AIDS: Prevention and Control

HL Deb 18 March 1985 vol 461 cc358-87

5.5 p.m.

Baroness Cox rose to ask Her Majesty's Government what steps they are taking to prevent and control the spread of the disease AIDS.

The noble Baroness said: My Lords, I am grateful to have the opportunity to raise these issues as discussion of them is timely for a number of reasons. First, there has been a great deal of understandable public anxiety about the nature and spread of the acquired immune deficiency syndrome, generally known by its acronym, AIDS. Secondly, this anxiety has been exacerbated by misinformed press publicity which has fostered the belief that AIDS is highly infectious. Thirdly, this belief has in turn led to uncertainty about the appropriate ways of responding to people who are, or who are suspected to be, suffering from AIDS. Finally, new information is becoming available which should help to clarify the situation and, by putting it in context, to offer some reassurance.

Therefore, I thought that it might be helpful to begin the debate with a brief outline of the nature and extent of AIDS. This will be very general. I am grateful to see that other noble Lords will be speaking later, including noble Lords who are medical practitioners, who will be able to provide any further details that they think are appropriate.

In essence, AIDS is a very rare condition which prevents the body's own internal defences against infection from working effectively. This loss of resistance renders a person more likely to succumb to illnesses which he would normally fight off quite easily. Two of the illnesses which most commonly afflict AIDS patients are relatively rare diseases. Kaposi's sarcoma is a type of cancer mainly of the skin, but it can also affect other parts of the body. The other is pneumocystis carinii pneumonia, which I shall refer to as PCP, a serious infection of the lungs. Many AIDS patients have one or both of these diseases.

The origins of AIDS can be traced back to 1981 in the United States of America, when a number of previously healthy homosexual men were reported as suffering from one or both of these conditions. Five cases of PCP were reported in Los Angeles, and, at about the same time, 26 cases of Kaposi's sarcoma were reported in New York and California, four of those affected also having PCP.

Within a few months, the Center for Disease Control at Atlanta had detected 159 similar cases, and a new disease was formally identified in terms of the following characteristics: first, a reliably diagnosed disease that is at least moderately indicative of an underlying cellular immune deficiency, for example, Kaposi's sarcoma in a patient aged less than 60 years, or an opportunistic infection; and, secondly, no known underlying cause of the cellular immune deficiency nor any other cause of reduced resistance reported to be associated with the disease. This definition has been accepted by most other countries and by the World Health Organisation Collaborating Centre for AIDS.

By January 1985, about 7,000 cases of AIDS had been reported in the United States of America, about 700 in Europe and 118 in the United Kingdom. Classification into groups with the highest risk of catching the disease shows that about 75 per cent. are practising homosexual or bisexual men. Other groups at risk include drug abusers who inject drugs into their veins, sexual partners of persons with AIDS, some people who have lived in Haiti or Central Africa, especially Zaire, the Congo, and Rwanda, and haemophiliacs who have received infected blood products. The risks to haemophiliacs have been a cause of considerable anxiety, and it is therefore worth noting that in Britain no one in this category has developed symptoms fulfilling the criteria of the disease as given above, although several patients have developed antibodies after receiving blood transfusions. However, it is hoped that very soon this risk will be effectively minimised by adequate screening.

It is too early to predict with any accuracy the rate of spread of the disease; but it is reasonable to hope that Britain will not see the same escalation as occurred in the United States of America because now more information is available and more precautions can be taken. However, it must be recognised that the disease has a long incubation period of several years, and some increase must be expected. Epidemiologists indicate a figure perhaps of the order of 1,000 to 2,000 cases by 1988 unless there is a scientific breakthrough in the meantime.

Although these figures are obviously disturbing, they need to be seen in context. For example, deaths from measles in the past four years numbered 70, compared with 51 from AIDS. Moreover, any predictions about the future spread of the disease need to be treated with great caution. Epidemiologists have stressed the need for great care in the interpretation of predictions—a point which has been well made in the article entitled, AIDS for All by the year 2000?, in the British Medical Journal on 9th February 1985. It is most important to emphasise that AIDS is not highly infectious in the same way as, say, smallpox used to be. It is not transmitted by aerosol infection; in other words, one does not become infected by sitting in the same room as an AIDS sufferer, by sharing a meal, by shaking hands or talking together. So there is no need to treat a person who is suffering from AIDS as if he or she were a leper or some kind of pariah figure. The main way in which AIDS has been transmitted has been through sexual intercourse between male homosexuals, especially those who have many different partners. It has also been transmitted to people suffering from drug addiction, who have shared needles, and by contaminated blood products.

Although the virus known as HTLV 3, which is considered to be a primary causative agent of AIDS, has been isolated from blood, semen and saliva of patients with AIDS, there is no evidence that the disease is transmitted through the saliva. This is a very important point when discussing the implications of AIDS for people involved in first aid and other emergency procedures such as mouth-to-mouth resuscitation. This brings me to the question of the anxieties felt by many people with responsibility for caring for patients who have, or who are suspected of having, AIDS. Anxiety is a natural concomitant to uncertainty. Thus, while little was known about the ways in which AIDS might be transmitted, it was understandable that many people working in health care and in the voluntary services should feel apprehensive about becoming infected through direct contact, especially such close contact as is involved in cardio-pulmonary resuscitation. Thus, certain unions, wishing to protect their members, instructed them not to take such risks. But now more information is available and various guidelines have been issued which should allay such anxieties. If followed, they should ensure that patients receive the specialist care they need and that staff are protected from risk of infection.

Two such documents issued recently are the interim guidelines issued by the Advisory Committee on Dangerous Pathogens (ACDP) and the nursing guidelines on the management of patients in hospital and the community, issued by the Royal College of Nursing. These two documents give comparable and complementary advice. The ACDP guidelines are naturally aimed at all staff who come into contact with people who have AIDS, or with specimens of their excreta. The Royal College of Nursing guidelines are naturally more concerned with nursing care and with trying to meet patients' physical, psychological, social and spiritual needs; and they also draw attention to the particular needs of patients' families and friends. Both documents discuss specific points concerned with health and safety of staff and other patients, with advice on important practical matters such as disposal of plastic aprons, gloves, soiled linen and dressings. Particular attention is paid to procedures for venepuncture, with useful advice on the care of needles.

An important point, which is made by both sets of guidelines, is that the responsible clinician should ensure that all staff who are likely to be involved with the care of a patient suffering from AIDS should be notified of the nature of his condition and made aware of the potential hazards. There have been a number of cases reported where nurses who have been caring for AIDS patients have not been informed of the diagnosis. Such a situation clearly puts them at unnecessary risk, and it also means that they cannot take the precautions needed to protect other patients appropriately. It is to be hoped that these situations will not recur, especially now that the guidelines are available for reference. These guidelines are to be warmly welcomed.

Also welcome are the initiatives taken by the voluntary services such as St. John Ambulance and the British Red Cross Society, which reassure first-aiders that nowhere has there been a recorded case of AIDS transmitted through first-aid treatment, including mouth-to-mouth resuscitation. They also seek to allay anxieties felt by some of their members about the use of models for instruction purposes by reminding them of standard procedures which have already proved to be effective in maintaining hygiene and safe practice.

It is to be hoped that these authoritative documents and statements will reassure front-line workers and will act as a corrective to the sometimes sensational and inappropriate responses which have occurred in some quarters. However, it must be recognised that they are still interim guidelines. They cannot stand as definitive statements while the condition of AIDS and its transmission are so problematic. I wish therefore to ask my noble friend the Minister whether any research is being done in this area of identification or clarification of the requirements of safe practice for health care workers, members of the emergency services and first-ciders.

Finally, I should like to turn very briefly from consideration of the protection of health care workers to the sensitive issue of patients' needs. People who have been infected with the AIDS virus may find themselves anywhere on a continuum from feeling physically fit and free of symptoms to episodes of illness of various kinds, to terminal illness and death. One of the most frightening aspects of AIDS is the fact that it can have a very long incubation period, and so people in the high risk groups may live in constant fear of having the disease with nothing to show for it but are perhaps just waiting for it to erupt. It has indeed been said that there are two diseases: AIDS, and the fear of AIDS. Given this deeply worrying situation, initiatives such as that taken by the Health Education Council are very welcome. Its booklet entitled, Some Facts about Aids, gives a very clear account of the nature of the disease, indicates those people who are most at risk, and gives advice on what to do if anyone is worried about the possibility of having the disease. It also gives practical advice on other matters, such as sexual behaviour and giving blood.

Another source of helpful advice, particularly for homosexuals, is provided by the Terence Higgins Trust, which runs an AIDS information telephone line and support groups for people with AIDS, and their friends and families.

One of the most regrettable aspects of the development of AIDS has been the tendency in some quarters for those who suffer from the disease to be treated as pariah figures. This may in part be due to ignorance and to fear of infection; it may also be related to the social stigma which may still attach to homosexuality. It is profoundly to be hoped that such attitudes towards the victims of this disease will change and that they will be accorded all the care which they need—care which needs to embrace not only them but their loved ones, in a particularly sensitive way, given the difficulties and problems inherent in their predicament.

It was largely because of this unhappy predicament of AIDS sufferers and the fear and uncertainty experienced by those who care for them that it seemed appropriate to raise these questions in your Lordships' House. I greatly look forward to learning more about these and related matters from the noble Lords and Baronesses who will be taking part in this debate, and I am most grateful to them for doing so. I also look forward to hearing from my noble friend the Minister the latest information concerning the control and prevention of this tragic disease, which is causing such widespread suffering, fear and anxiety. In this situation ignorance is the opposite of bliss—it is worry, uncertainty and even agony. It is my earnest hope, therefore, that the provision of more information may help to alleviate some of these problems and to reduce some of the suffering emanating from misinformation and the fear of the unknown.

5.22 p.m.

Lord Rea

My Lords, the noble Baroness, Lady Cox, has performed a very useful and timely service by putting down this Unstarred Question, and we should all be grateful to her for giving such a crystal clear account of the problem. We are used to hearing speeches of such quality from the noble Baroness, and her speech today has been no exception.

The noble Baroness has mentioned some points which should reassure us. In particular, she said that AIDS is not a highly infectious condition and that it spreads only through very intimate contact or through blood or blood products, or contaminated syringes or needles. In other words, normal social, rather than sexual, intercourse with affected or high-risk groups is perfectly safe. As the noble Baroness has pointed out, there is no need to make pariahs of the whole "gay" community.

Unfortunately, the discovery of the acquired immune deficiency syndrome has been used by many intolerant people as an excuse for what has been described as "gay bashing". I join with the noble Baroness in condemning such action in the strongest possible terms. Its extent was revealed recently in an unusually frank article in Time Out on 28th February, which also gave some extremely useful advice to high-risk groups.

I am sure that at the conclusion of this mini-debate the Minister will put us in the picture about current research into the condition and about possible avenues that may lead to the development of an antiviral agent that may be useful, or a vaccine. That is some distance ahead, but there is a great deal of work going on at present. The condition has caused great interest throughout the scientific community, and in the end it may lead to greater understanding, not only of AIDS but also of other virus diseases, and may assist the development of the relatively young science of immunology. It is also likely to prove a further boost towards research into the endemic diseases of Africa, to the great benefit of the African people as well as ourselves.

One of the causes of anxiety is that like some other so-called "new" diseases that have recently been described—such as lassa fever or legionnaire's disease—it is possible to depict it as a visitation by an enraged and vengeful god creating a new weapon to punish us for our sins. In fact, all these diseases have turned out to have been present for many years, usually in a tropical environment, but they have been unrecognised in those places amidst a whole host of other diseases. It looks as though AIDS is another of those diseases—"an old disease from Africa", as one BMJ article has suggested. It is highly likely that, in an area of high mortality with much serious illness, including malnutrition—an area such as Chad or Zaire—immune deficiencies would be overlooked.

The first death from an AIDS-like illness in a European was of a surgeon working in Equatorial Africa in 1977. The almost simultaneous occurrence of the condition in Haiti and the United States seems to have occurred after some American citizens visiting Zaire came home and passed the virus to the "gay" community in the United States. As Haiti was often used in the 1970s as a holiday haven by the American "gay" community, it was thus perhaps passed via the United States to Haiti and was not originally endemic in that country. That is only a hypothesis, but it is quite a likely one.

As the noble Baroness, Lady Cox, has pointed out, one of the major difficulties is that the incubation period is unusually long—from one to five years—and carriers are usually unaware that they have been infected. Small wonder that genitourinary clinics throughout the country are besieged by people wanting to know whether they are incubating the disease! A further problem is that the test for evidence of infection by HTLV III (the virus now thought to be responsible) is not yet a definite indicator of infection. Even if the antibody is present, it is not certain whether the subject will contract the disease or can pass it on. Those are some of the reasons why a reliable test has not yet been made available for general use either in genitourinary clinics or in the blood transfusion service. Work is going on as rapidly as possible in several laboratories evaluating suitable tests. I am told that later this year we may well have one that will be available for use. However, it cannot be 100 per cent. reliable, and those who are servo-negative—that is, who do not have the antibodies—but who are in the high-risk groups will still need to take sensible precautions and should certainly not donote blood.

While on the topic of blood products, a reassuring fact is that although one-third of the haemophiliacs who have been tested have been found to be positive for HTLV III, nearly all haemophiliacs in this country have received factor VIII made from pooled blood products imported from the United States. Despite the fact that one-third of haemophiliacs have the antibody, only three seem so far to have developed the full syndrome of AIDS. Another comforting fact is that although more than 100 minor "accidents" involving health staff looking after AIDS sufferers have occurred—such as pricking themselves with needles that have been used for collecting blood samples from patients—not a single case of AIDS has so far been reported as a result.

I do not want to criticise the way in which the DHSS has handled the problem. It is always convenient to point accusing fingers. Prompt and appropriate action has been taken in blood transfusion centres by the publication of the guidelines for health staff, to which the noble Baroness referred (and some people even say that those guidelines are too stringent), and by the encouragement of excellent research which is now going on at the Communicable Disease Surveillance Centre at Colindale, and other laboratories.

What I think the Government could do is to encourage the production of more guidance material for risk groups giving quite explicit advice; provide support for more counselling staff at the GU clinics; and take strong action against victimisation, so that the disease "Fear of AIDS" rapidly diminishes, while at the same time appropriate and effective action is taken to control the real disease of AIDS.

5.30 p.m.

Lord Winstanley

My Lords, I am very conscious of the fact that this is not a short debate but an Unstarred Question—an Unstarred Question admirably, and if I may say so, very professionally put to your Lordships' House by the noble Baroness, Lady Cox. If I wished to take issue in any way with the noble Baroness, Lady Cox, in what she said, and indeed to an extent with what was said by the noble Lord, Lord Rea, in his speech, I think that in some cases they gave answers to questions with perhaps a greater degree of certainty than I think our present state of knowledge entitles them actually to possess. The noble Baroness said quite clearly that there is no question, that this disease cannot be transmitted by droplet infection. She may very well be right. I think she probably is right. I certainly hope she is right, but I should like a little more certainty before we tell people with absolute certainty that this is the way it is spread, or that is the way it is spread, and so on.

This being an Unstarred Question I shall content myself as far as I can with merely underlining some of the questions which have already been put and perhaps putting one or two more myself to the Minister who, at the end, will reply. There is a great deal which I think we need to know about this fairly new, and undoubtedly very alarming, disease.

The first thing I should like to know—and I do not think that the noble Lord the Minister is going to be in a position to tell me at the end of this debate, and probably not at the end of the debate in 12 months' time; but at least he could make a start—is what steps are being taken to find out the following information. I, and many others, should like to know the precise nature and identity of the responsible virus. There are those who I think believe they do know. Is it a new virus? Is it an old virus that has undergone some kind of mutation? Or is it something that has become much more virulent than it used to be? The noble Baroness in her mention of measles pointed to the fact that diseases change. Not only do diseases change, but the response of human beings who contract various diseases changes very frequently also.

The noble Baroness mentioned measles. I think it is my recollection that when measles was first introduced into Fiji three-quarters of the population died. They died because they had never previously been subjected to that comparatively minor disease and therefore it had a very serious effect on that particular population.

I make those points merely to illustrate the fact that once one has identified a particular virus, one has not necessarily defined clearly what its effects are likely to be. But I should like to know what is the present state of our knowledge of the nature and identity of this particular virus.

Secondly, I should like to know what is the present state of our precise knowledge about the mode of transmission of this disease. I realise that the noble Baroness has suggested that we already know a lot. So, too, has the noble Lord, Lord Rea; and he knows a lot about a great many things. I have been in medicine perhaps longer than the noble Lord, Lord Rea, and longer perhaps even than the noble Baroness, Lady Cox; has been in nursing, but I am bound to say that the more I have found professional colleagues to be absolutely certain about things, the more I personally have been inclined to doubt them, and the more often I have sometimes found that they have subsequently proved to be wrong.

I should therefore like to ask the Minister what is the present state of our precise knowledge about the mode of transmission of this particular disease? In particular, one really wants to know whether or not this is a disease which is exclusively sexually transmitted. If it is not, it is high time we said so—and said so loud and clear. But if we are going to say that, then of course we have to say by what other means it can be transmitted. I am not saying that we must carry out some kind of alarmist propaganda to frighten people and to suggest that it can be picked up in all kinds of strange ways. But I believe that in your Lordships' House we have a duty to try to find out the real facts before we can decide what is the best way in which to communicate those facts to the public as a whole and, indeed, what are the best steps to take.

Thirdly, I should like to be told a little more as to what we know about the length of the incubation period. The noble Baroness, Lady Cox, told us with absolute conviction that it was seven years. I thought that that was what she suggested. I should like to know at least—

Baroness Cox

My Lords, perhaps I may say that I said that it is presently thought to be any time between six months and six years, according to present state of knowledge.

Lord Winstanley

My Lords, the noble Baroness confirms my view that the state of our knowledge on the length or shortness of the incubation period is extremely limited; and that is something about which I should like to know more.

Lord Rea

My Lords, our state of knowledge as to the length of the incubation period is not lacking. It is fairly definitely known that it is very variable and can be between six months and six years, and that is knowledge which is scientifically backed up. It may be anything between those times; there is a variable length of time.

Lord Winstanley

My Lords, it would appear that the noble Lord, Lord Rea, is a rather more willing absorber of knowledge than I am. I have heard things, too, but I do not necessarily regard them as entirely finite and proved for all time.

Let us move on. I think we want to know a little more about high risk groups. Certainly enough has been said to realise that we know of one high risk group. We also, of course, know of another—the unfortunate people who suffer from haemophilia. Because of their need for blood products, Factor VIII and so on, and the method by which this is supplied to them, they are of course at risk. With regard to that particular group which is at risk—persons suffering from haemophilia—the well-known expert, Dr. Peter Jones, has already done admirable work with his book Aids and the Blood, A Practical Guide. It is a very comprehensive work which gives all the answers which those suffering from haemophilia, or those associated with persons who suffer from haemophilia, might wish to know.

It is time that similar guidance was compiled for any other groups who may happen to be at risk. Of course, there are many other people who require blood transfusions and blood products of one kind or another. They, too, will want to know the news, whether it he good or bad news. They are entitled to know it; and so are we.

To get the answers to all these questions we really need a great deal of research and effort and I think I am right in saying that these are not things that can be done very hurriedly. It takes a great deal of time and, if we look back at the experience we have had with other diseases, we see that it has not always been quick. Sometimes when we thought we had the answers we in fact did not have them.

I am moving from virus diseases to bacterial diseases. Let us take whooping cough, for example. When we finally found the responsible organism and discovered the vaccine, we found that we had created new difficulties which also had to be looked at. Let us go back to viruses and consider infantile paralysis—acute anterior poliomyelitis (to give it its proper name) or polio, as it is more commonly called. We identified that virus a very long time ago and then it took a very long time indeed to devise and to develop an acceptable, and efficient and wholly safe vaccine. A great deal of research was done by ourselves, by the Americans, and indeed by the Russians in the Soviet Union, before we finally had the present oral vaccine with the outstanding, successful results.

I quote that particular example merely to show that this is not a very easy matter in which one can find all the answers very rapidly and then provide the solutions rapidly. It takes time. Not only does it take time; it takes investment and it takes money.

The noble Baroness, at the end of her speech, expressed the earnest hope that the ministry would be able to provide the answers. I think that in order to provide the answers the Minister and his colleagues will have to provide some of the cash. At Question Time a day or two ago questions were raised about extra funds in this regard for the Medical Research Council. The noble Earl, Lord Caithness, in reply to a question which I put, said, entirely in good faith and most sensibly, that additional funds had been provided for this purpose. That is precisely the answer that any sensible, well-intentioned Minister would give. It is the obvious assumption that when the nation is faced not with a crisis, but with a peril of this kind, funds will be provided with which to combat it. The noble Earl has since told me that that was his honest and sincere opinion, as I am absolutely sure it was, but in fact they were not extra funds; it was merely that the Medical Research Council had spent extra money out of its existing funds.

That I wholly accept, and I wholly accept that the noble Earl in his answer was giving a sincere answer and what he thought was a sensible answer. Surely, my Lords, it was, but extra funds have not yet been given either to the Medical Research Council or to the National Blood Transfusion Service, who may indeed need them for further research, or perhaps to the Blood Products Laboratory, who are going to have to do a lot of thinking in relation to this disease.

What kind of a society do we live in if we can readily provide extra funds for policing picket lines, for Trident, or for maintaining a substantial military presence in the Falkland Islands—I am not going into these matters—and not provide extra funds to combat a menace which may perhaps ultimately spread far beyond the Falkland Islands in its significance? We do not yet know anything like enough with certainty about this particular disease. We are not going to know enough until we have made the necessary investment in research. Having carried out the research and got the answers from that research, we shall have to have further investment in order to provide further answers.

I shall say no more save to welcome the noble Baroness's timely Question and to welcome in advance the answers we are going to get from the noble Lord when he comes to reply. I hope that he will be able to tell us that his ministerial colleagues in the department are sufficiently seized of the importance of this particular problem, that proper efforts are being made and that the necessary finance is being provided to deal with what is in fact an emergency.

5.42 p.m.

Lord Richardson

My Lords, I am sure you were all much impressed by the lucidity and the manner in which the noble Baroness, Lady Cox, introduced this Question. It was in fact no surprise to me. She is the daughter of an illustrious surgeon who wrote a textbook of medicine whose brevity and lucidity were such that it enabled me to compete with my Cambridge examiners 51 years ago. My only anxiety this evening is that many of the points that I wished to make were made by her, and that you, my Lords, will have the same sensation that doubtless my examiners had that I had read the book but had not understood it nearly so well as the author had.

There are many lessons and there are some questions which arise from this discussion this evening. One is the creation of anxiety. A great deal of appalling anxiety has been created in connection with this disease. Of course there is appalling anxiety. It is a very dangerous condition indeed. Not least is the question of the incubation period, which was taken up by the noble Lord, Lord Winstanley. To have to wait for three weeks to know whether your child is going to get measles is an anxious business, but to have to wait at least six months and perhaps even six years to know whether you or your child—your son in most instances—will have to face this terrible disease must be appalling. Therefore, much support, as has already been emphasised, is needed for those who are potential sufferers—and that potential is known—and for their families.

Dr. William Hams was quoted in The Times of the 6th as saying—and this is a question— Has the media any idea of the terrible problems it gives us through irresponsible reporting? Those terrible problems are not only problems which lead to questions being asked, and pressures being exerted, which are at that time virtually unanswerable and could therefore be misleading or productive of anxiety, but if they are sufficient they could lead to wrong decisions.

It is a matter of great gratitude that we should feel that the medical advisers and the Ministers at the Department have not made this into a notifiable disease despite the pressures. If they had, disaster—and that is not an exaggerated term—would follow, because the confidentiality which must surround this sort of situation would have been broken, or at any rate threatened, and the essential process which applies in all venereal disease situations of contact tracing would become even more difficult, and the risks of spread and of failure to recognise those at risk would have been enormously and, as I have already said, disastrously extended.

Again the pressures which can arise from reporting which is alarmist and ill-informed can lead to all sorts of unnecessary precautions, diverting attention and resources from the areas where they are most needed. The noble Lord, Lord Winstanley, raised the point about the numbers, the degree of infectivity, and how the disease is transmitted. At the present time, it is clear that it is transmitted sexually by homosexuals, or by blood in presumably large doses as in transfusions. The answer to the question whether there can be a great many more groups which are at risk is at any rate partially given by the fact that if it was transmitted by the sputum—the virus is there in the sputum—then there would be a vast quantity of patients with this disease, at any rate in the United States where the incidence is so much higher than it is here. Therefore, the ordinary, non-statistical, common-sense answer that it just has not spread as it would if it were to do so by droplet infection, or through the sputum, can in that sense be reassuring.

Again it has been said—and I think it was the noble Lord, Lord Rea, who said so—that of the tens of thousands of health workers in America who have been in contact with patients, and a few thousand in this country, none has acquired AIDS. It is apparently—and at this point it is wise to say "apparently"—considerably less infective than is hepatitis B, a condition which has plagued us for many years but about which we now know a great deal.

Before this debate I talked to the professor of virology at my old hospital, Saint Thomas's, and he said, "The disease is not very spreadable". That is a heartening little sentence. He went on to say that the precautions which should be taken in the wards and in the laboratories could well be described as good housekeeping. This is in step with the much larger experience that the United States has had. Doctors there and the professor of virology, Professor Banatvala, stress that it is the established precautions about which we—doctors, nurses and hospital workers—should all know must be applied thoroughly, with understanding and with tight discipline, but that more than that does not seem to be necessary. Where such precautions were applied more stringently in the States they have now largely been given up. I said "the precautions that we ought to know". There should be much more education about the simple precautions and their rationale for all those who work in hospitals. I do not exempt doctors or even nurses from that need.

Mention has been made—and here the noble Lord, Lord Winstanley was strong—about the importance of research. It is very remarkable that difficult though viruses are to work with in the laboratory, this virus was isolated as recently as May last year and now already its entire genetic structure is known. That was a considerable feat and the rate at which it was achieved was encouraging. But that does not mean to say that we are anywhere near the point where we have a vaccine as a preventive or a drug as a curative. A great deal of research is needed. Perhaps the Minister will be able to help, as the noble Lord, Lord Winstanley, asked, and tell us what research is being done. We know that it is going on into tests: the significance of false positives and negatives; the latter easily understood and the former more difficult. Indeed epidemiology can and should help us by working out some of the utterly unploughed ground of the natural history of the disease: that is how it can affect the individual in varying degrees.

It was very recent that we felt that every case was invariably fatal. This was easily understood because the diagnosis was made by the fatality of the disease. But now things are slightly different. I should like to quote from Dr. Don Jeffries, a virologist at St. Mary's Hospital, a hospital that is taking a great lead in the AIDS problem. He wrote in The Times: There has been a significant number of people with AIDS antibodies plus immune disturbances"— those one will feel very gloomy about— who, followed up over a year or two, have gone back to normal. We don't know what these changes mean —more research— but it is very encouraging that people with at one time quite profound laboratory defects and with swollen lymph glands can return to normal. As I have said, a vaccine and a drug may be a long way off. They certainly were in the hepatitis-B researches leading to a vaccine. The difficulty is that the virus is in the body cell and to kill the parasite one must be careful not to kill the cell at the same time.

Intensive research—even if it is not leading very rapidly to a cure—through more understanding of epidemiology and on the immune responses of the body and how they are disturbed, greater knowledge of the possibilities of the patients with the extraordinary disease called Kaposi's sarcoma in Africa which is related to this condition to possibly mild cases with little but blood changes to show that the patient has ever been infected may—and I think will—come out with epidemiological study.

I should-like to end by emphasising the point made so clearly by the noble Baroness, Lady Cox, that support, advice and counselling for the relatives, sufferers and potential sufferers is absolutely essential. This is going on. Great initiative has been shown; and it is of major inportance, as I am sure the noble Lord the Minister understands, that it should receive all possible encouragement.

5.56 p.m.

Baroness Dudley

My Lords, I am most concerned about the risk to our young men and boys in catching AIDS. I believe that in America the number of cases has doubled every six months since 1980, and that 97 children under the age of 13 have caught it. Could something be done about it in this country before our young people are affected in similar proportions? Is it possible for the Government to issue an information leaflet on AIDS, its nature and causes, to parents of schoolchildren? Perhaps a film giving details of the virus could be shown in schools and colleges of education where boys and young men may be exposed to approaches from homosexuals. Already in Britain I believe there have been 132 cases with 58 deaths, and the public is anxious and confused about the disease and how it is transmitted. As male homosexuals are the main people at risk, they must be made fully aware of the dangers so that the progress of the disease can be checked. All "gay" communities should take a responsible attitude to safeguard those who are likely to be affected by any irresponsible actions. If possible, stricter checks could be made on giving blood.

Recently a baby was born in Birmingham with the AIDS virus in its blood after its mother had received contaminated blood from an AIDS victim. More research could perhaps be done on the screening of blood and the treatment of AIDS sufferers. Perhaps the Government should now consider a review of the current law relating to homosexuals and children to ensure that the risk of AIDS is taken into account. Is there any danger from acupuncture and pierced ears and those sort of things?

5.58 p.m.

Baroness Masham of Ilton

My Lords, this Question on AIDS which has been put down by the noble Baroness, Lady Cox, follows from a Question which I asked on 13th February. That followed from one asked last year by the noble Baroness, Lady Dudley. We have had three Questions asked on the acquired immune deficiency syndrome by three female peers. Females are a small percentage in your Lordships' House and it is interesting that 100 per cent. of the questions on this important subject have been asked by women.

Looking into a new disease is fascinating, but in this case it is extremely worrying. In AIDS the immune or defence system becomes defective leaving the way open for potentially serious invaders which the body normally rejects. One arm of our two-armed defence system is affected. These are the T-cells which normally are primed to repel invasion by viruses and other organisms. The other arm, in which the B-cells work, is left relatively intact so that most bacterial invasions are still repulsed. Therefore, it is the T-cells which cannot combat a viral attack. AIDS, for the people who do not know, stands for "acquired immune deficiency syndrome". "Acquired" signifies that it is caught as an infection rather than inherited; "immune deficiency" means that the body cannot defend itself properly; and "syndrome" means the illnesses that result. One of the greatest concerns is that at the present time there is no diagnostic test for AIDS yet available. We hope that scientists and doctors throughout the world will work closely together to find preventive measures and a cure.

I wonder whether this vital matter was discussed between our Prime Minister and the President of the United States of America when they last met. War against disease should be considered as important as any other sort of war. It would be wrong if any countries working on a vaccine did not work together because of the monetary gain on finding a vaccine. With the amount of fear and suffering that this virus is causing, the sooner a remedy is found, the better the world will be.

There is a great deal which can be done by many people to relieve some of the human suffering until a cure is found. The Government, through its machinery, can help. We should look at the positive things that can be done. I quote a few lines from a very useful book AIDS and the Blood, written by Dr. Peter Jones and published at the Newcastle Haemophilia Reference Centre in association with the Haemophilia Society and the Terence Higgins Trust: AIDS hurts. It intrudes on the security and privacy of families. It attracts ill-informed and sometimes cruel comment. Faced with the possibility of AIDS, people experience bitterness and anger. Sometimes anxiety or depression threatens to overwhelm them". People with fears about AIDS should be able to talk about it in confidence to well-informed people. I do not think that a worried woman who may suspect her husband of having dual relationships with herself and homosexuals should have to go to a special clinic, a VD clinic. She might not go. Could there not be a confidential centre in each health region where these people could be referred by their general practitioners?

I hope that this debate will be useful and will help people to understand a little more the needs and the problems created by AIDS. The symptoms and signs of AIDS listed by the Centers for Disease Control and the American Association of Physicians for Human Rights are: (1) profound fatigue, persisting for weeks with no obvious cause; (2) unexplained weight loss (more than 101b in two months); (3) drenching night sweats that may occur on and off for several weeks; (4) fever lasting for more than 10 days; (5) cough lasting for more than two weeks and not due to smoking—this may be associated with shortness of breath, persistent sore throat and difficulty in swallowing and the white spots of "thrush" may be visible in the mouth; (6) persistent diarrhoea; (7) swollen lymph nodes (glands) lasting more than a month; (8) purplish or pink blodges in the skin.

These symptoms and signs could mean many things and, in themselves, they do not mean that AIDS is present or that the person concerned is going to develop AIDS. They may not be of consequence, but anyone experiencing prolonged ill-health and worried about AIDS should seek consultation with a doctor quickly. There is a vital need for considerate and correct counselling up and down the country. Many people are worried. They need to have their questions answered. Fear grinds away. Innocent people may have had blood transfusions; hundreds of haemophiliacs and people suffering from Christmas disease will have had Factor VIII and IX. I have been asked by someone who has worked in Africa as a missionary if gamma globulins could carry the virus.

My Lords, the fear of the unknown is very great. I think it would be wise and helpful if the Government would set up a series of conferences in different parts of the country for medical, nursing, social and technical staff so that they can be kept up to date with information and can gain counselling skills. Junior staff will always need continual back-up from senior staff. Many people who are going to have operations are asking if they can have their own blood collected a few weeks beforehand and use that blood should the need arise. This seems a reasonable request and perhaps the Minister would look into it to see whether it is practicable.

It is known that the bowel wall is very thin and delicate and can easily have lesions and I think I am correct in saying that the purple blotches in Kaposi's sarcoma are only present when homosexuals develop AIDS. As much as possible should be done to prohibit at-risk groups from giving blood. Perhaps if people are bisexual and married and have been giving blood for years, they do not want their wives to suspect them if they have been living double sex lives. It seems to me that counselling ought to take place at blood-donating sessions to make at-risk donors realise what danger they might inflict on innocent people. This is most important now as no diagnostic test for AIDS is yet available.

I should like to ask the Minister whether the AIDS virus has changed and whether the AIDS antibodies which are found are themselves immune. They are passive. What is making them unable to fight? This mystery illustrates the need to encourage doctors and scientists who work in the field of virology: their work is most vital and should be considered a top priority. Blood is the lifeline of the National Health Service. When I sustained my injury I also had a mammoth internal haemorrhage. It was blood transfusions which saved my life.

The impact of AIDS on the blood transfusion service will not be limited to the cost of testing AIDS alone. It is hoped that a test will be available during 1985–86 and it is thought that the cost will be about £2 extra on every unit of blood. In order to prevent any possibility of infection from blood products, heat treating will be necessary. This process of heat treating reduces the potency of the substance by approximately 20 per cent. and therefore 20 per cent. more blood will be required to produce the same level of product, and I do not think that red blood corpuscles can be treated in this way as it would damage them.

My Lords, I think that for years we have been taking our blood transfusion service for granted. A great deal of amazing work goes on and I should like to pay tribute to the dedicated people who do such an excellent job. Perhaps in the past they have been neglected and perhaps that is why we are not yet self-sufficient in blood products and are still importing them from America and, sadly, we have also imported the AIDS virus. This extra need for plasma and the extra work that AIDS is imposing on the regional blood transfusion services means that they need more money. Is the extra money going to have to come from the normal regional budget; or is the money going to be forthcoming from the Treasury? Is there going to be something special in the Budget tomorrow for "blood money"?

I cannot see any reason why people should be fearful of donating blood. I read in The Times today that Britain's blood transfusion service is facing a serious shortage. I am sure that if an appeal is widely made, many "clean" people will come forward to give their blood. We cannot do without an adequate supply of blood. This is a good opportunity to say that new needles are used each time for blood donation. They come in sterilised packs and after being used once only they are thrown away. This knowledge should be widely advertised to help recruit donors.

I am sure the Minister will agree with me that screening for AIDS should not be done at blood transfusion centres. If the problem spreads, so should the services required. The stress on the staff dealing with many cases must put an enormous extra workload on a hospital. Tribute ought to be paid to Dr. Pinching and his staff at St. Mary's Hospital, Paddington, who have been dealing with 45 AIDS patients. The large cities like London seem to attract the high risk groups. More resources will be needed for the acute services, and I hope the Government will learn now from the experience gained at St. Mary's Hospital.

There does also seem to be a problem over disinfecting some instruments such as flexible endoscopes, which are used to examine the bowel for cancer. The endoscopes are used many times in each session and the disinfectant which is efficient in regard to AIDS is causing some problems to nurses who have allergies to it. With the constraints on the National Health Service budget, these are all added problems. Please, will the Government look into all these matters?

With AIDS, prevention must be of paramount importance. It must be remembered that many nurses over the years will have become accustomed to a routine of dealing with used needles after taking blood. It is while putting them back into the sheath that the nurses can prick themselves. The needles should be placed in a rigid container for disposal. The instructions should be simple and straightforward so that nurses do not forget. With the problem of hepatitis B and drug addicts, most general practitioners have become more careful over the disposal of needles because drug addicts scavenge dustbins for used needles for drug use. It is advisable to take used needles to a hospital for disposal. This precaution should help to lessen the risk of spreading AIDS.

Dr. Peter Jones from Newcastle, when talking to me last week, said that he enjoyed talking to patients and felt that close communication was vital especially for mothers with young children. I felt that maybe AIDS brings the worst out in some people but with a doctor like Dr. Jones it is showing the good and positive side of human understanding.

The Haemophilia Society has among its members many high-risk people. I just want to say that AIDS has put extreme pressure on that small society, which is producing information and advice for its members. They are most grateful to the Government for their helpful grant, which was most timely.

When the part-time prison chaplain died from AIDS, it was understandable that prison personnel were concerned because very little positive information about the virus had then been circulated. Inmates and staff live in very large human factory-style institutions, with people coming and going like a conveyor belt. Information has now been circulated. Far more cases from the AIDS virus have been confirmed in America, but no one working in the American penal system has contracted it as a result of their work. With our large prison population and a great variety of inmates, it is really very remarkable how few outbreaks of infections there have been in our prisons.

Having said that, and knowing of some overcrowding, I would humbly ask whether perhaps it would be wise to increase the washing facilities for prisoners. Hot soap and water could be a precaution well worth taking. As it is, in some prisons the inmates only get one shower a week. I hope the Government will endeavour to do everything possible to prevent and control the spread of AIDS and the neurosis which goes with it.

6.15 p.m.

Lord Kilmarnock

My Lords, we are all grateful to the noble Baroness, Lady Cox, for introducing this short debate on this very important subject. I should like to start by agreeing with her that great damage is done by the misinformation and the hysteria which has been fostered by the popular press. I think that point was also made by the noble Lord, Lord Richardson. Some extrapolations have been quite extraordinary as a result of this disease. I think one of them produced a certain figure for the year 1990, and had it been extrapolated to the year 2,000 it would have produced 100 million AIDS sufferers—that is to say, almost more than twice the population of these islands. So the press has obviously not been doing us a good service in spreading these sorts of rumours. And of course, as has already been pointed out, exaggeration tends to lead to victimisation of the groups at risk. The noble Baroness, Lady Cox, also referred to this. The noble Baroness also said, as have other speakers, that more information is becoming available fairly rapidly from other parts of the world and in particular from America, from the National Cancer Institute of Bethesda, Maryland. That is welcome news, but of course it does not mean that we should relax our own efforts.

The noble Baroness and, I think, the noble Lord, Lord Rea, and also the noble Baroness, Lady Masham, mentioned haemophiliacs, who are particularly at risk from imported blood products, not only from AIDS but also from hepatitis, as they have been for many years. I wonder whether the noble Lord, Lord Glenarthur, can tell us about the current situation in respect of heat treatment of imported blood products. The long-term answer is obviously the development of self-sufficiency in Factor VIII; but of course we are not there yet. Is the noble Lord satisfied with the arrangements for the treatment of imports, in particular from the United States?

Still on the subject of haemophilia, I understand that in the long term, in the next 10 years perhaps, we can expect synthetic Factor VIII to become available. Can the noble Lord assure us that when this is the case there will be no financial obstacle to the widest possible use of what will, after trials, be a clinically safe material carrying no risk whatsoever?

I want to address the rest of my brief remarks to the question of research funding, which was referred to by my noble friend Lord Winstanley and also by the noble Lord, Lord Richardson. My noble friend mentioned the reply that he had received from the noble Earl, Lord Caithness, in regard to a Question put by the noble Baroness, Lady Masham, on the 13th February, when the noble Earl, Lord Caithness, said at col. 182 of Hansard: We do not intend to starve the Medical Research Council of funds: in fact we are giving it more funds on this particular matter. Later during the exchanges on the same Question, in response to a supplementary question of mine, he said this (and again I quote, from col. 183): I believe I am right in saying that they are extra funds, and we shall continue to give extra funds wherever there is a special project on this which is worth it". After that exchange, the noble Earl, Lord Caithness, came to me, very commendably, and said he thought he might have misinformed the House and that he might have been wrong in relation to the additionality of the funds that he was talking about. He suggested that I should put down a Question for Written Answer which would enable him to put the record straight.

Accordingly, on 5th March I put down a Question, which I shall now quote, and then I shall give the noble Earl's Answer, to which I think he will have no objection, which I received today. The Question which I put down was as follows: To ask Her Majesty's Government, whether, in view of the references made by the Earl of Caithness on 13th February 1985 (Official Report, Cols. 182 and 183), to the provision of additional funds to the Medical Research Council for research into AIDS, they will now state the level of funding for this purpose for the years 1984–85 and 1985–86". The first part of the noble Earl's Answer is as follows: The Medical Research Council have authorised grants for AIDS research at a total estimate of £369,000 of which £59,000 will be provided by my right honourable friend the Secretary of State for Social Services". So we have there a figure of £369,000. I checked this with the Medical Research Council, and they came up with a figure of £387,000. The difference is not great, and I am sure there is an explanation for it, so I do not want to pursue that.

But what I should like to draw the attention of the House to is the figure of £59,000 which has been provided by the noble Lord's department, the DHSS, because I think we should try to consider whether we think that is sufficient. I think I am right in saying that it means that there is an element of additionality to the tune of £59,000, though the rest of the funding is all coming from within the Medical Research Council's main budget.

As I understand it—and perhaps the noble Lord will correct me if I am wrong—that £59,000 from his department is distributed as follows: £45,000 going towards the project headed by Professor Ardler at Middlesex on research into all aspects of the disease, and £13,500 going to the project headed by Dr. Craske at the Public Health Laboratory in Manchester on haemophilia. I understand that those are the two areas in which the noble Lord's department is making a contribution. That is useful information which we are glad to have, but I should like to ask the noble Lord whether, in view of some of the remarks that have been made in this debate, he considers that that sort of contribution from the Department of Health and Social Security is really sufficient in the circumstances.

In the second part of his reply to me the noble Earl, Lord Caithness, said as follows: The grants authorised are for periods of 2 and 3 years; it is not possible to estimate expenditure for 1984/85 and 1985/86 as two of the grants have not yet incurred expenditure and their starting dates are unknown". That is perfectly clear. We all know that these projects are carried on over a period of time and that the money is used up only gradually. But I should like to seek the noble Lord's assurance that additional funds will be available for good, new projects if and when they come forward, and indeed for any trials which may be required resulting from epidemiological research.

I go back to the point that I made earlier. We are learning a lot from the United States of America, but I suggest to the noble Lord—and I hope he will agree—that we really must have our own research capability fully open and available for trying to find a cure for AIDS. I particularly noticed that the noble Lord, Lord Richardson, said that the virus had been isolated only in May last year, which is not very long ago, so there is a great deal to be said on the plus side. But as the noble Lord also said, we are still nowhere near to a vaccine or to a drug, so it seems that we should not relax our efforts and, particularly, that there should not be any drying up of funds if promising research is coming forward.

Finally, I should like to ask the noble Lord this question. I understand that there is a working party of the Medical Research Council which is monitoring all these areas of research, and I believe that five research projects are in progress at the moment. I also understand that there is a new group within the DHSS which, presumably, is monitoring the progress of the disease and of the research into it. I should like to ask the noble Lord to say a little more about this command post which is said to exist inside the department. Is it in constant touch with the Medical Research Council, and will he guarantee that there will be no shortage of additional funds, if and when they are genuinely required and there are real research projects which need them?

6.25 p.m.

Lord Ennals

My Lords, like other noble Lords and Baronesses, I think we all owe a very great deal of thanks to the noble Baroness, Lady Cox, for opening this debate and for doing it, as the noble Lord, Lord Richardson, said, with such skill, knowledge and sensitivity. It has been interesting that four of the speakers have been professional people, with two general practitioners, a consultant and a very senior nursing Baroness. The noble Baroness, Lady Masham, referred to the minority of women in your Lordships' House. If we look at today's debate we see that they have distinguished themselves, as they usually do. That means that male laymen like myself are in a very small minority in today's debate, so we must just do our best.

The main reason for congratulating the noble Baroness is that we in this House and Members of the other House, and all those who are concerned, have the major task of educating ourselves—which I think we have been doing—and of educating the public. After all, we are dealing with a virus which is relatively new; for which, as the noble Lord, Lord Rea, said, no preventive vaccine has yet been found; and for which there is as yet no known cure. Its importance is added to by the fact that, though the disease is still comparatively rare—I think the noble Baroness gave the figures of 7,980 cases in the United States and 118 in Britain in January—all the signs are that the numbers will, certainly for a period, continue to rise quite sharply. It is for this reason that we have to be very careful about some of the horrendous reports to which reference has been made.

The noble Lord, Lord Winstanley, posed some questions to which I would certainly not dare to give an answer, but from what one knows the epidemiological features so far indicate that the disease is virtually unknown outside the group that a number of noble Lords have defined—homosexuals, intravenous drug abusers, people from the Caribbean and from central Africa, and haemophiliacs.

Nevertheless, as the noble Baroness, Lady Cox, said, the existence of this disease, even though AIDS seems not to be contagious, has created a tremendous degree of concern, and indeed fear, among those who think that they may be severely at risk. We must know some, and we must also know that there are tens of thousands of others who today are living in desperate fear, partly because they have been misled, their misleading having been stimulated by some of the horrendous, over-dramatised press reporting. Part of the duty of your Lordships in a debate like this is to seek to set the record straight, in so far as people are prepared to listen to what we have to say.

The dangers are put into perspective in the authoritative article in the British Medical Journal, which was referred to by the noble Baroness, Lady Cox, on 23rd February 1985, and I want to re-quote just two sentences: The fact that tens of thousands of hospital workers in America and several thousands in Britain have been exposed to the virus and yet none has developed AIDS is reassuring, for it suggests that it is appreciably less infectious than Hepatitis B". I have no hesitation in repeating that because this should be clearly understood by those full of fear.

The article ends by saying: Doctors have a responsibility to put the record straight, to help people view the disease in perspective. Patients with AIDS not only need our professional help, but also our sympathy and understanding". I was glad that the noble Lord, Lord Rea, referred to "gay bashing". I heard only a few days ago of a public house in East Anglia that has a sign over its bar which says, "No homosexuals allowed". It is this kind of danger which we must seek to allay.

As early as 21st April 1984 an editorial in the British Medical Journal said: Even though our experience of patients is limited, we have our own examples of hysteria taking over from reasoned judgment of the facts". The editorial then referred to the fact that some 94 per cent. of American patients so far fall within the group which we have already mentioned. From American experience we can narrow down the group very substantially.

Personally I am most grateful to the Royal College of Nursing for their excellent guidance, which has been referred to by the noble Baroness, Lady Cox, which has value for people far beyond the nursing profession. I hope that these guidelines will be widely read not just by people who need to know, but by people who seek to know. Perhaps I may briefly paraphrase one or two of the points made in the guidelines. Referring to health education, they say that those who comprise the main at-risk groups should be advised to observe certain precautions within their particular life style: No one in the at-risk group should at the present time donate blood unless for research purposes or allow their organs to be used for transplantation. Such education and advice must make the subjects aware that they have an important role to play in preventing further the spread of that condition". So far as homosexuals are concerned—and again I shall paraphrase—there should be no contact with body fluids—saliva, semen, faeces and urine. These subjects should be strongly advised, to avoid sexual contact with men from North America. These restrictions also apply to heterosexuals within the at-risk group". The guidelines go on to say that health education is much more effective when the adviser stresses the things which can be done to maintain or promote a meaningful relationship and at the same time to encourage safe sexual practice. There are of course substitutes for those who feel deep affection for their male partner and we should not underestimate at all the grave problems that are faced by some of those who are living in perfectly stable homosexual relationships.

There is also some advice to intravenous drug abusers. The best advice that the health care adviser can offer is that the subject should seek help with the problem, and the adviser can give information on drug abuse centres. Of course, even more important advice is to give it up, but having said, "Give it up", one recognises that everyone is not going to give it up and that to do so is difficult. Where such advice from drug abuse centres is not welcome or relevant, hygiene education is essential and drug users should be advised to use only sterile equipment, as was pointed out by the noble Baroness, Lady Masham, including needles, when preparing drugs. There is more helpful and sensible advice and I think that it is our task to ensure that it is widely communicated throughout the community, especially to those who are at risk.

I want to say a word about a subject that has been mentioned by a number of your Lordships. I want to endorse the appreciation of the work of voluntary organisations and of volunteers in this field. Reference has been made to the Terence Higgins Trust, the role of which has been very important. It is the only organisation which has been able to concentrate virtually entirely on this problem. Reference has been made to the Blood Transfusion Service which, although run departmentally, is a voluntary service. Reference has been made to the Haemophilia Society. They are faced with people with grave worries at the present time. I admire the way in which they are helping to put the facts before those unfortunate people.

I want to deal now with the Government's responsibilities. I say straight away that I welcome the guidance to nurses and other action, particularly that concerning the Blood Transfusion Service which I think was rapid and exactly what was needed. I wish to make a number of other points. First, funds must be found to provide special units for handling what we know will be an increasing number of cases. Reference has been made by both the noble Lord, Lord Richardson, and the noble Baroness, Lady Masham, to the very heavy burden that is now falling on St. Mary's. This emphasises the need for other recognised equipped units which can deal with this increase.

Secondly, I endorse all that has been said by the noble Lord, Lord Winstanley, the noble Baroness, Lady Masham, and the noble Lord, Lord Kilmarnock, about research. I shall not repeat what they said.

Thirdly, I wish to make an urgent plea to the Government to take no action on the proposals of a DHSS cost-cutting working party in relation to the Public Health Laboratory Service. The recommendation that has been made in the working party's report, which I think has not yet been published, is that the PHLS should hand over its 52 laboratories in England and Wales to local health authorities. I do not think that the local health authorities, in view of their own financial difficulties, will appreciate this new burden being placed upon them.

Members of the governing board of the service are warning that such a move might seriously jeopardise the agency's ability to monitor the spread of infectious diseases, particularly AIDS. Scientists and technicians in the local laboratories test some six million specimens a year for viruses and for bacteria. Their skills in microbiology and their equipment make them uniquely qualified to track down the AIDS virus. I say to the noble Lord the Minister that I hope nothing will be done for cost-cutting reasons to undermine the status of the Public Health Laboratory Service, which I know from my own experience renders an extremely important service. This would be quite the wrong time to time any change.

Fourthly—and this is my penultimate point to the Government—I believe that AIDS should be a notifiable disease. Of course I noted the point made by the noble Lord, Lord Richardson, in which he took the opposite view. I have known the noble Lord, Lord Richardson, long enough to realise that in these matters he is wiser than I. I suppose that I must think again; nevertheless I say that there would be great merit in making it notifiable. I believe that it would not so much scare off from coming forward people who have or who fear they have the disease, but would do a great deal to reassure other people who are at present scared. I know that the Government are considering this matter and I hope that the Minister will say a word about it when he replies.

Finally, advice, information and guidelines must be made available not only to nurses, as has been referred to, but also to the prison service, to the police and to the fire service, because fear born of ignorance leads to decisions which add to the hysteria and panic which can only do harm to those who are patiently struggling to cope with this new and deadly disease. Therefore, anything more that the Government can do to make the facts as they are now known available to all who might have reason to fear would be action which I believe would be welcome by all Members of your Lordships' House.

6.40 p.m.

Lord Glenarthur

My Lords, the disease AIDS has certainly attracted considerable media attention and has generated much public concern and even unnecessary hysteria, as the noble Lord, Lord Richardson, suggested when he spoke. I therefore welcome this opportunity to explain some of the facts and to dispel some of the myths. I am most grateful to my noble friend Lady Cox for providing an opportunity to do this. She is certainly an expert, as is the case with so many other noble Lords who have spoken. Indeed, much of what I shall say tonight will be simply reinforcing many of my noble friend's remarks and those of others of your Lordships who have taken part.

It may be helpful if I first confirm some basic facts about the disease AIDS. AIDS is still a rare disease in this country. At the end of last month, as we have heard, 132 cases had been confirmed, of whom 58 have died. Contrary to some of the stories which have appeared in the media, AIDS is not a highly infectious disease and poses very little threat to members of the public who are outside the at-risk groups; it was these particular groups about which the noble Lord, Lord Winstanley, asked. The main way in which AIDS is passed is person-to-person through sexual intercourse between male homosexuals, particularly those with many different partners. Cases have also been recorded as a result of the infection being transmitted between drug misusers sharing needles and through contaminated blood products. A few cases have also occurred in the heterosexual partners of bisexual men.

Despite the attention it has attracted, much remains unknown about AIDS. What we do know is that in 1981 an apparently new disease appeared in the United States of America after separate reports of pneumocystic carinii pneumonia and Kaposi's sarcoma occurring in homosexual men. One hypothesis is that AIDS originated in sub-Saharan Africa and then spread to Europe in two ways; first, via the homosexual population in the United States and secondly, by Africans coming directly to Europe, particularly from Central Africa. The search for a causative agent resulted in the isolation of a virus from patients with AIDS and in AIDS risk groups in France and the United States. Both the French virus, known as LAV, and the United States virus, known as HTLV III, are now considered to be very similar and to be the primary causative agent, or at least one of the agents, of AIDS.

As to the incubation period about which the noble Lord, Lord Winstanley, asked, he and others who spoke were broadly right. Incubation is variously given to be between six months and five or so years. Through research under way in this country and abroad, we are confident that knowledge about the disease will improve. Research in the United Kingdom is being co-ordinated by a working party of the Government-funded Medical Research Council and is proceeding through five MRC projects. The DHSS is also funding the evaluation of AIDS antibody screening tests, and other work is going on in laboratories in various parts of the country.

As far as concerns detailed projects being conducted through the agency of the MRC, I can say that the two major projects into which the DHSS has a financial input are those being carried out by Professor Adler and Professor Tedder at the Middlesex Hospital with an investigation into the immunology and etiology of AIDS. The other is being undertaken by Dr. Krask at the PHLS in Manchester: he is making an epidemiological study of the relationship of AIDS in patients with disorders of blood coagulation to its possible acquisition through treatment with blood products.

So far as cost and the input of cash into the MRC are concerned, I am aware of the answer which my noble friend Lord Caithness gave to the question to which the noble Lord, Lord Kilmarnock, referred. I should like to look again at that particular answer because there appears to be some conflict in the figures which I cannot resolve immediately. I simply do not know why there should be this problem but I will look into this matter again and let the noble Lord know the answer.

So far as plans for further spending on research are concerned, it is of course a matter for the MRC to decide its specific priorities within the resources available to it from its grant in aid from the Department of Education and Science. I understand that the MRC is always willing to consider soundly-based research proposals but they do of course compete with other applications. In saying that, I do not want to leave the impression with either the noble Lord, Lord Kilmarnock, or the noble Lord, Lord Ennals, that the problem of AIDS is not one that is being taken extremely seriously.

Our officials are in regular contact with the World Health Organisation AIDS Reference Centre in Paris, which collates AIDS data from European countries. They are also in contact with officials of the United States Government, and staff of the Public Health Service and Communicable Disease Centres. There is also United Kingdom membership of the Comité de la Récherche Medicale Working Group on AIDS, which is responsible for European Community medical and public health research on the disease. As well as maintaining contact with the CRM working group, members of the United Kingdom Medical Research Council Working Party on AIDS are collaborating with research workers overseas who have isolated the AIDS-related virus to which I referred.

In the light of information available, the Government are taking a number of important practical steps to prevent and control the spread of the disease. We have set up an expert advisory group, the membership of which includes experts on all aspects of the disease from all over the United Kingdom. The group and its working parties have already met several times and further regular meetings will take place. The first priority of the group is to advise on measures necessary to control the spread of the disease.

The noble Lord, Lord Kilmarnock, asked about the connection between the MRC and the expert advisory group. The members of that group include Dr. Tyrrell, who chairs the MRC's working party, I can assure the noble Lord that liaison between those two bodies is extremely good. As some of your Lordships will be aware, and as the noble Lord, Lord Richardson, said, we have considered the desirability of making AIDS a notifiable disease. The noble Lord, Lord Ennals, also referred to this point. Having consulted the expert advisory group and sought the views of doctors specialising in the field, we are satisfied that the present reporting system to the Communicable Disease Surveillance Centre is operating effectively and that we do not need any new powers at the moment to monitor the spread of the disease.

Furthermore, experience with other sexually transmitted diseases suggests that notification would not assist in control of the disease; this was the main point which the noble Lord, Lord Richardson, was making. This is because the problems of sexually-transmitted diseases, including AIDS, are different from other types of infectious disease and require expertise in tracing, treatment and counselling not normally found in local authority environmental health departments which receive reports of cases of notifiable diseases.

There is also the possibility that this reporting system would cause problems of confidentiality which would make those at risk reluctant to come forward for treatment. It is for these reasons that no sexually transmitted diseases in this country are subject to a statutory reporting system to local authorities. Having said that, however, we will keep the situation under constant review.

We have looked at the benefits to be gained from making the disease subject to other statutory public health provisions. The limited infectivity of AIDS, and the minimal risk it poses to the general public, limit the need for such measures. However, very rare and exceptional cases might arise. We believe therefore that some reserve provisions should be available to safeguard public health if they do. We have therefore announced our intention to lay regulations to allow a patient to be admitted or detained in hospital in such exceptional circumstances.

The Government have taken other steps to prevent the spread of AIDS. At the centre of our strategy lie a number of public health measures aimed at health professionals and "at risk" groups. At the request of the health departments and the Health and Safety Commission, the expert Advisory Committee on Dangerous Pathogens has drawn up interim guidelines to safeguard the health of medical staff, nursing staff, those to whom my noble friend Lady Cox referred, and others who may come into contact with AIDS patients and specimens taken from them. These guidelines were distributed on 16th January to all health authorities.

It is recognised that rapid advances are taking place in the understanding of the disease and the virus related to it. It is for this reason that the guidelines are interim. In answer to my noble friened's question about further research on this issue, I can tell her that the advisory committee will be reviewing the practical operation of the measures recommended in the guidelines within the next 12 months. It will take into account any new scientific information, together with evidence or comments submitted by health care workers, researchers in the field, and other interested parties.

Secondly, leaflets have been produced by the Health Education Council to promote greater awareness of the risks of the disease. These are now being made available in substantial numbers to individuals in "at risk" groups such as male homosexuals and intravenous drug misusers. They are also available to the public generally, and that of course would include young people who have worries about the disease and for whom my noble friend Lady Dudley expressed concern.

There is also a valuable role for the voluntary sector to play in this field. We have already made a grant of £15,000 to the Haemophilia Society to help its AIDS-related information and advice activities. The Terrence Higgins Trust, to which my noble friend Lady Cox and others referred and which is a voluntary organisation named after the first person to die of AIDS in this country, has also been doing important work in providing information, counselling and support to AIDS sufferers and others who have worries about the disease. Today I am pleased to announce that we shall be giving it a £25,000 grant to allow it to expand its activities connected with AIDS. I hope that that will be some encouragement to the noble Lord, Lord Rea, as well, who particularly mentioned how worthy he thought that its work was.

Thirdly, measures are being taken to safeguard recipients of blood and blood products. We have strengthened our efforts to dissuade persons in the AIDS high-risk groups from donating blood. The latest edition of our leaflet, AIDS—Important New Advice for Blood Donors, has been sent to all regional transfusion centres and is being distributed individually to all donors.

Fourthly, tests to screen blood donations for antibody to the AIDS virus HTLV III are being developed both in the United Kingdom and abroad. We are concerned that no test should be introduced routinely into the National Blood Transfusion Service until it has been proved to be reliable and satisfactory. We cannot accept significant rates of either false positives or false negatives. We are therefore co-ordinating evaluation work to assess these tests as they become available in this country. We have written to regional health authorities asking them to set aside funds in 1985–86 to introduce screening tests, when proved satisfactory, into their blood transfusion centres.

Finally—and this was a point that was raised by the noble Lord, Lord Kilmarnock, particularly—we have granted a number of product licences for imported heat-treated Factor VIII for haemophiliacs. It is hoped that by April this year all the Factor VIII made by the blood products laboratory at Elstree will be heat-treated. Limited supplies are available at present for clinical trials. I hope that I shall be able to reassure the noble Baroness, Lady Masham, by saying that we are taking steps to ensure that the United Kingdom is self-sufficient in all blood products as soon as possible. In particular, as I think she will be aware, we are investing £35 million in new developments at Elstree to come into production in 1986.

So far as artificial Factor VIII is concerned—which was another point raised by the noble Lord, Lord Kilmarnock—I understand that it has been synthesised in recent laboratory work, but the commercial sale of manufactured products such as artificial Factor VIII is several years away. I think that the Factor VIII that we shall be able to get from the Developed Blood Products Laboratory at Elstree is the most immediate answer to the problem.

The noble Baroness, Lady Masham, asked several other questions about blood. I am aware of the concern of those who either receive blood, or blood products, or who give it. I am grateful to her for making the point that needles are used only once. The country is already self-sufficient in whole blood. Those who are at high risk from AIDS have been told not to donate blood, as I said. Our voluntary donor system means that there is no financial incentive for them to give blood, and there is therefore only a remote chance of contracting AIDS from ordinary blood transfusions given in hospitals. As we have stressed in the past, donors cannot get AIDS by giving blood—again on the point that the noble Baroness made about needles being used only once.

So far as the screening test itself is concerned, the diagnostic test kits to detect antibody in blood to the AIDS-related virus are likely to be offered for sale in this country shortly. They are intended strictly for laboratory use. It is the department's intention to evaluate those test kits as soon as possible and to use an independent test centre for doing so. It will then publish a list of those which are found to be satisfactory and reliable for routine use in the National Health Service. The tests will detect the presence of AIDS antibody in a person's blood; but of course that does not necessarily mean that he or she has or will have AIDS. That is an important point to make. The tests merely show that they have been infected with the virus at some time. Those tests are likely to find the greatest application in screening blood donations when they are validated. However, they may be appropriate for use in VD clinics and in the diagnosis of illness which is suspected of being caused by the AIDS virus.

Lord Winstanley

My Lords, are the kits to which the noble Lord refers of British manufacture or imported?

Lord Glenarthur

My Lords, I think that they are imported. I am not 100 per cent. sure. I can certainly look into it and let the noble Lord know. In any case, they have to go through the same evaluation procedure, which is the important point to make.

The noble Lord, Lord Ennals, asked me particularly about St. Mary's. The vast majority of cases have been dealt with by that unit in the past. I am aware of the concern which has been expressed by the noble Lord and others. As a result of that concern and the workload which falls upon the unit, we are now discussing with the regional health authority how best the difficulty can be met.

The noble Lord also asked about the future of the Public Health Laboratory Service. A review of the Public Health Laboratory Service Board has been carried out under the normal accountability arrangements for non-departmental public bodies. We shall issue a report of the review for consultation in the near future. I can certainly arrange for a copy to be placed in the Library when it is available. We shall consider the report's recommendations in the light of that consultation. But I should not like the noble Lord to think that in any sense will that review stand those who suffer from AIDS, or may do, at any risk in the future. I too have a responsibility—a special responsibility—for the PHLS. It is a separate issue, but I can certainly make the report available when it arrives.

As to the future spread of AIDS in this country, we have very few cases and it is too early to make accurate predictions. However, this is because there is evidence to show that people in the "at risk" groups have taken notice of the health education material and have been changing their behaviour in response to the threat of the disease.

Lord Harmar-Nicholls

My Lords, may I ask a question? My noble friend may already have given the answer. Is every batch of blood in the bank tested? The point that puzzled me a bit is this. I accept what my noble friend has said—that people in what we call the high risk groups have the pamphlets and are generally advised, but that they are not isolated because that could stop people reporting to transfusion centres for fear of being recognised as being in a high risk group. However, if someone in a high risk group has been a regular donor and is rather proud of the badges that he has received for having given blood over the years, is that not a reason why such a person, perhaps for social reasons, would not take heed of the pamphlet? That is the same basis as the argument for not isolating people. However, that would not matter if each batch went through some kind of test before it was put into the bank. Is that done? My noble friend may have said that it is, but I was not clear.

Lord Glenarthur

My Lords, I think the first point made is that the people who donate blood in this country are on the whole responsible people and they are not going to want to put at risk those who might need blood at any time in the future. There is not a test. This is the point that I was trying to make. I described the kits that may be available, but until we have a reliable test to check whether or not the AIDS virus or the AIDS antibody is present in the blood, we cannot really take it any further.

Baroness Masham of Ilton

My Lords, may I just follow on from that because that was the major point that I made in the debate? I was concerned about the need for counselling. A homosexual might well go to give blood and not want his wife to know that he has a dual relationship. This is the big problem.

Lord Glenarthur

Yes, my Lords, I agree that it is a very big problem. But in advising people at blood transfusion centres we have to be very careful not to run the risk of some kind of panic-induced collapse in the supply of blood. At the same time we have to balance that against the very real worries of those who might contract the disease through blood or blood products. As I have said, there is really no incentive on the part of anybody to part with his blood if he is from an at-risk group. The leaflets have been made available; they are going direct to donors and they are available at transfusion centres, and I think that that is the best way of dealing with this particular problem. I certainly agree with the noble Baroness when she says that counselling is important. At the same time, one cannot be too inquisitive about people's habits.

Lord Rea

My Lords, I am sorry to come in again. There is some information on this very point. I believe that many blood transfusion centres allow donors to state in private whether or not they want their blood to be used (I quote) "for experimental purposes only". This is done confidentially so that their partner does not know about it.

Lord Glenarthur

My Lords, I was interested to hear the remarks of the noble Lord. I can say that in Scotland they have decided to require a signed declaration that the person concerned is not in the at-risk groups. But this is not directed solely or specifically at their sexual habits. It is a very difficult area; I think both the noble Baroness and the noble Lord, Lord Rea, understand that. Nevertheless, we are satisfied at the moment that the response we are getting from the steps that we have taken is satisfactory. I should certainly like to leave it like that at the moment, while bearing in mind the concern which has been expressed this evening.

I end rather as I started, by saying that AIDS is a serious and often fatal condition. But I must stress, as others have done, that it is extremely rare; and it is not infectious in the way measles, chickenpox, hepatitis or 'flu are. It is not passed on by infection from lavatory seats or dirty glasses, or by shaking hands with an infected person. Although the virus has been found present in saliva, there is no record, here or abroad, of the disease being transmitted through it. Nevereless, the Government believe that the steps we have taken, coupled with widespread international research, are sensible and practical means to control the spread of the disease and deserve the confidence of the public at large.