HIV Care: Access

Question

15:31:00

Asked by

To ask His Majesty’s Government what estimate they have made of the number of people with diagnosed HIV in England who are not accessing HIV care.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a patron of the Terrence Higgins Trust.

My Lords, in 2022 England exceeded the joint United Nations programme on HIV and AIDS targets, with 98% of people diagnosed with HIV receiving treatment. The UK Health Security Agency estimates that between 6% and 15% of people living with diagnosed HIV in England did not access HIV care that year. Re-engaging people into HIV care is a priority for the current HIV plan for England and for the new plan that is in development.

My Lords, we know from the opt-out testing programme in A&Es introduced by the last Government that up to 15,000 people in England who are aware that they have HIV are not accessing life-saving care, with devastating personal consequences for them and profound ramifications for public health, because if you are not on medication, you can pass on the virus. Is the Minister aware of the case of a 45 year-old man, out of care for several years, who went to hospital with a headache and was found to have a CD4 count of just four. He was diagnosed with cryptococcal meningitis, an AIDS-related illness. He went blind and died three months later, one of a growing number of tragic preventable deaths. Can the Minister ensure that we get an HIV action plan as soon as possible and that this issue—with funding, if necessary—will be a key part of it, to ensure that we get those lost to care back into it?

My Lords, Ministers have already commissioned officials for advice on how to progress the development of a new HIV action plan. On the very tragic case that the noble Lord refers to, he will be aware that since April 2022, NHS England has funded emergency departments in London, and in areas of very high diagnosed HIV prevalence, to provide routine blood-borne virus testing for HIV as well as for hepatitis B and hepatitis C in everyone aged over 16. That attention at the point of contact is crucial in this area.

My Lords, I declare an interest as an ambassador for UNAIDS. Is it not a fact that we have been extremely successful in developing the means to combat HIV and AIDS, but we still face the obstacle of stigma around the whole subject, which is a serious deterrent for treatment and continuing treatment, as the noble Lord, Lord Black, suggested? Will the Government make the fighting of stigma around HIV a priority, so that we can become one of the first countries to be absolutely AIDS free?

The noble Lord’s campaign in this area is very well regarded, and for good reason; I certainly agree with him. The fact is that engagement in care is strongly affected by a number of factors, including a person’s well-being and quality of life, discrimination and, as the noble Lord says, stigma. That, alongside accessibility of service, will define how successful we are. I am keen that our new plan will absolutely take account of stigma.

My Lords, the crisis of people lost to HIV care is of course underpinned by serious health inequalities. Are the Government taking account of the pilot work by the Elton John AIDS Foundation in south London, which has successfully returned people to care through case-finding, focus follow-up and wraparound support for people when they return to clinics, thus saving the local NHS millions in the care that would be necessary if they were not receiving it?

I can confirm to my noble friend that we are, and say how grateful we are to a number of charities, including the Terrence Higgins Trust and the Elton John AIDS Foundation. As she says, there have been pilots for emergency department HIV opt-out testing since 2018. A pilot that began in April has expanded that to 47 additional sites, and we will be looking closely at the impact of that.

My Lords, if that pilot in the 47 areas shows, as it did in London with the Elton John work, that such testing finds people who not only do not know their status but are lost to care, will that form a basis of the national plan the Government are working on? Will there be a particular emphasis on extending services to people in rural areas, who do not have the access to clinics that people in metropolitan areas do?

Yes, and I thank the noble Baroness for making those points, which I certainly agree with. The challenge for us now is to reduce the number of people who live with undiagnosed HIV, but also to reduce the number not seeking care and treatment. For the first time, the latter has exceeded the former, which suggests that we have a challenge we must focus on in the new plan, and we will do so.

My Lords, I pay tribute to my noble friend Lord Black for his consistent campaigning on this issue, and especially for helping those with HIV. What has been learned from previous initiatives? We know that in recent years, the NHS and the previous Government looked at ways to address issues such as vaccine hesitancy, and the reluctance of some to seek tests and treatment at any time. What lessons have been learned from these previous initiatives for the HIV action plan—for example, by working with local communities and the charities that a number of noble Lords have mentioned to encourage more patients with HIV to seek treatment, especially in communities such as black and Asian communities, where there may also be a stigma, as the noble Lord, Lord Fowler, mentioned, around admitting that they have HIV?

There is what I call a three-pronged approach to interventions to reduce the number of people not being seen for care, which is so important, as I know the noble Lord is aware: identifying people who have not been seen for care; contacting them and re-engaging them; and addressing the barriers to engagement, which a number of noble Lords have referred to. This means sustaining engagement with care in the long term and supporting people with HIV. We will review what lessons we are learning from the HIV action plan for England, which runs to 2025, and that means we will be able properly to inform the development of the new plan. I look forward to updating your Lordships’ House on this.

My Lords, we have come a long way since the dark days of the 1980s and 1990s, when many lives were lost. Progress has been made primarily through the work of activists, NGOs, the commitment of Governments and, indeed, the commitment and leadership shown by the noble Lord, Lord Fowler, to whom I pay tribute. But we are seeing greater numbers of people disengaging from HIV care for many reasons, including stigma, mental health issues, poverty, discrimination, and the terrifying fear of isolation within families and communities. Will the Government therefore look at the projects carried out across the country, including in Greater Manchester, and, indeed, as has been mentioned, the NHS South East London Integrated Care Board project, which focused primarily on these issues and groups and successfully reintegrated people back into HIV care? Arguably, this approach must be in any national HIV action plan.

Yes, we will be looking at all the work currently going on and at the successes—and there are many. I believe that my noble friend is referring to Fast-Track Cities, an international initiative involving cities tackling HIV through a multidisciplinary, multi- sectoral approach. There are 13 signatory cities in the UK, and all are beacons of good practice that we must learn from, including in order to find out what is not working. I also want to emphasise peer support, which has been shown to reduce self-stigma, but also to improve engagement in care and the taking of treatment, and to having low levels of virus. This area will obviously very much feature in the new strategy.

My Lords, looking at HIV internationally, the UK has long been a proud supporter of the Global Fund. In 2022 alone the Global Fund reached over 15 million people with HIV prevention services, including 710,000 HIV-positive mothers, who received medication to keep themselves alive and to prevent transmission of HIV to their babies. Will the Government commit to continuing to support the Global Fund?

Certainly, as the noble Baroness says, the Global Fund is crucial in HIV care. The UK remains a world leader in efforts to end the global AIDS pandemic and funds all the key partners in the global AIDS response. I confirm to your Lordships’ House that some £1 billion was recently pledged to the Global Fund. That will save more than 1 million lives, including by providing antiretrovirals for 1.8 million people, and provide HIV counselling and testing for 48 million people. It will also reach 3 million members of key affected populations with prevention programmes. We will continue to have discussions with the FCDO about the support this Government give.