AIDS: World Health Summit

HL Deb 03 February 1988 vol 492 cc1077-114

2.59 p.m.

Lord Kilmarnock rose to call attention to the World Summit of Ministers of Health on AIDS and to the current situation in the United Kingdom with particular reference to Cmnd. 297, Problems Associated with AIDS; and to move for Papers.

The noble Lord said: My Lords, AIDS has penetrated into so many corners of our national life that inevitably in the time allowed for a short debate I shall have to omit some topics which I hope that other noble Lords will take up. Among them are some that are close to my heart, such as basic research; haemophiliacs and whether the Government's grant to them will be enough; and the London Lighthouse. I cannot let this occasion pass without paying my personal tribute to Ian McKellen, who, after a seven-week run of his one-man show "Acting Shakespeare", has contributed single-handed almost £½ million to the completion of that project. That is a fantastic achievement, as I am sure all your Lordships will agree. I am certain too that we are all looking forward with great expectation to the maiden speech of the right reverend Prelate.

Your Lordships will be aware of the International Conference of Ministers of Health on Aids Prevention which took place recently in London, jointly sponsored by the World Health Organisation and the British Government. The final statement declared that AIDS poses a global threat to humanity and that urgent action is needed by governments and people all over the world to prevent its spread. It warned, significantly, that public health would be undermined if discrimination against and stigmatisation of people with AIDS was not avoided, a point to which I shall return.

During the conference some of us in your Lordships' House, together with some Members of another place, had the opportunity to meet the Health Ministers, or their representatives, of France, Canada, Uganda and the Bahamas, all countries with a higher rate of AIDS cases per head of the population than ourselves. All those countries expressed considerable respect for the British handling of the disease to date. But there were some reservations and those sprang in part from their detection of a certain loss of impetus in our campaign, particularly on television.

This coincides with a slightly uneasy feeling I have had that we have not quite recovered the sense of urgency about AIDS which we had before the general election. This may be something to do with a new Secretary of State getting into his stride. I think Mr. Fowler gave real leadership on dealing with AIDS and I have no doubt that his successor will follow suit in due course. But the message from our foreign friends, which I endorse, is that what we have done we have done well but we have not yet done enough and certainly cannot afford even the briefest flirtation with complacency.

One feature of virtually all other countries' approach to AIDS is that they have a national coordinating committee. I suggested such a body in an article in The Times a little over a year ago but it did not find favour. The French call theirs a Committee of Reflection. Its job is to advise the leading Minister. Its members include scientists, specialists in ethics, education, communication and leisure, and also representatives from industry, insurance companies and the Churches. Perhaps it is not surprising that the French should want to have a national plan. That is the way they do things and by nature we are suspicious of grand national plans. But if one is fighting a war, as we are, it is sensible to have a strategy.

The Select Committee on Social Services of another place has recommended such a body, but this suggestion was rejected by the Government in their response on the grounds that the present arrangements are working adequately. I am not sure that that is wise and I think it smacks a little of complacency. I am not reflecting adversely on the AIDS unit of the DHSS, which does an excellent job with a tiny staff, or on the Chief Medical Officer, who deserves our gratitude for his cool head, wise advice and constant vigilance. What I am saying is that we need a strategic body, which we do not have.

Before the election there was a Cabinet Committee headed by the noble Viscount, Lord Whitelaw, but this was an extremely shadowy body to the general public and its very existence was sometimes denied. I see from the press that it is now to be headed by Mr. Moore, who seems the obvious choice. But would it not be better if we had something that was more out in the open with known and named members and a defined role? I believe that public confidence would be much increased in this way and I shall be interested in the noble Lord's comments on the proposal.

All the countries represented at the international conference were agreed that education and counselling are at present far the most powerful weapons we have against AIDS. But information, however efficiently disseminated, is not enough. Professor Alain Pompidou, the French national coordinator, warned that being informed does not mean knowing, that being aware does not mean taking steps and that deciding does not necessarily mean doing.

I turn again to Cmnd. 297, Problems Associated With AIDS, which is also mentioned in my Motion. As it is a response to the Third Report of the Social Services Committee of the House of Commons of the last Session of Parliament, it will no doubt be debated in detail in the other place. I just want to refer to one or two of its paragraphs.

In the part devoted to education and prevention, there are a number of references to the Health Education Authority. I have not the time to discuss the authority's remit in any detail, but can the noble Lord say how far it extends into schools? The Government appear to be committed to providing educational material on AIDS and sexual behaviour for young people through collaboration between the Department of Education and Science and the Health Education Authority. But paragraph 3.35 tells us: Under the provisions of the Education (No. 2) Act 1986 it is now the responsibility of individual governing bodies in England and Wales to decide whether and, if so, how sex education is provided in schools. The Government trusts that, in determining their policy in this area, governors will take note of the Committee's recommendations".

I seriously doubt whether this very mild exhortation is sufficient. If we also take into account the tight curricular framework proposed in the Education Reform Bill, it seems to me that anything like the French video campaign to all secondary schools might well be impossible under English law. Can the noble Lord offer me any encouragement here? If not, I shall certainly feel obliged to raise the matter again when the Education Reform Bill comes before the House.

It is impossible to speak about education without referring to counselling. You can produce all the material in the world—written, visual or audiovisual—but it is useless if awareness campaigns are not backed up by trained personnel in advice centres, information outlets and so on. In Britain we have only just begun to wake up to the need for trained counsellors. Without the voluntary sector we would virtually have none at all. We are a long way behind comparable countries in this respect.

In paragraph 4.2 of the Government's response to the House of Commons report, we read that the Government: has funded regional workshops for senior community nurses and has awarded 13 AIDS fellowships worth £3,000 each".

This is peanuts compared with the French initiative under which more than 20 programmes are in operation with almost 2,000 trainees, consisting of paramedics, other health workers and social workers. Incidentally we learn from M. Pompidou that France has 150,000 social workers, a figure that will, I think, bring envy to the otherwise blameless heart of the noble Baroness, Lady Faithfull. A sizeable contingent of them is participating in the training programmes I have indicated. Can the noble Lord say anything on the training of British social workers in the field of AIDS?

Apart from lack of funds, I still suspect that a threat to AIDS counselling lurks in the heart of Clause 28 of the Local Government Bill. I raised this point yesterday in the debate on clause stand part. The noble Earl, Lord Caithness, gave some rather generalised assurances in his reply which I want to study further. So this is something I shall probably want to pursue at the next stage of that Bill.

I turn to the scale of the threat. Approximately 75,000 people have AIDS at present and that number is expected to double to 150,000 this year world-wide. By the year 2000, it is suggested in a recent book, there could be a cumulative total of 25 million cases world-wide. On another projection the peak will be reached in 1998, with 65,000 sick from AIDS in the United Kingdom and another 48,000 dying. But even if we are chary of catastrophic predictions, current totals, if projected forward only two or three years, are quite sufficiently alarming.

Canada, with less than half our population, had 1,334 cases at the end of September 1987 and expects this to rise to 7,000 by 1991. France, with a population almost equal to ours, had 3,073 recorded cases by the end of last year, a number which will inevitably double this year. Our numbers are lower. At the end of last year, there was a cumulative total in the United Kingdom of 1,227 cases of whom 697 had died. But this was a 2.4-fold increase on the previous year's end.

If this rate of increase were maintained we might, according to the Office of Health Economics, expect about 5,500 deaths in 1990. This in turn would imply that there would be some 5,000 live patients requiring treatment in our hospitals. I am not citing those admittedly imprecise figures simply as a scaremonger. The point of them is that even the projections at the very lowest end of the scale will place vastly increased strains on our already overstrained National Health Service.

This brings me to a very important area in the report of the Select Committee dealing with medical manpower. Time and again in their evidence leading figures in the hospital world, including Mr. Miller, senior clinical psychologist at Middlesex Hospital, Dr. Antony Pinching, senior lecturer in clinical immunology at St. Mary's, and Professor Adler, head of the Department of Genito-Urinary Medicine at the Middlesex, drew attention to manpower constraints, due basically to financial constraints, which are not only pushing existing staff to the point of burn-out but making the recruitment of new staff impossible. Even the present case load could not be handled at all if academic clincial doctors were not devoting a far higher proportion of their time to patient care than is consistent with their research responsibilities.

In view of these eloquent appeals, which your Lordships will find in paragraphs 117 to 123 of the Select Committee's report, the committee said in its recommendation 52: We believe that, with large numbers of people developing an illness which requires intensive levels of care and a high level of expertise for its proper management and which affects a sector of the population who would not otherwise have placed any demands on the health services, additional manpower provision is urgently needed in both training and consultant grades in traditional specialties and in the specifically relevant specialties of clinical immunology and infectious diseases".

The Government's reply to this is one of the weakest in their whole response. In paragraph 4.28 they say that they take the point about the additional workload, but at consultant level the responsibility for this lies with regional health authorities and with the Royal colleges. The joint planning advisory committee will then ensure that there are enough training posts to balance consultant vacancies. No indication is given whatsoever of how any of this expansion is to be paid for. This is a totally inadequate response to the telling points made by Dr. Pinching and his colleagues. I must ask the Government to look at this again.

Thus, I come to the central question of the funding of hospital services. One of the most important of the Select Committee's recommendations is paragraph 94, which reads: If the current estimates of the likely spread of the disease are in any way accurate, then the demand on resources will increase substantially and rapidly. In our view the rising demand must be met from new resources and not by diverting resources from other parts of the health and social services". The Government's reply at paragraph 4.35 is again inadequate in my view. After coming out against separate resource allocations for AIDS, they say: Nor is it realistic to assume that AIDS-related services or research can, or should be given absolute priority over all other health and Government spending; nor protected from the pressures and constraints that other health and personal social services experience. In short, there can be no blank cheque". But it is not a question of a blank cheque. The Social Services Committee specifically said so. It is a question of meeting particular pressures at particular points in the service.

Perhaps I can best illustrate the problem if I refer to a debate before London University students in which I participated with Mr. Tony Newton. I was arguing that there should be a centrally earmarked AIDS fund to which health authorities should be able to make bids to meet additional costs imposed by AIDS, by-passing the normal lengthy process from central government to region then to district. Mr. Newton argued that it was wrong to treat AIDS in a different category from other diseases. We did not after all have separate AIDS hospitals and frequently AIDS patients are treated in the same wards as patients with other diseases. He argued that AIDS should be handled within the mainstream of the NHS; therefore funding should flow through the normal channels with occasional top-ups for emergencies.

I have great respect for Mr. Newton. I regard him as an able and committed Minister. I have sympathy with his argument that AIDS should not be marginalised and relegated to a ghetto-type service. That is morally correct. The difficulty is that this tends to mask the underfunding that leads to the terrific pressure on medical manpower that Dr. Pinching and others have referred to. Also it adds to the genuine fears of trade-off and backlash as other areas become threatened by the necessity of funding clinical research and care of AIDS out of the same general budget.

I now believe that the best course is for the normal channels to be used, as Mr. Newton suggests, but for the Government to recognise more readily the additional pressures. They will point to the £58.6 million that they have pledged for 1988–89, over which the noble Lord, Lord Skelmersdale, and I got into a tangle on Wednesday, 16th December, and which he will no doubt unravel today. But this is well short of the £80 million or so which the Office of Health Economics has calculated as being the likely real additional cost. The Social Services Committee recommends that injections of money should be made at specific points, each request being judged on its own merits and if justified given the funding it requires. Therefore I hope that there will be some flexibility. I frankly think that the only way ahead is fully to fund additional AIDS costs where they can reasonably be substantiated by health authorities. I hope that the Government will come round to this view.

I come finally to the ethical questions which underlie our attitude to AIDS and will ultimately dictate our response. I believe that the Government deserve to be commended on the way in which they have so far avoided scapegoating. They have treated the disease first and foremost as a huge public health hazard requiring the collaboration of all sectors of the community. They have funded and do fund homosexual organisations as frontline troops in the battle, and I hope they will continue to do so. There is obviously a moral dimension. But immorality attaches less to one group or another than to those of any group who continue to behave in ways that threaten others. After all, the virus pre-existed any particular act of sexual intercourse. Sex is a principal means of transmission; it is not the cause.

In what Professor Clayton of Canada called a plague mentality, there is an obvious but regrettable tendency to seek scapegoats among certain social or ethnic groups. The danger of focusing disapproval on particular groups is that it distracts attention from the real risk of spread among the "normal" population. There is quite a volume of evidence to suggest that the heterosexual community is not putting its house in order as fast as the homosexuals.

In the United Kingdom only 322 out of 7,557 antibody positive persons reported to the end of September last year could be attributed exclusively to heterosexual contact. But this was an 80 per cent. increase on the count taken only six months earlier, so the composition of future AIDS case loads is likely to reflect a slow but nonetheless steady expansion into the heterosexual population. Professor Clayton told us that in his view those who had least progressed from awareness to action were multiple sexually active heterosexual males and females. This goes to show that one cannot simply put a ring fence or a cordon sanitaire round a supposedly "normal" morally and physically healthy population. In this sense we are all willy-nilly very much members one of another.

In her speech to the international conference the Princess Royal was perfectly right to draw attention to the dreadful scourge unleashed on haemophiliacs and to the awful tragedy of children born to AIDS-infected mothers. But with respect to Her Royal Highness, there is virtually no evidence in this country of "revenge sex", and the Social Services Committee's report refers specifically to that in paragraph 172. It would indeed be an "own goal" if we drove AIDS sufferers or sero-positive people into such desperate action against their fellow creatures.

Dr. Okware, the eloquent and expert delegate to the conference from Uganda, said something memorable that I noted down: If you mishandle AIDS patients they can be more dangerous than the virus itself. We are fortunate in having far greater preventive, clinical and financial resources than Uganda. With a much larger population we have only half the number of cases. But I am convinced that we shall waste these advantages if we allow the current climate of intolerance to spread into the field of AIDS. Our Government have so far resisted any such tendency. I hope they will stand firm. I beg to move for Papers.

3.17 p.m.

Lord Quinton

My Lords, for anyone like myself at a very remote distance from the professional frontline on this subject, there is a more than usual danger that one will be saying things that are already totally out of date. It is for this reason, as part of my gratitude to the noble Lord, Lord Kilmarnock, for introducing the subject, that I welcomed the emphasis in the early part of his remarks on the need for both a continuous flow of up-to-date information about what is going on—in view of the horrific statistical gradients that the dotted lines of prediction place before us and which to some extent in Africa seem to be being realised—and his recommendation of some central body to be a pool of information. After all, this problem has only been clearly identified for less than a decade, even if the virus was already present in people for some considerable time before that.

One very depressing belief that has altered with the passage of time concerns the incubation period. It seems constantly to turn out to be longer and longer. People can carry the HI virus around in themselves for years and years before contracting, or showing symptoms of, the disease. The average incubation period goes up year by year as the history of close observation of the disease prolongs itself.

There is, however, a kind of compensating consideration. Here again I put forward a reasonably well established truth that itself may be questionable, although I think it is fair to say that all the evidence at present seems to support it. This is that the disease is rather hard to catch. It requires that some bodily secretion of an infected person enters a lesion in the skin surface of the receiver of the infection. The two most familiar ways in which this has occurred are in a certain form of homosexual activity and by intravenous drug use. These define the two main groups who are at risk as a result, one might say, of positive actions of their own. There remain over and above them sufferers who are haemophiliacs, or other receivers of transfusions where the blood involved is infected, and the children of AIDS-infected mothers.

This fact about the difficulty of contraction of the disease is an important one in a social problem which has manifested itself in a conspicuous and rather repulsive way in the United States, where the parents of children in schools have resisted the presence of children with AIDS. Various forms of offensive, violent and aggressive pressure have been exerted on the parents of such children, who are normally haemophiliacs or the receivers of transfusion.

I suggested earlier that it seemed to be reasonably clear that, as a physical transaction, AIDS is quite hard to contract. It is important that that information should be widely spread—that is in so far as it is well founded, and at the moment all the evidence we have suggests that it is—in order to prevent some kind of ugly mob behaviour against those sufferers from AIDS who make the most obvious and immediate appeal to human sympathy: the children who have acquired it by blood transfusion or by inheritance.

I believe that information should be spread in an authoritative way with such caution as there must always be in matters of this kind. Parents should be told that there is no evidence that ordinary social presence with an AIDS sufferer constitutes any danger. It has been suggested by some people that there are perhaps two classes of child where a measure of sequestration must be appropriate. The first group includes those who are given to violent behaviour so that they are likely to collide in a skin-splitting way with other children. Secondly, there are children with limited control of their own bodily movements. However, they will constitute a minimal fraction of the involved population although this is one of the dangers.

I believe that the problem relates to the point made by the noble Lord, Lord Kilmarnock, in quoting from the Minister in Uganda who said that AIDS patients, if wrongly treated, can turn out to be more dangerous than the disease itself. A society can be gravely torn and upset within by unthinking mob reaction to what is described as a plague, applying to it ideas derived from bubonic plague which are totally inappropriate.

The need for the central body is to act in a responsible way; to co-ordinate existing information from the experience of this country and others; and to provide the kind of authority that cannot be aspired to in the terrific confusion of witness in newspaper articles and television programmes. They are no doubt written with the best possible intentions but in them authoritative knowledge has been very considerably diluted.

I should like to disagree with the noble Lord in his comments about heterosexuals. I do not know whether the 300 or 400 cases out of the 7,000 to which he alluded include any intravenous drug users or any sufferers from venereal disease. There is good evidence that certain features of some of the symptoms of venereal disease constitute the kind of lesion though which the virus can enter the system of the recipient. It would be a significant fact if a disproportionate number of the 350-plus cases he mentioned as regards the population as a whole were cases also of venereal disease. Normal, straightforward human interactions do not seem to involve the transfer. Quite a large number of female prostitutes appear to have contracted the disease, but, in the developed world, they do not appear greatly to pass it on to their male clients.

It is argued by many people that if one looks at the statistics in Africa one finds that there is not the extraordinary disproportion between the numbers of males and females infected by the disease. In Africa there is a rough equality between the sexes in the proportion of infection. I think that there are good explanations for that: possibly three main ones, although two are fairly closely connected. First, most of the blood used in transfusions in Africa is not screened, for the obvious reason of the poverty of the medical services. Much of the disease is communicated through ordinary transfusion where in a developed, well-off society, steps can be taken to throw away any blood likely to carry the infection. Secondly, needle use in Africa is equally insanitary. The same old needle is used again and again. If just once in its history it enters into the secretions of an infected person that needle can pass the infection on to any others who use it. It is a fact about Africa that the success of inoculation in banishing some diseases has had a disastrous social effect in that it has created a profession of totally unqualified injection-givers. They inject goodness knows what and practise as medical auxiliaries of some kind. Patients who are not drug users have been seen in African clinics pitted with needle marks from the receipt of this highly informal and, as it now turns out, exceedingly dangerous form of treatment. Thirdly, there is a great deal of venereal disease in Africa.

I have not raised those points in order to demolish the thesis put forward by the noble Lord opposite that we should not suppose that a ring can be drawn around some infectable minority of the community while the rest of us can look over the wall quite happily. I think it suggests that we do not have to suppose the likelihood of some universal involvement in this disease. There is time to do something. It is important to spread information and educate because there is no cure. That situation is somewhat exacerbated by the fact that there is no such thing as spontaneous remission in the disease; it seems that everyone who contracts it dies. Another melancholy fact is that the proportion of those who carry the virus and then contract the disease seems to be constantly increasing. That ties up with what I said earlier about the length of the incubation period. I do not want to reinstate the argument which the noble Lord was opposing.

On the other hand, it is desirable to emphasise that certain clearly identifiable behaviours enormously enhance the risk of the disease because that will allow steps to be taken to prevent its spread at the point where it has most intensely congregated and has become congested at the present time. One must also balance my comments about the relative likelihood of the risk of the relative groups against what I urged to be an important and well-founded belief that there is little danger in ordinary social transaction of people contracting the disease from those who have it. There is no need to introduce leprosaria or the horrors of sequestration for people with the disease. They are people who are found to be HIV positive and at considerable statistical risk of ultimately contracting the disease.

The danger of which I am conscious is that of a cruel and unsympathetic reaction to all those who have the disease. That would be greatly enhanced by the belief that the disease could be easily transmitted from one person to another and that all the infected are Typhoid Marys. I believe that it is important to resist that danger, and part of the resistance is the fact that it appears to be hard to contract the disease by relatively moderate heterosexual activity—that is to say, by not having resort to prostitutes who have many other contacts which may involve infected people. This means that the disease is not therefore likely to sweep through the entire population. We must, however, be aware of the fact that the disease is so awful, and has such an indestructible hold on people when they contract it, that we have to do everything possible to contain it. On the other hand, we do not want to stop it at the cost of cruel treatment of those who have already contracted it.

3.30 p.m.

The Lord Bishop of Worcester

My Lords, all Members of the House will understand that one could have wished to make one's maiden speech on a subject less doleful than this, especially when required to be uncontroversial. One dreams of a maiden speech in which one propounds pleasantries on the development of English campanology in northern Italy. One can be fairly sure that only a few Members of the House would become contentious on that issue. But no; there is this very important debate, and we are grateful to the noble Lord, Lord Kilmarnock, for bringing it before us.

One difficulty about this subject is the length of time of incubation which is always liable to catch us off our guard so that we become complacent. I believe we should be grateful that the international conference was hosted in this country and that Her Majesty's Government are foremost among nations in the way they have tried to respond to the crisis. For that we should be grateful, though of course there is much more to be done.

I want to limit my remarks to offering your Lordships information about what the Churches are trying to do in responding to the crisis and to say something on the other part of this issue; namely, how lifestyles could be changed in order to prevent the spread of this disease.

First, let me say that the Churches are determined to have a high profile in caring, arousing public awareness and promoting education in this field and in combating those demons of ignorance, prejudice and fear which are such terrible enemies in the matter of AIDS. I can say that the Church of England Board for Social Responsibility was consulted by, and gave evidence to, the Social Services Committee of the other place. It promoted, with a very carefully assembled report, one of the more responsible debates in the General Synod, and it has published guidelines for pastoral care of which 20,000 copies have been sold. The Churches are particularly able to help because of their ubiquity. In all parts of society, there are Christian communities and congregations on the ground which can be aware of the disease when it comes their way and which can care not only for the victims but also for their families and friends.

Furthermore, the 43 dioceses of this country have programmes of education such as the one in the diocese of Gloucester, organised with the local social services and health authority, which seeks to be ready to respond to need where it arises. I received only last week a considerable paper for the Industrial Mission Association entitled AIDS in the Workplace so that industrial chaplains may be informed, educated and prepared for that eventuality at work.

Hospital chaplains are receiving, as part of their in-service training, education and preparation for the care of AIDS victims and their families. I have heard a most moving address on this subject indicating the ways in which those who have the disease desperately need to be affirmed as people, desperately need not to be rejected and shunned, even to the point of being held and having their hands shaken so that they are not treated as lepers. The YWCA has recently published guidelines showing that in their hostels people who have the virus will not be refused entry and people who know them will be informed and educated as to how to make friends with them.

I have been able to question those who represent the mainstream Churches. I find that they are determined to be a sign and symbol in our land of compassion and not condemnation and judgment. We believe that this comes before propounding any of the moral principles which might be right in looking at the way in which we can improve our lifestyle. Where people are ill, they must receive care; that is the principle on which we work.

Incidentally, I hope that the international conference will help us in England to keep matters in perspective, bearing in mind that countries with a gross national product sometimes of less than one-twentieth of a multinational company like ICI are going to find their health services under enormous strain. It will be second only to the problem of famine in the third world to meet the needs of the health services where the country is terribly poor. This will not be forgotten, I hope, when we are quite rightly spending multi-millions in this country on our own efforts to combat the disease.

Furthermore, the Churches are determined to support efforts to promote the right kind of debate. I have in my own house people concerned with the hospice movement. The whole question was argued and discussed as to whether hospices are places where people should go if they have AIDS or how they can be cared for in their home and continue a normal life for as long as possible. As I have said, we want to prevent scapegoating. A minority of people who are gifted and good to know should not become the object of persecution in our land. What happens to them now might happen to another minority tomorrow. We must be on our guard.

Equally, we can say to them, "If we are to protect you or defend you, we ask you to curb your proselytising and promotional activities which, if they were in the heterosexual field, would be equally unacceptable". This is not only because they will do their own case a great deal of harm but because young people who do not yet have their sexual orientations balanced or decided may have it balanced or decided for them under pressure from proselytisers.

I want to look at the question of life styles. It is not enough merely to talk about safe sex. It is not enough to have a condom campaign. Surely, after the last 25 years of enormous and rapid social change, we have come to the point where we need to look carefully at the place of sexuality in our lives and in all our relationships. In that, I believe, the Churches must say their piece. However, we cannot imagine that the Churches any longer have any social control and that merely to inveigh from the pulpit will cause people to alter their life styles.

A society which has been reared on the maxim, "It does not matter what you believe as long as you believe it does not matter" is not overnight going to be able to exercise a self-denying ordinance in these matters. A massive and corporate counselling and consultation process is required in which I hope the Church, with its traditional belief and teaching about monogamous marriage, celibacy before and faithfulness within marriage, will say its piece. The Church is no use to society which does not state its case.

However, we are in a very different world from the world in which many of your Lordships were brought up. We should be ready to listen to those who in every other way are highly moral but who do not buy our Christian sexual morality. In listening, we shall together be able to discover ways in which relationships between friends, between man and wife and between parents and children can be built up, improved and stabilised in such a way that we shall forefend the spread of this disease by the changing of our life style.

3.41 p.m.

Lord Bonham-Carter

My Lords, it is a very great pleasure for me today to have the opportunity to follow the right reverend Prelate and to be able to congratulate him on a most notable maiden speech. It was a speech which not only told us of the constructive work which the Church is performing in the very important area we are discussing today, but it was a speech which was uttered with great sincerity and conviction and it leads me and, I am sure, many other noble Lords, to look forward greatly to more speeches from him.

I join with other noble Lords in congratulating the Government on the vigour with which their campaign for informing the public of the dangers of AIDS has been conducted. It has been radical, bold and doubtless to some shocking—as it should be. However, promoting a campaign against AIDS is one thing; taking action to prevent the spread of AIDS is another. The action programme which they have to undertake needs to be equally open, equally radical and equally bold.

That having been said, together with my noble friend Lord Kilmarnock I should like to emphasise that the position in this country could well be worse. The dangers which we face are in fact to be witnessed not in England but in the east of Scotland and, above all, in Edinburgh. The McClelland Report states: The east of Scotland faces a problem which is at present unique in the United Kingdom but which threatens the rest of the country". That was written in 1986. As far as I can discover it is still true in 1988. Perhaps I may indicate with some figures why I have come to this conclusion.

In England less than 10 per cent. of injecting drug misusers are infected with the virus. In Scotland more than 50 per cent. of IDMs are infected. This alarming figure compares with New York or, to take another example, with Milan where 70 per cent. of IDMs are sero-positive. The difference between the United Kingdom, excluding Edinburgh, and, for example, Italy is that in Italy 64 per cent. of those with AIDS are injecting drug misusers and about 21 per cent. are homosexuals. In England the figures are almost exactly the reverse. Of those infected, 80 per cent. are homosexuals and 20 per cent. are IDMs. In this situation we have an opportunity in this country because there is substantial evidence that the education of homosexuals in practising safe sex produces positive results but to change the behaviour of injecting drug misusers is extremely difficult. That must be our target because it is among IDMs that infection can increase most rapidly.

Edinburgh is useful as an example because we can ask why it has happened there and why it has not happened elsewhere. The McClelland Report provides some answers of a tentative variety. First, in Edinburgh the police discouraged the sale of syringes and needles and confiscated syringes and needles from individuals on whom they found them. Hence drug misusers, drug dependents, resorted to what are called "shooting galleries"—that is, single rooms where people share needles. That is the classic way in which the infection is propagated.

Secondly, the medical profession in that part of the world was in general rather opposed to maintenance prescribing. Thirdly, there was low expenditure on the provision of services dealing with drug dependents and, consequently, individual drug users either never made contact with agencies or severed contact with those that existed. As far as I can discover, the present position in Edinburgh is not much better than it was then. The recommendations of the McClelland Report were not carried out with the vigour that they deserved.

I will be told in response to that rather severe judgment that Edinburgh has set up three AIDS units. However, AIDS units deal with people who are already infected. They are necessary and they are desirable, but what we must concentrate upon, and our first priority, must be prevention. It is a campaign to prevent the spread of AIDS which is the most important priority in society.

One facile answer sometimes given to those who advocate or who are arguing about prevention, is mandatory testing. I am glad to say that both the Select Committee and the Government in their response rejected mandatory testing, first, on technical grounds, in that it cannot be relied upon to identify all those at risk and, secondly, on the broader ground that mandatory testing has such, profound, ethical and legal consequences as to rule it out". In addition to those two compelling reasons, I would add that it is the wrong strategy.

The problem that we face and the strategy that we have to pursue is one that will allow us to identify those who are at risk. Having identified them we must obtain their co-operation. We can probably best do that by providing them with the advice, help, support and assistance they require. Having identified them, secured their co-operation and provided them with advice, we have the most difficult task of all, to which the right reverend Prelate referred, of changing their behaviour. That is a difficult task to achieve at any time and in any area. It means continuing the programme of public education on which the Government have embarked, not least in the schools.

I draw your Lordships' attention to the report of the Select Committee on this matter, which is not irrelevant to the debate we had yesterday. Recommendation 43 reads: Whatever policy governing bodies adopt towards sex education, we recommend that DES issue forceful guidance to schools on the risk of AIDS associated with drug abuse and on necessary immediate amendments to education about drug abuse". In fact we have to pursue almost exactly the opposite policy to that followed in Edinburgh. We must engage the co-operation of the police with the social services. We must co-ordinate the activities of the medical profession with other measures and we must consider, as the Government are considering, the wider distribution of free needles, as is done in Amsterdam. I shall be interested to know whether the Minister, in his reply, can give your Lordships information about this. It may be that it is too early to give the results of the experiments which the Government are conducting.

There is one particular danger to which I should like to draw attention, and that danger is in prisons. We know that in prisons drugs are prevalent; we know that homosexuality is practised; and therefore it is a dangerous area. On the other hand, it provides another opportunity in that we have a genuinely captive population who we can take the opportunity to educate, to counsel and to teach how to avoid the dangers and the practices which lead to AIDS. The opportunity is an obvious one; and the danger of failure to take that opportunity is that the prisons will become a breeding ground for AIDS.

Once again, I should like to quote your Lordships Recommendation 41 of the. Select Committee: If the Departments responsible for the prisons of this country have grasped the full implications that AIDS and HIV will have for the prison system, they have yet to show it. They must develop a much more responsive and responsible attitude if they are to meet this problem". I hope that is rapidly happening.

I would not only draw that recommendation to the attention of this House, but to a further recommendation which they make: that we might have to consider the prescription of methadone to drug users in prisons. I should also like to draw the attention of your Lordships to one of the conclusions of the World Health Organisation which was published in their report: Careful consideration should be given to making condoms available in prisons in the interests of the reduction of the spread of this disease". Finally, I should like to ask the Minister when the report of the Advisory Committee on Drugs Abuse called AIDS and Drug Abuse (which I believe has been with the Minister for some weeks now) will be published? It is potentially an exceedingly important report, and it is a pity that it was not available to us in time for this debate.

3.52 p.m.

Lord Auckland

My Lords, your Lordships will be grateful to the noble Lord, Lord Kilmarnock, for enabling us to discuss a problem which is depressing but which is of much urgency.

As the first of your Lordships to speak from these Benches, I should like to congratulate the right reverend Prelate the Bishop of Worcester on an outstandingly sensitive maiden speech. The Lords Spiritual and the Church as a whole have a very vital role to play in this particular matter because the relatives and dependants of those who die from this dreadful disease need sympathy and condolence. In a maiden speech of great distinction the right reverend Prelate has revealed how the Church can help.

Some months ago there was a picture in some of the newspapers of my right honourable friend Mr. Norman Fowler, who was then the Secretary of State for Health. In the course of a visit to San Francisco (where AIDS is alleged to have originated) Mr. Fowler was seen holding hands with a young man who was terminally ill with the condition. Anyone who saw that picture would have felt a shudder down his or her spine—whatever views one might have about AIDS and about those who contract it. I mention this because I believe that any Health Minister—and this applied to the noble Lord, Lord Ennals, during his distinguished career in office—visiting San Francisco would probably have done the same thing. More than anything else, I believe that picture made those who were unaware of AIDS and who saw the picture very much aware of the horrific implications of the condition.

The really sad aspect of all this is that the symptoms of AIDS—pneumonia, lung congestion leading to dementia—are, at least in the first two conditions, curable in themselves. It is a very sad situation that at the end of the 20th century, or nearing the end of it, with medical research making such huge progress, there is, as yet, no cure for AIDS.

I believe the real solution here lies in medical research. The work of the Medical Research Council has already been most distinguished. We must all hope and pray that they will come forward with a solution. I was not present at the international conference; but on the day of the conference I went to a luncheon given by my long-standing friend, the Ambassador of the Republic of Finland. It was a lunch given for Mrs. Pesola who was their Health Minister. The lunch took place at the Ambassador's residence.

Although there was not time during the course of the luncheon (which was attended by about 40 people) to discuss the specific problem of AIDS, it was quite apparent that she, a young person, was very visibly moved by what she had heard during the conference. Those who have visited Finland and other Scandinavian countries, will know of the enormous contributions that they have made to medicine as a whole. I have visited several hospitals in Finland, and I know what they are contributing towards medical research in various spheres. I am quite sure that AIDS is included in that research. I believe that the international conference, with more than 100 Ministers in attendance from all over the world, will do more to make one aware of this problem than almost anything else.

The main aspect of the problem is in research. Schools have a large role to play. Sex education, given properly in the course of biology classes (which I believe are handled far more sensitively and sensibly than in the days when many of my noble friends and others were of that age) is most important. Regarding the Government, I believe that there is a very big problem. The Government have been assailed for their own contribution. But we all know, looking at the health service generally—and there are many taking part in this debate who have had far more clinical experience of health matters than I—of the enormous pressures upon the National Health Service.

This is not in any way a party matter. One looks at the dreadful cancers now, and the amount of money which we all want to be spent on overcoming that disease. However, when we are looking at the finances of central government in relation to AIDS, we have to be a little more temperate. AIDS is not—as it was when it was first adumbrated—entirely caused by homosexual activity. In this country it was not until 1981 that we became aware of this illness. In 1981 everyone asked: "What on earth is AIDS?" The symptoms were there before; namely, pneumonia congestion of the lungs, brain disease, and so on.

We have now moved on seven years, and I should like to conclude by saying this. We can only hope and pray that a cure will come. The pharmaceutical companies are often criticized—and at times rightly—on a number of matters. But I believe they are playing their part. Medical research is also playing its part.

I return to that picture of Mr. Fowler in San Francisco. It would be no bad thing if that picture was circulated around the whole country even now; not because it was Mr. Fowler, but because it was the Secretary of State for Health who was visiting a country from where this tragedy emanated. I conclude by saying that I hope the Government will do all they can in relation to the whole problem—not only concerning AIDS but with other conditions—in the matter of medical research.

4.1 p.m.

Baroness Masham of Ilton

My Lords, I also add my thanks to the noble Lord, Lord Kilmarnock, and my congratulations to the right reverend Prelate. On Thursday, 14th July 1983, three noble Baronesses in your Lordships' House asked the Government pressing questions on the AIDS virus. They were the noble Baronesses, Lady Dudley, Lady Gardner of Parkes and myself. The noble Lord, Lord Glenarthur, answering for the Government, said: Although there is no conclusive evidence that AIDS is transmitted by blood or blood products, the Department is considering the publication of a leaflet indicating the circumstances in which blood donations should be avoided. Since 1983 we have seen the alarming spread of this terrible affliction which is causing so much human devastation and fear throughout the world. Last week 148 states plus the Vatican, declared: AIDS is a global problem that poses a serious threat to humanity. I was worried about AIDS in 1983. I am even more worried about it now. I quote from the Sunday Times: While heterosexual men who don't inject drugs, and others who avoid high risk acts, are likely to remain more or less safe from AIDS, women will not be so lucky.". As the conference heard, although AIDS is not easily spread from females to males, the unprejudiced behaviour of the virus is already revealing a huge incidence of male bisexuality causing some women to be infected by their men.

In Edinburgh it is said that they are no longer talking about a wild bunch of drug addicts: it is ordinary young people. AIDS has spread so much into the community that people do not know who has it. A young person I know aged 22 was infatuated with a young man from abroad. I suggested that she took care because of the risk of AIDS. Her reply was: "How can you say a friend of mine might have AIDS?". My reply was: "If you don't know much about him, whoever he is, you just don't know.".

There are many people who seem to want to shut out the thought of the risk of AIDS. The Government have done a great deal to try to advertise the problems. It is sometimes not until a close friend is affected that a person will take notice. The Government have put a great deal of extra money into the AIDS dilemma. But on reading Cmnd. 297 "Problems Associated with AIDS", I feel they are not making a positive enough approach over testing. The problem is far too serious to duck the issue of testing.

Recommendation 2 states: We are unable to recommend the general use of anonymised screening at this stage. I see little use of that sort of screening at any stage. If we want to prevent AIDS, I think the Government will have to make screening much more readily available. One Minister said to me: "What do we do when we find people positive'?" They should be carefully counselled and the greatest persuasion used so that they do not sleep around and spread the virus. If they are injecting drug users, they should stop sharing needles.

Many people who visit certain countries now have to be tested; and that is the policy of several countries. I have not heard of anyone who has refused. If it is the policy that hospital patients when admitted have a routine test along with the other usual blood tests, it would not single out any one group. Perhaps recruits to the armed forces should be tested when they have their entrance medical. Also, social testing should be made more available. Perhaps people could pay for the cost of the test for their own peace of mind or that of their partners. Should the tests prove positive, then counselling should be freely available. The report says that there should be more trained educators, and I totally agree with that. When news is bad, people should always be supported.

I totally agree with Recommendation No. 31 which says: We conclude that the wisest approach is to advocate celibacy before marriage and fidelity within it as the ideal, but to accept that people may find this hard to achieve. The sad situation is that so many young people come from divorced parents, and that many of them seem frightened these days to get married. Two weeks ago I visited the Mildmay Mission Hospital in Hackney. This is a small independent Christian hospital which was started when cholera was a serious problem in London. It has just created a hospice for AIDS patients and has a day ward. Great thought and care is going into this, and patients will he looked after with understanding and dignity.

One of the most interesting parts is a conservatory. Therefore, dying patients can be among living plants. Before this hospice was opened several people telephoned trying to make self-referrals. They knew that they had AIDS, but they had not been to a doctor. Many people in London—and, I am sure, in many big cities throughout the country—do not have a general practitioner. Out in the community at large, there are most likely many sero-positive people who are known to no one.

I am chairman of Phoenix House. That is an organisation running several houses, and re-entrance houses, dealing with drug rehabilitation. There are main houses in London, Sheffield, North Shields and the Wirral. If funds allow, we hope there will be a house on the south coast and one in Glasgow. Drug takers are generally alienated and therefore difficult to reach with a preventive educational campaign. As a consequence, it is unlikely that the majority of drug takers will present themselves at clinics for sexually transmitted diseases for assessment, counselling and testing unless they are encouraged by the drug treatment agencies. That implies that the numbers of sero-positive drug users is much higher than is known from test results.

Statistics indicate that injecting drug abusers are the fastest growing group of people who have been tested as sero-positive. Sero-positive drug abusers are more likely to develop AIDS and have a worse prognosis than other groups because the effect of drugs further suppresses their immune systems.

For some time there has been heightened concern at drug treatment agencies by the rapid increase of late-in sero-positives among clients who are seeking help. To give your Lordships an example of test take-up, of 106 residents counselled in the northern region, 94 per cent. elected to have the test. Seven were found to be positive. In London it is now 12 per cent. in Phoenix House. Blood testing should always be preceded by a discussion of the advantages of having the test. Whether the test is chosen or not, it is always an opportunity to provide health education in order to try to initiate a change in life style.

A positive result is "bad news", and it needs careful handling. Last Friday there was a television programme, following the world summit of ministers, about AIDS. A picture was shown of a large, grim building in the Bronx where poor people went, many of whom were dying of AIDS. The television crew had not been allowed to film inside. It was easy to imagine what it was like. It sent shivers down my spine. We must avoid that kind of degradation at all costs. A few weeks ago at lunch I sat next to an American from Houston. He told me that a hospital for AIDS patients had had to close down because of the lack of funds. The expense of caring for AIDS patients can be very high. We must go all out for prevention whenever possible.

Phoenix House proposes to develop a 35-bed special project for their AIDS and ARC (AIDS-related complex) clients who need supported accommodation to provide a home for those rendered homeless because of ARC and AIDS. The development is also to provide accommodation for people living in conditions which are unsuitable and who have ARC and AIDS. Support will also be provided for these people who are unable to cope, and Phoenix House sees this provision as urgent. It is a new venture, and it will need new resources.

Up and down the country there are new problems emerging. In two of the health districts, a problem has presented itself. Drug addicts who are sero-positive, and have been treated in their home district, have gone for further treatment in another district. They have been given methadone which they are selling on the street of their home district. The doctors from the second district will not communicate with the first district. There is frustration. This is just an example of the need for people at all levels to communicate. Too much confidentiality due to AIDS might be made use of by the drug addict who wants to satisfy his craving for drugs.

At a recent meeting of the all-party Drug Misuse Committee we were told that drug taking was still on the increase. Drug treatment agencies need support. The drug addict with AIDS is far less of a risk if he or she is being cared for by people who understand the problems. All voluntary agencies have the task of raising funds. That takes time and energy. I hope the Government will help to keep up morale and keep up the funds. I certainly have found some remarkably dedicated and motivated people working in this difficult field.

4.14 p.m.

Lord Kennet

My Lords, I believe the whole House will join me in congratulating my noble friend Lord Kilmarnock on the unfailingly well informed, constructive and good-humoured way in which he brings this dreadful subject to the attention of the House year by year.

I emphasise to the Government the amount that can be learned as we find out what it is best to do in the present predicament from the experience of other countries. I mention in particular the work being done by the School of Development Studies at the University of East Anglia which is investigating how African countries will be able to cope with the reduction in food production in future years due to the deaths of a large number of able-bodied men. It is projecting that far ahead; and that is wise. I hope that if it needs further money to carry on with its work it will receive it. I hope also that all other agencies will be looking bravely, and pessimistically, that far ahead.

I wish to make one other general point. I expect most of your Lordships have read the report of the House of Commons committee and the Government's response to it, the Office of Health Economics report, the British Medical Association's report, and so forth. It is interesting that none of them—not even the Government's response—makes any reference to the private sector of our medical structure in this country. It is obvious to everybody that this is a matter for the health service. That is taken for granted, so much so that the alternative does not even figure in discourse and conjecture. We may learn something from that fact; especially the Government. There may be a danger of chipping holes in what some people may think of as an ideological yacht or something, which is actually going to be the lifeboat for the whole of mankind. I mean our public health service.

The noble Lord, Lord Quinton emphasised the possibility that the virus did not travel through unbroken skin, unbroken membranes. I am not sure how up to date that view is. In any case, I should like to draw your Lordships' attention to the spread of the virus among heterosexuals. I cannot refer to a heterosexual community or a homosexual community, because I do not think there is such a thing in either case. They are just people. But the virus is spreading among heterosexual people.

We are often told in the press that only 4 per cent. of AIDS sufferers in this country are heterosexual. We have that figure in our minds. It is not the right figure. The right figure is that only something over half of the HIV positive people in this country have received the virus by sexual transmission. So, although heterosexuals constitute only 4 or 5 per cent. of all cases, they account for about 9 per cent. of sexually transmitted cases. That figure puts a different view upon the matter. I do not know whether other people feel this way; but I do. Four per cent. is an almost negligible minority but if it increases to one in 10, then one has something that one can no longer "peer over the wall at", to use the vivid phrase of the noble Lord, Lord Quinton.

In the main I want to speak about testing and various other matters in the House of Commons committee report, which I did not fully understand the morality of. I dare say other people did not understand either. I believe that the area of anonymised testing, or even what I should like to call responsible testing—that is when one tells people the result and where one knows whose blood one is testing—is likely to be one of growing confusion and concern as the condition spreads. It has been quoted with approval by some people, including the House of Commons committee, that it is bad ethics and bad science to carry out anonymised testing for HIV on certain categories of people who have their blood tested for some other reason. I do not understand why it is either bad science or bad ethics.

I was surprised to see the opinion attributed to the Chief Medical Officer of the Department of Health and Social Security that the mass of results, which would be available to medical science if general anonymised testing were adopted, would be so great as to be useless. I cannot understand that statement. I thought that when doing statistics the more one received the more certain one could be of whatever conclusion one was debating. But there may have been a misattribution of that opinion.

Perhaps the noble Lord, Lord Hunter, who will be speaking next, will be able to tell the House whether anonymised testing is routinely done for other conditions—I take measles as an example—to form some opinion about its incidence without bothering about who has or who has not got the disease individually. If such testing is carried out, why would it be less ethically desirable to do so in the case of HIV than in the case of any other disease? I do not see that point. I may have it wrong. That may not be the case. Would the noble Lord like to tell us now whether it is. I can see that he does not wish to do so.

I shall turn now to what I think may turn out in time to be the solution to all these matters, although a great deal of opinion must develop before changes can be made. It is what I would call responsible testing, in the sense of identifiable tests the results of which can be communicated to the sufferer to enable the sufferer to behave responsibly. I was struck by something that the head of the French programme, Professor Alain Pompidou, said, which was quoted by my noble friend. I should like to rewrite the observation to make it even clearer in English. To he informed is not to know; to know is not to understand; to understand is not to decide; and to decide is not to act". The purpose of all public bodies, government, Parliament and all good people, is to encourage and to enable action to be taken by some people. At the moment, people who wonder about having an AIDS test or who have one offered to them for some other reason, are counselled before they take it. I understand that it is common for the counsellor to say: "You do realise, don't you, that if you take this test and it turns out positive, you may have difficulty in obtaining life insurance cover. You may even have difficulty with a mortgage." I have heard of that. That constitutes negative counselling. The people who give such advice are putting a life and death matter in second place to an economic matter. That practice is questionable; it is one that should be thought about and inquired into.

On the same subject, recommendation 88 of the House of Commons committee states: There are no grounds for disclosing a patient's antibody status, without their consent, except to safeguard another from infection". How should that recommendation be interpreted? Does it include the patient's spouse or regular sexual partner? The context in which the committee considered that point was that of unborn children. That is not the whole issue by any means. If society could move gradually towards the, perhaps, more painful and more risky course of what the noble Baroness, Lady Masham, called better communication, it would have the effect of reducing or slowing down the increase of the incidence of the condition.

People, including AIDS patients, must always be given the chance to do right. Some present practices do not give them a fair chance to do right. Full cost-benefit analysis with full projections of future alternative scenarios is bound to show that the amount of money which will have to be spent on the disease is likely to be colossal. Any underspend beneath what later turns out to be the right level will be paid for tenfold in human suffering and economic setbacks. I say "tenfold". I could just as well say a hundredfold. The doubling time for the incidence of the condition has increased to 13 months or so in this country, but the doubling time for heterosexuals obtaining HIV-positive results is eight months. On an eight-months' doubling period, it is not long before we are talking about a one-hundredfold increase.

I say to the Government that if they are in doubt they should spend, spend and spend again now. And all the governments of the world, if they are in any doubt as to where the money should come from, might try to come to their senses about the arms race.

4.25 p.m.

Lord Hunter of Newington

My Lords, for a moment I should like to stand back a little from our immediate problem, consider the old public health and then say something about the new public health, public-responsibility and AIDS. It is appropriate to do so now, because it is about 10 years ago almost to the day when the last case of smallpox in the world occurred in Birmingham. It was a laboratory infection. There has been no further case, so the old public health scored well.

Last week the report of Sir Donald Acheson, the Chief Medical Officer, on the New Public Health was published. It is a document well worthy of study. When we think of the old public health in the old days, we think of housing, nutrition, tuberculosis and immunisation against infectious diseases. Tuberculosis was a tough problem. It required preventive measures—screening and specific therapy—to eliminate it. Apart from preventive inoculations, the individual contribution to the old public health was modest. With regard to inoculations, it was variable. For example, we have never managed to achieve the 90 per cent. inoculation rate required to prevent measles epidemics. Other countries have. In that respect we have not been the best in the world.

In contrast to the old, the new public health depends heavily on the individual for success. It often involves his or her lifestyle. Smoking, for example, promotes heart disease and cancer of the lungs. The approach has been twofold—propaganda and reducing the tar and nicotine content of cigarettes, which we recommeded when I was chairman of the Scientific Committee on Smoking and Health in the 1970s. Heart disease and the importance of diet and exercise are part of the new picture. But behind today's problem what is the individual's responsibility for his health?

Then we come to AIDS, the subject of the debate. There is no protection and no morning-after pill. There is no serological evidence of infection for four weeks or even up to four months. To those who would ask, "What is the fuss? After all there have only been 1,200 or so deaths so far", we must point to the experience in the United States and tell them that if no further infection took place, the burden of cases would go on increasing in this country for six or seven years.

In the United States, where to begin with a somewhat relaxed view was taken, AIDS is already the commonest cause of death in young women. It is as well to remember that the increase in the number of cases does not necessarily mean failure because of the long delay that I have mentioned.

There is no doubt that homosexuals here and in the United States have drastically altered their behaviour. As a result, there has been a dramatic drop in the number of people attending venereal disease clinics. As the noble Lord, Lord Bonham-Carter, and others have said, the same improvement has unfortunately not been recorded among drug users. They continue to be a danger to themselves and to their friends and relations. Under present circumstances, the new public health depends upon personal behaviour for improvement. There is no early diagnosis and no treatment. We are back to individual responsibility to protect the family and future generations.

The noble Lord, Lord Kennet, sought my opinion about testing for AIDS. There is a great deal of conflict about this at the moment. However, I would guarantee that if a therapy was available tomorrow everyone would want it. The nation would desire to have it in order to be cleared of this evil. However, until that therapy is available the conflict will continue.

We in this country are concerned about the National Health Service in relation to the needs of the aged and the new technology. Many of us believe that it has been sorely neglected over the last 10 years. We are now faced with a new aspect, that of overwhelming demands from a section of the population that otherwise makes hardly any demands. This has to be built into the strategy. We have heard a great many statistics this afternoon. I am sure that the Minister will be telling us about them. However, I ask him this question. Could the strategy consume all the new new money for NHS development over the next decade? That is the question to which we should like a reply.

In the new public health issue in relation to AIDS we are back to public responsibility and individual, personal responsibility. In this country we have the public health laboratory service and the Medical Research Council, with its outstanding record in basic research and with no fewer than 28 projects on research, which ensure that we are playing our full part to try to advance knowledge and to discover a cure for the disease. I would encourage the Medical Research Council to continue to work in the Gambia where a new and particularly nasty virus related to the better known one has appeared.

Another ray of sunshine and perhaps hope is this. I understand that there was a remarkable atmosphere at the final session of the AIDS Summit to which many speakers have referred. The people of the world are coming together. They are uniting to defeat this threat. They will in the end defeat it, and perhaps through that there will be a greater understanding of one another across the world.

4.32 p.m.

Lord Winstanley

My Lords, over recent years your Lordships' House has debated this subject on many occasions. I am sure I am right in saying that every one of those debates has shown a degree of understanding of a very difficult problem, a grasp of complex figures and facts that one would not find in any other forum anywhere. That is to be expected in your Lordships' House, where we show a degree of understanding and an awareness of issues which is not common elsewhere.

Of all those debates, I have no doubt that this is the best. From every speaker we have heard we have seen a grasp and understanding of the problem, although different aspects have been emphasised by different noble Lords. However, each and every one has contributed to what has been an admirable debate. In that context I most certainly include the right reverend Prelate the Bishop of Worcester, with his admirable maiden speech. Having said that they have all been excellent speeches, I have not yet heard the Minister. However, I am absolutely certain that by the time I have heard him I shall not wish to depart from that judgment on the nature of the debate.

Therefore our thanks are due to my noble friend Lord Kilmarnock for initiating this debate. We should also thank my noble friend Lord Kilmarnock for his initiative and enterprise in setting up the all-party group on AIDS from both Houses of Parliament and for chairing it. That has enabled noble Lords and Members of another place to have regular meetings with experts in this field and to keep themselves fully informed. These all-party groups on different subjects do invaluable work. The noble Baroness, Lady Masham, has mentioned the all-party committee on drug addiction. That also has enabled many of us to hear speeches on this subject. Those organisations do a great deal to improve the level and standard of understanding in your Lordships' House.

In winding up a short debate which is time-limited, one cannot possibly elaborate on all the points which have already been made, I shall merely try at this late stage to fill one or two gaps which have arisen. However, in general terms I concur with what has been said. My noble friend Lord Kilmarnock initially said that the Government have made a splendid start. I have no hesitation in saying that the Government deserve all possible congratulations for starting the initial campaign. I also congratulate the chief medical officer of the Department of Health, Sir Donald Acheson, for his understanding and extremely mature attitude to a very difficult subject.

I believe that the Government's initial campaign has brought about a public awareness of this situation very rapidly in a way which could not altogether have been foreseen. Our congratulations are due to the Government for that. The noble Lord, Lord Kilmarnock, implied that in discussions with our European friends, the Ministers from other countries who were present at the conference, there was some feeling that we had perhaps gone off the boil in this country and had begun to become a little complacent. I do not agree with that verdict for a moment. I accept that we appear to have stopped for a while. But it was wise to do so because there were extremely difficult decisions to take.

We have reached an area in which we have a tightrope to walk in deciding to what lengths to go. Do we frighten people unnecessarily? Do we reassure them inadvisedly; or what do we do? It is very important that the Government think extremely carefully about the next steps that they take in their publicity campaign. One must agree with Mr. Tony Newton, who said at the international conference—and I entirely agree with him—that here we have a disease for which we have no available protective vaccine. Nor do we have any therapeutic substance. We have one which delays the progress of the disease, but we do not have a cure. Therefore we must rely wholly on prevention. The Minister for Health was entirely right in saying that, and therefore the Government must think about it.

In the first debate on this subject, I asked a number of questions. We needed to know the nature of the organism. We know that in great detail; we know a great deal about it. We needed to know the mode of spread of the organism. We now know that. We needed to know with some kind of precision the incubation period. We do not know that with any precision and I doubt whether we shall ever know it with any precision. What we know is that it is an extremely long period, and that adds to some of the difficulties.

The noble Lord, Lord Quinton, referred to this. We also know that this is a very difficult disease to catch. When the Minister replies he may say that there are many cases of one spouse of a married couple who has contracted full-blown AIDS. The couple have continued to live together and to cohabit in the fullest sense of that word, and yet the other, uninfected, spouse has remained uninfected. The Minister will confirm that. It shows it is not a very easy disease to catch. That is a useful message to give to the general public since it allays anxieties and perhaps stops panic. But of course there is a danger that if one says that too often people will say, "What are we bothered about?"

When this matter first came to public consciousness, there was this general view: "What is this AIDS?" It was described as a disease that kills homosexuals and intravenous drug addicts. People said, "That's all right, isn't it?" That was an extremely dangerous judgment and an unwise one. We have rapidly learnt that a disease is a disease, and once an infectious disease is present in a community all that community is at risk and all that community must regard itself as at risk. We have progressed, and we now understand the position. We have now to take very difficult decisions. We have to advise people who are at risk and who are not.

Frequently the word "carrier" is used. The BMA sent me guidance today. I wish that it had sent it earlier; the morning of the debate is a little late. It refers to the AIDS foundation which has been set up. It is admirable. It is charged with the duty of providing ethical guidelines to medical practitioners involved in treating patients carrying the AIDS virus. What does "carrying" mean? The term "carrier" in medical science is a quite specific and exact term. Usually it is applied to a person who carries a pathogenic organism but does not manifest the pathology that that organism can cause. We had carriers of diphtheria and typhoid fever.

What is the present situation in relation to AIDS? We know that a person with full-blown AIDS is infectious. But do we know that everybody who has a positive antibody reaction is necessarily a carrier? I do not know. I hope that when the noble Lord replies he can give us a more accurate definition of a carrier. Are we to assume that all those people who have positive antibody reactions on a blood test are carriers? I do not know. We need to know that.

I am glad that my noble friend Lord Kennet raised the difficult question of blood tests. It was commented on by the noble Lord, Lord Hunter of Newington, who is an expert in the field. His advice should be listened to carefully. I rather share the views implied by my noble friend Lord Kennet that if one is taking a blood test one wants to know what, if anything, is wrong with the blood that one is testing.

Were Ito become a pathologist—I am not likely to now, it is getting a little late in the day for me to do that—and take a sample of blood from a patient to examine it for one purpose or another, I do not think that it would necessarily be my duty to explain to the patient, "All I am going to do is to work out the haemoglobin percentage, count the red cells and count the white cells". If I take a blood sample I think that I have a duty to look at it overall and find what if anything is the matter with it, including whether antibodies are present. I hope that eventually when blood samples are taken we may move to a situation in which that information is obtained. Beyond that, we have the problem of what is to be done with the information. That of course is a delicate problem, as Lord Hunter of Newington implied. It needs a great deal more consideration.

There is another difficulty in regard to the future course. I remember an admirably conducted campaign during the war—a very expensive one—with regard to the increase in venereal disease, both gonorrhea and syphilis. Working as a doctor in Her Majesty's Forces and among the civilian population at that time I had more difficulty dealing with young patients who thought they had contracted venereal disease than with people who had in fact contracted it. I saw many suicides take place of people who had become obsessed with the idea that, through some kind of misbehaviour, they had contracted venereal disease when they had not done so. We have to face the problem when we walk along this tightrope: how do we advise people to modify their lifestyles without at the same time making them think that they have contracted a disease that they may not have contracted?

We should also remember this. Doctors throughout the country are dealing with patients who even at this late stage of the twentieth century continue to suffer from early Victorian teaching about sex. It has left a legacy in terms of psychoneurotic disease of one kind or another which is prevalent in certain sections of the population. It is clear that we have to tell people that promiscuous behaviour, whether homosexual or heterosexual, renders them liable to contract infections. That is perfectly proper information to give people. It must be given in such a way that it does not bring back the kind of fears of sex that were engendered by the Victorian campaigns or other campaigns in days past.

I wish to put one or two specific points to the Minister. One that should be in his mind, as he dealt with it in the last Question today, is the matter of benefits. As the Minister knows, certain benefits are available long term for the chronically disabled, particularly those who have been chronically disabled for a continuous period of six months. The Haemophilia Society is extremely worried about this, and it should know because some of its members have contracted AIDS in tragic circumstances. However, once AIDS has developed, it does not necessarily exist continuously for six months; it tends to be up and down in short periods.

As the Haemophilia Society has pointed out, it is both a fatal and a very expensive condition to have. It is very costly to live with AIDS. The Haemophilia Society hopes—and rightly so—that the Government will be prepared to regard the diagnosis of AIDS as ipso facto proof of the existence of a condition for a continuing period rather than having to monitor it and say, "This person has been continuously ill for six months". Perhaps the Minister could answer that.

I was interested that my noble friend Lord Bonham-Carter raised the question of prisons. This is an important subject. A specific question was raised at the all-party mental health committee in both Houses: what would be the Government's attitude and how would they assess their degree of liability were a prisoner in the custody of the Home Office prison service in one of Her Majesty's prisons to contract AIDS as a result of homosexual rape? What would be the legal liability in that case? I do not say that it has happened, but I say that it is likely to happen. I say nothing about the practice of homosexuality in prisons, but I say that prisoners must be protected from homosexual rape. I should like to have the Minister's reply about the legal liability if such a case arose.

In general terms, as part of the information that we want on a continuing basis from the Government, we should like some information about how we are doing. An excellent campaign has greatly increased public awareness of the disease. As some noble Lords have said, it has probably modified the behaviour of certain groups already. I hope that the Government will give us figures at regular intervals so that we can know precisely how we are going on in relation to certain special risk groups and in relation to the population as a whole. We shall then have a proper opportunity to assess and monitor progress on the disease and to monitor the effects of the money being spent—and rightly so—by Her Majesty's Government.

4.46 p.m.

Lord Ennals

My Lords, I am sure that I express the view of all noble Lords in offering thanks to the noble Lord, Lord Kilmarnock, for introducing what has been a very thoughtful debate. Part of that thoughtful debate was an outstanding maiden speech by the right reverend Prelate the Bishop of Worcester. We should not have had that if the noble Lord, Lord Kilmarnock, had not introduced the debate on this important subject.

I express appreciation also to Her Majesty's Government for facilitating last week's World Health Organisation conference in London. I spoke to several of the Ministers, not only those who attended the all-party meeting. They clearly found it a very valuable conference. I welcome the decision taken by the conference to share information not just during the conference but subsequently, to develop a total strategy and to have a year of communication and co-operation about AIDS. I thought that it was useful at that conference to be able to see Britain's problems in a world context. As several noble Lords have said, we now know so much more about the disease than we did a few years ago.

Evidence to the conference showed that 5 million or even 10 million people world-wide are already infected with the AIDS virus. While I agree that we do not know to what extent they are or are not carriers, that is potentially the situation. In his opening speech to the conference, Dr. Jonathan Mann, director of the WHO special programme on AIDS, said that while AIDS had stolen a march upon us there had been a rapid global response with an unprecedented move to prevent and control the disease. I have no doubt that the WHO conference in Britain will have stimulated that process.

The epidemic has different patterns in different parts of the world. The first pattern occurred in Western Europe, North America, Australia, New Zealand and some parts of South America. In those areas most AIDS infections have occurred among men. Sexual transmission in those countries is predominantly homosexual. Over 50 per cent. of homosexual men in some urban areas are HIV infected. While heterosexual transmission is increasing in those areas, it currently accounts for a much smaller proportion of sexually acquired HIV infections than homosexual transmission.

The second pattern of transmission occurs in Africa and the Caribbean. In those areas sexual transmission is predominately heterosexual, so that the ratio of males to females suffering from the disease is approximately equal. It is a totally different pattern from that in our own country. In some urban areas, one-quarter of the 20 to 40 age group is infected with the disease, and up to 90 per cent. of prostitutes.

In the United Kingdom there has been an unprecedented move to understand and absorb the educational material put out by the Government and by voluntary organisations to stop or discourage the spread of the disease. It is too early to assess the effect on personal conduct. I agree with the noble Lord, Lord Winstanley. I would not now say to the Government, "Please start it all over again". There is a great awareness on the part of the public and we have to pause to think again, so I am not critical of the Government on that score.

The Office of Health Economics has recently published an important study on HIV and AIDS in the United Kingdom, to which reference was made on a previous occasion. That is a very disturbing study. It shows that mortality from AIDS is still steadily increasing. Nearly 60 per cent. of all deaths from AIDS recorded in the United Kingdom so far occurred in 1987 alone. Furthermore, during last year more than one death from the disease was recorded every day. If the latest annual rate of increase in AIDS deaths is maintained, 5,500 deaths from the disease may be anticipated during 1990.

As several noble Lords have said during the course of this debate, the make-up of AIDS case loads seems likely to change over time. Homosexual or bisexual males currently account for about 85 per cent. of AIDS cases in the United Kingdom, but they contribute less than half of the known HIV infections, and future cases of AIDS could therefore increasingly come from other high-risk groups. In particular, as the noble Lord, Lord Bonham-Carter, said, more cases can be expected from intravenous drug abusers. In turn, this development will mean growing numbers of AIDS cases among women as well as a shift in the geographical distribution of the disease. Of the current total of known HIV infections among intravenous drug abusers, about one-third involved women, and two-thirds of the total have been reported from Scotland, as was said by the noble Lord, Lord Bonham-Carter.

I think it is appropriate for your Lordships to pay tribute to all those professionals who have been involved in the treatment and care of this very difficult and disturbing disease. We should pay tribute not only to the professions but to the voluntary organisations such as the Terrence Higgins Trust, the Care Trust, CRUSAID, and especially to the hospice movement, whose task is going to grow greater as the years go by, as well as to all those who are involved in counselling and social work; and also in that connection to the Church, as was quite rightly pointed out by the right reverend Prelate.

I should also like to pay my tribute to the Association of London Authorities, which has shown the way in which London local authorities can work together with housing, social services and environmental health services to create a pattern of service at local authority level.

A good friend of mine over many years, Dr. Patrick Dixon, has just published what I believe to be an outstanding book, The Truth about AIDS, which some noble Lords may already have seen. If I may quote a few paragraphs, he said: Gay people have felt totally ostracised and rejected by society. Beaten up in alleyways, labelled as perverts and victims of relentless low-grade discrimination, they have often felt misfits. Rejected by family and former close friends, many have found tremendous security and self-acceptance among those who have been through an identical experience. The feeling of togetherness is very strong. At least they can be themselves without fear of rejection". He refers later to the false "gay plague" label which has been stuck to them.

This is an extremely important question to tackle because if we are going to pay tribute to those who have helped in dealing with this disease we must also pay tribute to the homosexual community, who, if evidence is right, as it seems to be from figures that have been published, have made a very significant change in their own lifestyle in a way which for them must be a considerable sacrifice. That must be said because these are people who are to be sympathised with in the sense of their own sexuality and especially in the light of the fears which they must all have at this time.

This almost inevitably brings me to Clause 28 of the Local Government Bill, which has been debated but which will again arise at a further stage in the process of that Bill. I share the views of those who expressed great concern about the divisive effect of the clause. I am glad that the noble Lord, Lord Skelmersdale, will be replying to the debate today. I do not want to put him in a difficult position and I am not asking him to comment, but it is true that little more than 12 months ago he recognised that the words in Clause 28 and those in the Bill of the noble Earl, Lord Halsbury, which was then before the House, were capable of harmful misinterpretation and were moreover unnecessary. I hope that the Minister, who voted as he properly did yesterday, will consider the effect that this clause could have—I do not say will have—upon a community whose cooperation we desperately need in fighting this sad disease of AIDS.

This is not a party view. I am not trying to score party points. In fact, some of my noble friends may disagree with me, but the point that I am making is the view of the Royal College of Nursing. Some of your Lordships may have seen the comments on our debates on Clause 28 by the Royal College of Nursing, although it put it in the context of the debate on the prevention of AIDS. It said: The Royal College of Nursing is fully committed to the programme of health education to prevent the spread of HIV and has been actively involved in this area of the problem since 1984. One of the prime functions of a nurse is to be a health educator, and many health education AIDS adviser posts are held by nurses". It was the college which gave one interesting statistic about the changes in the behaviour of male homosexuals. It drew attention to figures from the San Francisco health department and reported that in 1982, 21 per cent. of male homosexuals became infected with HIV. "Stop AIDS" a specially targeted educational campaign, saw this figure fall to 2 per cent; that is, from 21 per cent. in 1983; and to 0.8 per cent. in 1986. That must be the result of a substantial change in behaviour.

Lord Kennet

My Lords, would the noble Lord care to comment on the rather more grim interpretation of that figure; namely, that the yearly new cases are dropping so dramatically because there are so few left to get it?

Lord Ennals

My Lords, I have no doubt that that has had its effect, and that if that is so these percentages would not have been the same. However, I do not think one can argue that that totally explains the remarkable fall in percentages.

To pursue the point that I was making, the Royal College of Nursing went on to say that the Health Education Authority will need to ensure that all sections of society will be reached by future educational interventions. Voluntary agencies dedicated to education about AIDS and supporting people with AIDS have performed a useful and worthwhile role, but the RCN is concerned that their future activities may well he daunted or, indeed, curtailed by Clause 28 of the Local Government Bill now before your Lordships' House.

In my concluding remarks I contend that in considering the issues before your Lordships' House today we cannot totally dissociate ourselves from the issues that we debated yesterday. Since there are other processes through which the Bill will go, there is time for this House and the Government, and indeed the Minister himself—his influnce in this matter is considerable—to think again. I want the Minister to convey to his right honourable friend the Secretary of State for Social Services the view expressed by some of your Lordships that resource considerations must not stand in the way of whatever action the Government need to take to deal with what Her Royal Highness Princess Anne calls the AIDS pandemic.

The noble Lord, Lord Kilmarnock, said that the response to the Social Services Committee in the context of resources was inadequate. I thought that that was taking it a little-too far, but it would be a tragedy if in facing up to an absolutely unique disease a lack of resources were in any way to stand in the way of taking steps that need to be taken.

Finally, I want the Minister to ensure that the considered views of the British Medical Association—as the noble Lord, Lord Winstanley, said, they have suddenly been brought to our attention, if we did not see them two years ago—on health education, prevention of the spread of infection, research, antibody testing, medical and dental treatment, the importance of avoiding the need to import blood products and strategic planning within the National Health Service are all carefully considered.

I believe, as I said at the beginning, that this has been a thoughtful debate, and I hope that the results of that thoughtfulness will lead to further reflection by the Government, who have come in for very little criticism in the course of this debate.

5.3 p.m.

Lord Skelmersdale

My Lords, on behalf of the Government I should like to congratulate the noble Lord, Lord Kilmarnock, for initiating this debate. Not only is the subject of AIDS an immensely important one, as borne out by the speeches of noble Lords, but the debate is also timely coming as it does only a few days after the world summit of Ministers of Health on programmes for AIDS prevention. The noble Lord has drawn particular attention to this historic summit, and I shall return to it later in my remarks. But first I would like to turn to the other aspect of the Motion before us which is the Government's response to the report on AIDS of the Social Services Committee in another place.

I must emphasise straightaway that the Government greatly appreciate the work that the Select Committee put into its report. The committee has addressed a wide range of questions and has brought to bear a valuable and constructive focus on the major issues to which AIDS gives rise.

In our response we have made abundantly clear how seriously we take the problem of' AIDS. As yet there have been relatively few cases in this country—1,227 had been reported by the end of 1987—but that number looks set to rise inexorably over the coming years. That was a point made by several noble Lords. Indeed the number has so far been more than doubling every year since 1981 when the first case was seen here. We must also remember that for every case of AIDS there may be two or three cases of other HIV-related illness which puts further demands on NHS resources. To meet this growing challenge we have devised a comprehensive strategy. This is set out in some detail in the report, and in the time available in this debate I can attempt to do no more than briefly outline the main elements of the strategy.

First, there is public education which plays the central part in our efforts to prevent the spread of the disease. A sum of £20 million was committed to the national public education campaign in November 1986. The Health Education Authority, which assumed responsibility for the campaign last October, is now well advanced in its work on planning the next stages. The national campaign is complemented locally by work carried out by individual health authorities and NHS staff to reinforce the education messages.

Secondly, a great deal of research is being carried out into the medical, biological, economic, social and service aspects of AIDS. I am most grateful to my noble friend Lord Auckland for the comments he made on government action in relation to research. A particularly notable example is the Medical Research Council's directed programme of research on vaccines and anti-viral drugs for which we are giving it £14.5 million over the next three years. This money is on top of the £3 million for the general AIDS research it supports. My department has also recently agreed to provide a further £700,000 so that the council can develop its epidemiological research on AIDS.

Thirdly, a number of measures are being taken in the field of infection control and surveillance. We are continuing to take all the steps necessary to make blood and blood products as safe as is humanly possible. As the noble Lord, Lord Ennals, will remember, the new Blood Products Laboratory opened last April and this should enable us to be totally self-sufficient in blood products by next year. We have put in place a confidential, voluntary reporting system to monitor the spread of infection and we are currently considering the recommendations of an expert group on how we can further improve surveillance. The effectiveness of the existing reporting system will be strengthened by the duties placed on health authorities under the AIDS (Control) Act 1987. Under this Act authorities have to produce annual reports on their estimates of cases and the measures they are taking. The first such reports are due by the end of July.

Fourthly, we are developing health and other services for people with HIV infection and AIDS. Over £58 million is being made available to health authorities in the coming financial year to meet the growing need for care and treatment services. And we have set out in the response to the Select Committee the policy aims that health authorities should work to achieve in providing these services.

I agree with the noble Lord who said that as far as possible people with AIDS should be assisted to live in their own homes, making use of hospital only when it is really necessary. One of our central aims to achieve this is to ensure that an effective partnership is established between statutory and voluntary bodies.

The voluntary sector has a most important part to play in the overall response to AIDS. To provide further support for voluntary bodies, we have just announced a grant of £500,000 to the National AIDS Trust for distribution to the voluntary sector and an additional capital grant of £750,000 to London Lighthouse.

I turn now to answering specific points that have been raised. I would agree with the noble Lord, Lord Winstanley, that the action taken by government, which I have outlined, does not indicate a government who have gone off the boil.

The noble Lord, Lord Kilmarnock, asked about a national co-ordinating committee. In the Government's response to the Select Committee, we agreed on the need for a long-term strategically planned response to AIDS. However, we pointed out that extensive co-ordination arrangements already exist at ministerial level and also between the Government and the statutory agencies and voluntary bodies. I should like to consider the noble Lord's suggestion that the ministerial committee at a very senior level does not have the reaction with, and to, the public that perhaps it might. However, I also bear in mind that perhaps that is a role better given to the Health Education Authority.

Nonetheless, we inevitably need, as the noble Lord, Lord Winstanley, pointed out, information on how we are doing. I draw the attention of the House again to the AIDS (Control) Act which would give that information. We shall have to see from the first reports in July how that is working.

Neither HIV infection nor AIDS are notifiable diseases in the United Kingdom. We have established a national system of voluntary confidential reporting systems which work well. A statutory system could be counter-productive, as some people may be discouraged from coming forward for medical help.

I agree with my noble friend Lord Quinton and I can confirm to the noble Lord, Lord Winstanley, that HIV is not highly infectious. It is not transmitted through normal social contact. However, there are practical difficulties which we have to face. Like the noble Lord, Lord Ennals, I am not sure whether to congratulate the noble Lord, Lord Kilmarnock, in attracting the right reverend Prelate the Bishop of Worcester to this subject or the right reverend Prelate for being attracted. In any event, we were all delighted by, and grateful for, the maiden speech of the right reverend Prelate and we hope to hear from him again, soon and often.

The United Kingdom Government consider that voluntary bodies, including, as the right reverend Prelate pointed out, the Churches, have a key role to play in complementing the work of statutory agencies. The United Kingdom voluntary bodies are making a valuable contribution in this country and elsewhere. The Government are providing substantial and increasing support for voluntary sector activities.

The voluntary sector activity is particularly important for those who need counselling and training. The Social Services Committee made six recommendations about the two linked subjects. We must distinguish between the need for personal counselling and support for people with HIV infections and AIDS, and the more general need for NHS staff and social workers to give accurate health education information about AIDS. We have already put in hand a number of counselling training initiatives. The three centrally funded courses referred to in Paragraph 4.11 have been attended by 2,000 health, social and voluntary workers.

The Government's reply in Paragraph 4.15 makes clear that we are considering seriously the future planning and funding of courses of counsellors and in particular the need for support of carers. We look to the relevant professional bodies to ensure that proper basic training in AIDS exists and to recommend to their members, such as doctors, nurses and social workers, that they should be receptive to such training.

The right reverend Prelate, together with several other noble Lords, mentioned hospices. I welcome the helpful comments which have been made regarding the response of the hospice movement to the AIDS problem. There is a debate going on within the movement and we have been greatly encouraged by the sympathetic attitude which has been shown. The Government believe that it is vital for health authorities to work closely with the voluntary sector hospices in planning the appropriate response to the need for terminal care of people with AIDS.

Turning to the Mildmay Mission, I can say to the noble Baroness, Lady Masham, that the Government approved a capital grant of £150,000 in May of last year towards the cost of converting a ward in Mildmay Mission hospital to provide hospice care for people with AIDS. We have now received a further request for financial assistance in converting another ward for the same purpose. We hope to respond shortly to the request.

I welcome the emphasis placed by my noble friend Lord Auckland on treating AIDS patients no differently than other patients are treated. Within the terminally ill sector whose care is provided for by the hospice movement, that is exactly what is happening. I am also grateful for the references he made to the action of my right honourable friend the Secretary of State for Employment in shaking the hand of an AIDS patient in San Francisco. Moving a little way ahead of my theme of the moment, the London Declaration of the World Summit of Ministers of Health on AIDS stated that the stigmatisation of people with AIDS must be avoided. Anything that we can do to achieve that must be praised.

That leads me to consider the education of schoolchildren regarding AIDS. The noble Lord, Lord Kilmarnock, raised an important point about such education. The Government consider that schools and the education service generally have a clear role to play in ensuring that young people are fully and accurately informed about AIDS. A video and resource package about AIDS entitled "Your Choice for Life" is being distributed to all secondary schools in England and Wales and to education authorities in Scotland. We anticipate that that will be very widely used as part of the schools' overall programme of health and sex education.

I part company with the noble Lord, Lord Kilmarnock, on his suggestion that AIDS is too serious a subject to be left to the decisions of school governors. I do not believe that any school governor worth his salt would vote against AIDS education. I wish to point out that school governors are, in their own turn, elected.

Comment was made in passing to my attitude to Clause 28 of the Local Government Bill, on which your Lordships have been dividing fairly regularly in the last two days. The noble Lord, Lord Ennals, sought to tweak my tail. I point out to him that the clause stand part debate was a different matter from that on the Halsbury Bill. I shall say no more than that.

Lord Graham of Edmonton

It was amended.

Lord Skelmersdale

It was amended by a Government amendment. Irrespective of the argument about whether local authorities are suitable bodies to carry out health education—I am well aware that discussion on that matter is going on up and down the country—I gently suggest to the noble Lords, Lord Ennals and Lord Kilmarnock, that they take another look at Clause 28(2) of the Bill which says, firmly, clearly and shortly, that: Nothing in subsection (1) above shall be taken to prohibit the doing of anything for the purpose of treating or preventing the spread of disease". That would of course include AIDS.

The noble Lords, Lord Winstanley and Lord Bonham-Carter, raised the matter of prisons and AIDS resulting from homosexual or drug activity in them. I have noted the first point and particularly the point made concerning the possibility of homosexual rape. I shall ensure that that matter is brought to the urgent attention of my right honourable friend the Home Secretary.

I agree with the noble Lord, Lord Bonham-Carter, concerning the great importance of drug misuse practices in the spread of infection. Indeed, I should put that near the top of the list in terms of likelihood of transmission of the disease. Both the reports which the noble Lord mentioned have been received recently and are being considered. They are the first report from independent researchers on the pilot syringe exchange schemes and the first report from the working party of the Advisory Council on the Misuse of Drugs on measures needed to inhibit the spread of infection in drug misusers. Where we go from there, I am not quite sure. I shall keep the noble Lord informed on the dissemination of the reports.

Even before the reports were received, the Government funded a major expansion of drug misuse services. The aim has been to establish a multi-disciplinary community-based service involving primary health care teams and generic youth and social workers, as well as specialist facilities. A high proportion of central funding has gone to the voluntary sector, which provides a range of advice and counselling services, together with longer-term rehabilitation facilities. Fifteen pilot syringe exchange schemes have been established. It is with those that one of the reports which I have mentioned deals.

The noble Baroness, Lady Masham, mentioned Phoenix House in connection with drug misusers and the particular problems faced by people with HIV infections or AIDS who are injecting drugs. The working party of the Advisory Council is now looking at that issue, perhaps with a view to making a second report. We know of and welcome the interest of Phoenix House in the field. We shall be looking for advice to the working group on the role that drug rehabilitation can play and how we can ensure that adequate funds are made available.

The noble Baroness devoted the major part of her speech to the question of screening, which I would accept is one of the most important issues arising from AIDS. However, I must say to her and to the House that the Government have no intention of emulating those countries which have introduced compulsory screening for immigrants or other groups. Quite apart from the grave problems of principle that would arise, our expert advice indicates that it would be of little value in controlling the spread of AIDS. Instead of compulsory screening we have established an effective system whereby anyone who wishes can voluntarily be tested and tested with complete confidentiality. In our view, that approach is likely to prove far more effective as well as being less socially disruptive. As the noble Baroness pointed out, it is essential that such testing is accompanied by counselling.

The noble Lord, Lord Kennet, asked why anonymised testing was bad science and bad ethics. I can tell him that an expert group under Dr. Smith of the Public Health Laboratory Services has been considering surveillance of the AIDS epidemic and we have recently received its report, and are now studying it. The group discussed the scientific pros and cons of anonymised testing for HIV antibodies and it would be inappropriate for me to comment now on its conclusions. I confirm that anonymised screening is indeed undertaken for other surveillance, for example for influenza strains, but, as was pointed out a few months ago in legal advice to the British Medical Association, testing for AIDS has such consequences that it cannot be considered like other routine tests.

Lord Kennet

My Lords, perhaps I may ask the noble Lord a question on that point. Are we to take it that, in the view of the Government and their advisers, the desirability of widespread routine screening for a disease is in inverse proportion to its gravity—that is to say, the more serious the disease the less we need to know about it by widespread screening?

Lord Skelmersdale

My Lords, no, I do not think that one can draw that conclusion from what I have said. However, I shall look again at what I have said and perhaps I may write to the noble Lord.

The noble Lord, Lord Hunter, continued the theme of testing and therapy. I share the hope expressed by him that there will soon be an effective therapy and eventually a cure. As the noble Lord said, the Medical Research Council is supporting excellent research work and we all hope that it will produce results shortly. As he remarked, when there is a cure everyone will come forward for testing; but that is not the present position. Therefore we must ensure that, in the absence of a cure, people are not discouraged from asking for advice, counselling and testing, where appropriate, by the fear that they will suffer discrimination or be made scapegoats as a result of those tests.

I realise that other points require a response but I observe that I am running very rapidly out of time. Therefore I shall write to noble Lords who have raised those points.

I was especially glad that in his Motion today the noble Lord drew attention to the summit, at which I was privileged to be present, since I consider that it marks a historic step forward in the global fight against AIDS. As the House is aware, the summit was jointly organised by the World Health Organisation and the Government, and we were extremely indebted to Her Royal Highness, the Princess Royal, who graciously consented to open the proceedings. It brought together an unprecedented number of Health Ministers from all over the world. Almost 150 countries were represented, over 74 per cent. at ministerial level, together with major international agencies, voluntary bodies and distinguished individuals. I believe that it was a unique gathering.

Not only did the summit establish a general consensus on the urgent need for co-operative international action on AIDS, but it demonstrated a universal commitment to take that action; and a recognition of the crucial role of public education. The London declaration adopted at the summit makes several important statements about what preventive programmes should contain and the principles that should underpin them. Copies of this important declaration have been placed in the Library. In view of the time I shall not read out the declaration as I had intended.

In my speech I have set out a substantial record of action and achievement, both nationally and internationally. But I do not wish to give the impression that we are in any way complacent. Far from it. As the London declaration states, AIDS poses a serious threat to humanity and urgent action is necessary to defeat the disease. We do not have the luxury of time to spare. That is why we must and we shall redouble our efforts to contain its spread and ultimately to eliminate it altogether. In the concluding words of the declaration: We can and will begin now to slow the spread of HIV infection. That is why I congratulate the noble Lord, Lord Kilmarnock, on this most timely, important and interesting debate.

5.26 p.m.

Lord Kilmarnock

My Lords, fortunately, I have two minutes left in which to thank speakers, on my own Benches and on all sides of the House who have participated in what I believe has been an extremely constructive and varied debate. Practically all the main topics associated with AIDS have been touched upon.

I simply say to the noble Lord, Lord Quinton, that I was not trying to draw any false conclusions from the figure of 322 cases contracted through heterosexual contact that I mentioned. They had been separated out from intravenous drug users, but obviously one cannot tell whether or not they were suffering from venereal disease.

It was interesting that the topic of anonymised blood testing came up in the debate. It was mentioned by a number of speakers, including the noble Lords, Lord Hunter, Lord Kennet and Lord Winstanley, and I think that it offers legitimate ground for debate. There are two points of view and I think that we must take this debate further. One can simply say that some interesting points have been made today.

I shall read what the noble Lord, Lord Skelmersdale, has said on the question of education. I was very glad to hear the importance that he attached to it. I think that there is a legitimate question to be asked about the Education Reform Bill. We may have to write something into it to ensure that there is room for AIDS education to take place. He chided me for doubting the wisdom of elected governors. I accept the rebuke, but there must be time for it to happen if they are to choose that it should. The noble Lord did not have time to reply to my point relating to the pressure on medical manpower, which I thought was an important aspect of my speech. I hope very much that when he writes to us on one or two of the other topics he will include that one. With those few words, I beg leave to withdraw my Motion for Papers.

Motion for Papers, by leave, withdrawn.