trends between the exposure categories. Whereas AIDS incidence in homosexual males may peak in 1993 and 1994, the incidence in those exposed heterosexually is expected to increase steadily. I stress strongly that it is wrong for the Government, intentionally or otherwise, to lull people into a false sense of security. The ignorance about AIDS among the young is appalling. The young always believe that they are immune from the dangers about which their parents warn them. Whether we like it or not, young people are having sex much earlier than we did and they are not as careful as many of us believe that they should be.

In "The Health of the Nation", the Government rightly said that they wanted to reduce the number of teenage pregnancies, but the number is indicative of the fact that 616 many young people do not take precautions when having sex. In some cases, their activities can result in sex, but, sadly, they can also result in HIV and AIDS.

When considering the statistics, it is important that we do not make moral judgments. Society may not be as we would wish it to be and children and young people may not behave as we behaved or as we would wish them to behave. There are various role models which we may wish young people did not have. Nevertheless, young people have sex earlier and take risks in doing so. That is why I was so angry on Monday when, because of the guillotine, the Government accepted a Lords amendment without debate in this House.

Some time ago I wrote to the Minister and I was pleased that he expressed his belief that sex education and related matters should be dealt with in schools. However, we have undermined much of the work that could have been done; we must reach young people.

I have gone into the matter as far as I can and I could talk for an hour if I dealt with all the material that I have. I do not suggest an epidemic—I am not an alarmist—but the figures that I have seen suggest to me that unless precautions are taken we shall land in great difficulty.

Before I finish, I shall raise one other matter. The Government have talked about reducing teenage pregnancies, sexually transmitted diseases and the instance of drug misuse over the next few years. We all hope that that happens, but we cannot allow ourselves, or other people, to get the impression that because the incidence has not been as bad as some people predicted, we can now relax and treat AIDS and HIV in the same way as we treat other diseases.

The age at which people are dying of AIDS shows that they are getting the disease very young. That is one of the most worrying aspects, whether those involved are boys or girls. As I have already said, we know that youth does not always listen and does not always want to be counselled. If one talks to young people, one finds that their ignorance about the transmission of AIDS is frightening, because they have not had the opportunity to be educated about it I understand how many parents feel; they want the right to prevent their children from being, as it were, contaminated with that knowledge; they want the right to remove their children from the education. But the children, too, have rights to know the world in which they are growing up —a world that many of us, because of our age, will never enter.

The Government must take the subject seriously and reconsider ring fencing and other factors. Like my hon. Friend the Member for Islington, South and Finsbury, and one or two other hon. Members here, I am a member of the all-party group on AIDS. We receive much information and guidance and we are not scaremongering, but we are realists and we are anxious to ensure that the Government take the matter seriously. If the Government give the impression that things are getting better, the message will not get through to many people, especially the young, who still think that those of us who are trying to warn them are scaremongering. They do not think that anything will happen to them. Sadly, as we know, AIDS does happen to a minority of them.

§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I thank the hon. Member for Eccles (Miss Lestor) for introducing a debate on this alarming and sad subject.

First, I shall look back a few years to remind her that, when we were first confronted with HIV in this country, in the early 1980s, we acted much more speedily than did some other countries. We were in the forefront of developments such as needle exchange, which have shown enormous benefits in reducing the spread of the disease among drug users, and we can be justifiably proud of that.

We embarked on what was then considered an advanced and controversial education campaign. Despite considerable criticism, to which the hon. Lady referred, we targeted the young heterosexual population, because we knew of the dangers of the spread of the disease. It may not be so apparent here as in some parts of the world, but it is here, and it is a growing danger.

We embarked on a considerable funding programme. The hon. Lady referred to money, so may I remind the House of the mainstream funds that have gone to health authorities for the treatment of HIV and AIDS in the past few years. The sum has grown from £25 million in 1987 —the first recorded figure that I have—to £181 million last year and £214 million in the current year. Those are very considerable funds when we consider that they form part of a hospital and community budget of £20,000 million. In terms of the public education campaign, to date we have spent £85 million. I doubt whether the Government have run a bigger public health campaign than that.

I am aware of the hon. Lady's concerns about more than one of the voluntary organisations which have been told that they will have their grants cut progressively in the years to come.

Section 64 funding in the current year is £1.92 million. That must be taken in the context of a section 64 budget of £17 million, so that funding represents about 10 per cent. of the entire voluntary organisation budget which is devoted to AIDs-related charities. The hon. Lady knows that we have to turn down requests for funding from hundreds of organisations concerned with mental health, cancer and many other areas. Therefore, the funding for AIDs-related organisations is very considerable. Those organisations include AI Ds and Housing Project, ACET, Barnardo's, Black HIV-AIDs Network, Blackliners, Body Positive and Landmark.

I appreciate that we have said that some of the largest single grants will be cut. However, we are talking about levels of central Government funding for those organisations which some would say were out of proportion to other Government funding for voluntary organisations. However, that was a response in the early days to a new threat when it was very difficult to fund those organisations.

Some of those organisations are now quite mature. As I have said, there are many demands for funding for voluntary organisations and we have reached the conclusion that we have. However, that does not represent a diminution of our commitment to AIDs, and I hope that the figures that I have given will demonstrate that.

The hon. Lady referred to the George House Trust. If I may, I will write to her about that as the matter is of considerable concern to her and my area of the country. 618 She also mentioned the figures for the Day report. Perhaps I can refer to some of our latest information on the basis of which we work.

It is reassuring that the projected figures for new AIDs cases have been borne out by events. Without being complacent, we have reason to have some confidence in the methods that we have used over the past few years to prevent the further spread of that dreadful disease.

The figures that we are working on are the fruit of 18 months' work by the expert group which has benefited from increasing amounts of information from surveillance networks. In particular, we were able to use data from the Government's programme of anonymous HIV surveys. The estimate on which we are now working is that there were between 19,628 and 28,400 HIV-infected adults in England and Wales at the end of 1991.

It has been suggested, and the hon. Lady referred to this, that that is good news and it has been used as an argument for reducing the commitment to AIDS. That is not necessarily our view. The figures are lower than might have been suggested at an earlier stage and we are clearly glad that we have evidence of the effects of behaviour change among homosexual men and drug misusers.

However, it must be emphasised that those figures still indicate a large reservoir of people who are not only likely to develop AIDS themselves, but may infect others. They also predict the number of people who are likely to require care. It must be remembered that nearly all of them are likely to be already infected with HIV. We were correct regarding the heterosexual spread of HIV as a real and growing threat and we proceed on that basis, even though, at present, the majority of cases of HIV infection are still transmitted through homosexual intercourse.

The hon. Lady mentioned the sexual behaviour of young people. I agree with her. We must accept that there is increased sexual activity at a much younger age than in recent years. We might regret that, but we must accept that it exists and that it poses a threat to health and to the spread of HIV.

We are committed to the provision of family planning advice and contraceptive services to what some people regard as very young teenagers whom we know to be sexually active. She referred to "The Health of the Nation". It contains one of the key targets for the reduction of under-16 pregnancies. That means some fairly controversial forays into family planning advice and contraceptive services for under-16s, despite all the taboos and legal uncertainties that surround it.

It is difficult, but we support and pay great tribute to pioneering organisations such as the Brooke advisory centre, whose priority it is to reach young people. I have opened innovative initiatives such as the youth advice shop in Accrington, of which the hon. Lady might be aware. It is run by Lancashire county council and others and it contains a family planning component. We must recognise that, in order to reach young people and try to reduce the dangers to them, we need to be rather subtle and make help accessible.

I am aware also of the controversy surrounding changes to the Education Bill, but I remind the hon. Lady and all those who predict dire consequences that one of the main changes is that it makes sex education compulsory for all schools. It is not open to a board of governors to say, "We are not going to offer sex education." That is very explicit for the first time. The hon. Lady regrets that parents will have the option to withdraw children. I predict 619 that very small numbers will be involved. We look to the Department for Education to give clear guidance on what is expected in terms of sex education programmes. There is no doubt that, if we do not somehow reach children —it is a truism that parents in this country are not particularly good at it—they will not get that basic education. The hon. Lady is right to highlight that matter.

I emphasise the theme of my remarks. There is no change of attitude. We recognise that the heterosexual 620 population, as well as the traditional groups, are vulnerable to HIV. We will continue to target them. We will continue to spend large sums on them. Once again, I congratulate the hon. Lady on raising this important topic.