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307WH HIV 1 DECEMBER 2010 HIV 308WH [Mike Weatherley] I wish to make two clear points. First, HIV does not always conform to stereotypes. HIV does not affect only young men on the gay scene, or people in or from Africa. As we heard earlier, it also affects white, middle-aged and older straight men and women. Until politicians, policy makers, doctors and the general public take that fact on board, dealing with HIV will continue to be hard work. Secondly, 26% of all who live with HIV in the United Kingdom are undiagnosed. Tackling this must be a priority. In Brighton and Hove City primary care trust, about 450 people are HIV positive without knowing it. The Government and local services must do everything that they can to bring the number down, and I am determined to do what I can to support the NHS at the local level in this task. My two earlier points are linked, because it is precisely those who are not in what are known as high-risk groups who get diagnosed the latest. Heterosexual men have the worst rates of late diagnosis, at 65%. That is possibly because they are less likely to consider themselves at risk, as we heard earlier, and unlike women they will never be tested in ante-natal settings. It could also be because clinicians may not consider them to be at risk. Heterosexual men over 50 years old have the worst rates of diagnosis; 73% of those not diagnosed until over the age of 50 are diagnosed late. HIV comes in many shapes and sizes. At 54%, more than half of new diagnoses in 2009 were among heterosexuals, something that surprised me when researching for the debate. At 51%, more than half of HIV-diagnosed individuals accessing HIV care in 2009 were infected through heterosexual sex. The proportion of heterosexual diagnoses in which people are believed to have been infected in the UK has risen year on year throughout the epidemic. From 2003 to 2007 it doubled from 12% to 24%, and it continues to rise. It is now about 32%. The over-50s represent one in five of all adults seen for HIV care in 2009. That is due to an ageing cohort of people diagnosed previously, as well as an increase in new diagnoses among older people. I dwell for a moment on the growing cohort of people of more than 50 years of age that live with HIV. This cohort will be bringing new needs to the NHS, and it should be ready for them. As people get older, they see more of their GPs. Many older people living with HIV suffer side effects from treatment; overall, they report twice as many other long-term non-HIV conditions as their non-HIV positive peers. As a consequence, they need to spend more time in health care, including primary health-care settings, than their peers. That makes their relationship with non-HIV specialist doctors almost as important as their relationship with HIV doctors. The Terrence Higgins Trust surveyed about 400 people aged over 50. It found that “respondents repeatedly told stories of discrimination, ignorance and poor clinical treatment in generalist healthcare, particularly in primary settings.” The survey concluded that there was important work to be done to address HIV discrimination in primary care settings, as doctors there may not be so familiar with people that have the virus. In Hove and in Brighton, we have some of the most HIV-aware clinicians in the country, and our specialists are among the best in the world. However, we must not be complacent, as parts of the NHS in our area will be less HIV-aware, as we heard earlier. I urge the Minister to work with her colleagues, the all-party group on HIV and AIDS and charities such as the Terrence Higgins Trust to tackle the problem. Training for GPs and surgery staff could be one way to do so. Medical care is not the only service needed by older people. In the same Terrence Higgins survey, fewer than one in 12 older people with HIV said that they would approach a mainstream organisation for older people for support. Age UK and the Terrence Higgins Trust are working to change attitudes and to improve understanding of HIV in mainstream social care and social networks for older people. Again, I hope that the Minister will listen to the views of people living with HIV as her Department moves to create a social care system fit for the 21st century. I turn next to late and undiagnosed HIV. Of all adults diagnosed with HIV in 2009, 52% were diagnosed late, when their CD4 count dropped below 350. People with the worst rates of late diagnosis are over the 50s. Recent research suggests that the majority of those people will have had previous contact with their doctors. Late diagnosis, whatever the age, is a problem; if treatment is not started promptly, it can do serious damage to the body and severely cut life expectancy. HIV treatment is excellent, and if diagnosed promptly, one can live to an old age. It is not right that some of my constituents will not have this opportunity by being diagnosed too late to benefit from it. It even makes financial sense to treat people early; it is much cheaper to have people someone stable on HIV treatment than it is to treat them for the endlessly recurring serious conditions that can result from undiagnosed HIV. HIV treatment also reduces viral load; as a result, those who are diagnosed and on treatment are less likely to pass on the virus. Now is the time, while we are focusing on public health and while we are worrying about public finances, to take action to tackle late diagnosis and undiagnosed HIV. I am proud to say that people in Brighton and Hove are not sitting back waiting for someone to come up with a solution but are already working hard to tackle the problem. There have been two pilot studies in our area looking into ways of reducing undiagnosed HIV, using clinicians in the area. Of 596 people tested, only two positives were found. However, even more people were identified through an anonymous survey done by the university of Brighton. I urge as many people as possible to be tested, because of the 3,872 anonymous tests 54 were positive. My constituency is proof that HIV can affect anybody, whatever their background, age or sexuality. As more people with HIV grow to old age, we must ensure that they receive services of which we can be proud. Such services should include prompt diagnosis. 3.6 pm Ian Austin (Dudley North) (Lab): I am delighted to take part in this debate. First, it gives me the opportunity to congratulate my hon. Friend the Member for Inverclyde (David Cairns) not only on securing the debate but on the important work that he does in chairing the all-party group on HIV and AIDS. Secondly, it gives me the
309WH HIV 1 DECEMBER 2010 HIV 310WH opportunity to recommend to the Minister the work of Summit House Support. It is a fantastic charity, led by its chair Claire Pennell and its chief executive Suzanne Callen; for the last 18 years, the organisation has provided phenomenal services and support for people with HIV and AIDS in Dudley and Sandwell. Thirdly, it gives me the opportunity to thank the Minister and her Department for the support that Summit House receives from the Department of Health through the Dudley and Sandwell primary care trusts. Finally, it gives me the opportunity to raise a number of points that I know are of interest to the staff at Summit House Support and those who work in the field. I am delighted that the Secretary of State for Communities and Local Government has written to local authorities promising to increase spending on AIDS support over the next 10 years—I understand by £10.5 million. Is the Minister able to tell us how organisations in the HIV sector such as Summit House Support can safeguard the way in which local authorities decide to spend their grants? Will there be criteria for allocation, a needs assessment or some sort of ring-fencing process that considers the real needs of those with HIV? We have heard that is often a hidden group, so it needs to be done through specialist agencies, and it is fair to say that some of those working in the field are extremely concerned that money could be sidelined for other uses by local authorities if things are not monitored correctly. As my hon. Friend the Member for Inverclyde said, people living with HIV are worried about the GP commissioning proposals now being considered. HIV is clearly a specialist area, and GPs historically have not had much interaction with those who have to live with it. In some cases, there is not the relationship of trust that should exist. Many people living with HIV are genuinely frightened or concerned about the proposals. The current sexual health strategy will end shortly. What plans do the Government have to write a new strategy, given that the sexual health agenda has changed since 2004? Has the Minister also considered the extent to which NHS employees are routinely trained in HIV routes of transmission? I understand from the service users I met at Summit house that staff who have received such training and who understand the facts about transmission and infection are likely to be able to deal with people infected with HIV more effectively than those who have not had such training. Does the Minister think that training in HIV routes of transmission should be incorporated into employees’ standard training if is not already part of it? Finally, would the Minister be prepared to visit Dudley to see first hand the fantastic work done at Summit house? If her diary does not allow her to do that, would she be prepared to let me bring people from Summit house to meet her in London? 3.10 pm Stuart Andrew (Pudsey) (Con): May I say what a pleasure it is to serve under your chairmanship, Mr Leigh? I congratulate the hon. Member for Inverclyde (David Cairns). I am rather reassured that, after seven years, he does not know how these debates are chosen, because I certainly do not have a clue after seven months. This is a significant day. It is a day to remember those who are no longer with us, it is a day to acknowledge and pay tribute to those who have worked so hard on this issue and, crucially, it is a day to raise awareness. On the first of those issues, the scars on those who have lost people, particularly in the early years, are clearly raw. Thankfully, I do not know anybody who has died from AIDS, but I have friends who do, and they recall the pain and suffering vividly. It is important that we remember those who have died and acknowledge their suffering. There is a wonderful quote in the film “Philadelphia”, where someone says that social death precedes physical death. That was certainly true in the early days, but I hope that things will get a lot better as time goes on. It is important, however, to look at how far we have come. This is also a day to acknowledge those who have done so much. I pay tribute to each and every person and organisation for their work. There are too many organisations to mention, but I would like to pay tribute to the National AIDS Trust and the Terrence Higgins Trust. I would also like to mention two individuals. The first is the chief executive of the Terrence Higgins Trust, Sir Nick Partridge, who is here. He has done a tremendous amount of work over the years, and he should be acknowledged. The second is Lord Fowler, and I was pleased last night when he was acknowledged for the work that he did in the very early years. Perhaps most importantly, today gives us an opportunity to raise awareness of HIV and AIDS here and abroad. I know that we are concentrating on the UK today, but I hope that we will have an opportunity to talk about the issues abroad, because they are significant. The latest figures from the Health Protection Agency show that more people than ever are living with HIV. Last year, there were more than 6,000 new diagnoses, which is fewer than the year before, but only slightly. That emphasises that this is still a major problem. As many Members have mentioned, statistics also show that slightly more than half of new diagnoses are among heterosexuals, but the rate of infection in the gay community is still very high. Worryingly, there is an increase in diagnoses among those over 50, as my hon. Friend the Member for Mid Derbyshire (Pauline Latham) rightly said. We have also heard about the quarter of people with HIV who are undiagnosed. That is a huge problem, which really needs addressing. I represent a constituency in Leeds, where the prevalence of HIV cases is average for England, with about 850 people receiving treatment and care in the city. Again, however, many of those people have been diagnosed very late, which highlights the need for early diagnosis. We also have a growing African population in the city, and there is a real link between HIV abroad and in the UK, as more and more people move around the world. In addition, we have one of the most vibrant gay scenes in Yorkshire, and I hope that we can encourage as much focus as possible on those two groups, because prevention really is the key. It is important to mention the campaigns of the 1980s. The Conservative Government of the mid-1980s faced a massive challenge on an emerging issue, and even the best experts were learning day to day. Those campaigns were scary. I was at school at the time, but I
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