World AIDS Day

16:30:00

I beg to move, That this House has considered World AIDS Day. It is an honour to serve under your chairmanship, Sir Mark. I am proud to have been elected on a manifesto commitment to end new cases of HIV in this country. Indeed, that goal, which crosses political divides, was a clear commitment from the last Government too. Only 20 years ago, that ambitious target would have been completely unthinkable. It has the power to change countless lives. That such a goal is even possible is a testament to the long, hard work of thousands of activists and researchers, going back over 40 years. We are living in an era when HIV is no longer a death sentence, transmissions can be prevented and people with HIV live long, happy and healthy lives. We all stand on their shoulders.

I apologise for intervening so early. Quite rightly, there will be many important policy asks in this debate, but on the point that my hon. Friend raises, can we take a moment to pay tribute to the grassroots campaigners who have been part of the history of the fight against HIV and AIDS? I am hugely privileged to have Martyn Butler, the co-founder of the Terrence Higgins Trust, as a constituent. He used his own home phone line as the first helpline for AIDS. As my hon. Friend rightly points out, we should pay tribute to those people.

I definitely pay tribute to Martyn Butler and to everyone like him who has tirelessly campaigned for change. It is the perfect example of progress being made through the sheer determination of those affected by HIV and of their loved ones—those who unfortunately they left behind. My hon. Friend and I have had the pleasure of meeting many tireless campaigners and fantastic organisations such as THT. Before entering Parliament, I worked for the National AIDS Trust, another fantastic organisation in the sector, campaigning to end new transmissions of HIV and improve the lives of those who are already living with HIV. That included working on a campaign for equal fertility rights for people living with HIV. I was delighted that just last month the law was finally changed to allow equal access to fertility treatment. That life-changing development means that people I met during that campaign can now have a family. It is not often that we can say that children will be born because of a statutory instrument, but in this case it is true. I thank the Minister for his swift leadership and action on the issue and every single person who campaigned to make that possible—thank you. The first project that I worked on at the National AIDS Trust was a collaboration with the Elton John AIDS Foundation and the Terrence Higgins Trust: the independent HIV Commission. It heard from experts and from those with lived experience and toured the country to look at good practice. Its recommendations laid out a framework for turning into a reality the goal of ending new HIV cases in England by 2030. One of the independent commissioners was a little-known, shy and retiring Back-Bench Labour MP who is now my right hon. Friend the Member for Ilford North (Wes Streeting). He went on to somewhat bigger and better things in the world of healthcare. A lot has changed since 2021 when the report was launched. Unfortunately, when it comes to progress on ending transmissions, a lot has not. To their credit, the last Government should be proud of the investment that they made in piloting opt-out HIV and hepatitis testing in emergency departments in London, Manchester and Brighton—the one key action in the last HIV action plan that was delivered on. That investment has changed many, many lives. In my constituency, opt-out testing at Hillingdon hospital has picked up 15 new cases of HIV, 28 of hepatitis C and 140 of hepatitis B. Those are people whose lives have been changed and who now have access to vital treatment. The story is the same across all the hospitals delivering that amazing programme. The programme is working, but it is facing a funding cliff edge. I welcome the commitment to expand the programme further to other towns and cities, but I hope that the Government will commit to continuing the pilot where it is already in place and working. We now know for certain that opt-out testing works. We cannot find everyone with undiagnosed HIV if we rely only on a system of people thinking that they may be at risk and then actively seeking out a test, navigating the complex system and overcoming the stigma of HIV to ask for a test. Instead, we must test, test, test. We need an opt-out testing programme that goes right across the health service and into primary care. Unfortunately, the reality is that despite the success of the testing programme, overall progress towards ending HIV transmissions has been far too slow. Recent figures suggest that this year we are potentially moving backwards. Recent data showed an increase in cases; we have seen poor outcomes around late diagnosis; and the disproportionate outcomes for women and people from black and Asian backgrounds continue. The gap has not closed.

My hon. Friend is quite right: a disproportionate number of black, Asian and minority ethnic individuals are becoming infected with HIV. Does my hon. Friend think that it is right to raise awareness of things like PrEP in communities that may be disproportionately affected, so that we can put them in the same position as the majority of the country, whose infection rates are declining?

I thank my hon. Friend for that vital point. HIV is a condition that knows no boundaries. It does not affect any one type of person: there is no one community that is alone affected by HIV. It knows no boundaries; it affects everyone. After 14 difficult years for the health service, we are not on track to reach the 2030 goal. At every single stage of the HIV treatment process, we are missing critical opportunities to get people on PrEP, test for HIV and ensure that everyone living with HIV has the support that they need. Pre-exposure prophylaxis—we can see why it is called PrEP for short—is an incredible advance in HIV prevention. It is a simple daily pill, now in generic form and therefore incredibly cheap, that prevents HIV completely if taken correctly. I have spoken before about how life-changing a drug it is in removing the fear and stigma of HIV. As a gay man who grew up in the 90s and noughties, the legacy of HIV has always weighed on me and, I am sure, on many others like me. Our sense of self, our sexuality and our relationships were always intertwined with the stigma and presence of HIV. Being able to take PrEP is game-changing, and not just for the individual and their wellbeing: it has a massive public health benefit. It has driven the significant falls in new transmissions, particularly among gay men, who have largely been the people who have accessed the drug to date. It is unacceptable that the drug is not being accessed by everyone who could benefit. The average wait list for this preventive medicine is 12 weeks. We know from research that people have acquired HIV while waiting to access the drug. That is a significant failure that I hope the new HIV action plan will address, as well as turbocharging access outside sexual health services—the only place where it can currently be accessed. It is entirely wrong that NHS silos are holding back access to PrEP in primary care, including in pharmacy and other settings. It is also unacceptable that people cannot get a postal test for HIV and sexually transmitted infections in 30% of rural England. It makes no sense that my borough of Hillingdon—not so rural, but on the edge of London—has a completely different postal testing system from the 30 other London boroughs that have their own system. Far too often, the patient is left to navigate complex systems. What test they get will vary depending on where they live. In vast swathes of the country, there is no option to test at home, although sexual health services are often inaccessible and chronically overwhelmed. Far too often, the individual has to fight for an appointment, and only those with the sharpest elbows, or persistence, get access to the sexual health services that they need.

I thank my hon. Friend for making such an eloquent speech. The point he makes is really important: in rural and coastal communities, testing services and public health awareness can often feel particularly remote. Looking at how we use primary care, particularly community hospitals and GP surgeries, will be essential to improving testing and public awareness. Does my hon. Friend agree that pushing this out into communities is essential to ensuring that take-up is just as good in a rural or coastal community as it is in a big town or city?

I completely associate myself with my hon. Friend’s comments. Particularly in rural settings, if getting to a sexual health service means travelling for miles and sometimes for hours, a lot of people, especially on the lowest incomes, will put off getting the test until another day. Unfortunately, we are seeing persistent rates of late diagnosis and of undiagnosed HIV outside major cities. I completely agree with my hon. Friend. What about those who make it through the complex online systems—the 8 am call queues, only on a Thursday—and actively go out and seek a test, or those who are fortunately now being found in our amazing opt-out testing pilot? If they are diagnosed with HIV, they are not always getting the support that they need to access HIV treatment in the long term. We have some of the best—if not the best—HIV treatment and specialists in the world. HIV is now a treatable long-term health condition. “U = U. Undetectable = untransmittable.” We need to say that over and over again. In simple terms, it means that when someone is on HIV treatment, they cannot pass HIV on. That is a powerful and life-changing message. Despite the advances, 14,000 people living with HIV in England are essentially lost to the health system. They have been diagnosed with HIV but are not being seen by their clinic because of stigma, poverty and other barriers that are holding them back from getting that life-changing treatment.

I thank my hon. Friend for calling this debate and for his powerful speech. Does he share my concern that the communities that we need to come forward are the very same communities that are not accessing treatment because of that stigma? Organisations like the Fast-Track Cities network, Sophia Forum and One Voice Network are doing fantastic work reaching black women and other black and minority ethnic groups.

I thank my hon. Friend for that comment and for her leadership on the all-party parliamentary group on HIV, AIDS and sexual health, on which I know she has been championing that issue and many others; I think she helped to host the important meeting and discussion about the recent report on disproportionality by the One Voice Network and the National AIDS Trust. If we look at the figures, the disproportionality of HIV is stark. We have made so much progress, including in access to PrEP, testing or treatment, but not all communities are benefiting in the same way. Particularly among black African and Caribbean communities in the UK, the rate of late diagnosis is far too high and the rate of accessing PrEP is far too low. It is completely unacceptable. We have to take on that disproportionality, those inequalities and the stigma that persists in holding people and communities back from accessing those vital measures. From a public health perspective, the people who are not accessing successful treatment are potentially also passing on HIV and are at risk of getting seriously ill. Many already are. The rates of people not in treatment and not going to their clinic appointments have increased through the covid period. I hope that the future action plan will fill in the gaps in the last plan. One major omission was action on that very challenge. There are already lots of examples of successful local projects that we can learn from, such as amazing outreach services with nurses going out to find patients lost to care. The value of consistent peer support comes through, time and again, from people living with HIV. We must ensure that every HIV team is proactively finding everyone lost to care and supporting them in a holistic way to overcome the barriers to continue with HIV treatment. All of this, it must be said, takes place against the backdrop of a wider crisis in our national health service, which is putting historic strain on health services and affecting outcomes across the board. Our task is an immense challenge, but it is not insurmountable. Although we are not on track, it is still possible to end the epidemic in this country by 2030. We already have all the tools we need. This week, my old colleagues at the National AIDS Trust released a report with THT and the Elton John AIDS Foundation with some clear recommendations for the new HIV action plan in England. I am pleased that the Minister has already engaged with them, welcomed them and attended the report launch, which I am sure was much appreciated. It is a clear sign of leadership on the issue. None of this is rocket science. We are talking about simple, deliverable actions. First, there should be a nationwide, year-round online HIV and STI postal testing service, which would be cheaper than the current patchwork of services that vary from place to place. Secondly, opt-out testing in all emergency departments should be expanded to other health settings, such as GP practices and termination-of-pregnancy services, and elsewhere so that we can find everyone living undiagnosed with HIV. Thirdly, we should broaden access to PrEP beyond sexual health services, starting with a digital service to ensure that those on long-term prescriptions get timely access to the medication. That will then reduce demand on sexual health services for appointments. Fourthly, we need an NHS England programme to find everyone already living with HIV and support them back into care, with proper care co-ordination, peer support and appropriately trained staff. None of this is unprecedented: it is happening or being piloted somewhere. We have all the tools we need; we must now implement them everywhere consistently. I emphasise that it would be an incredible achievement to meet our 2030 goal and become the first country in the world to end new HIV cases. Of course, that achievement would occur in the context of a deeply concerning global picture—with 1.3 million new cases in 2023 and 650,000 deaths from what is now a treatable long-term condition, as has been said. Much more work clearly needs to be done on the international front, so international development funding is vital. Ending new cases in England would make a remarkable contribution to the global effort to eradicate HIV by providing a replicable road map to prevent transmission elsewhere—learnings that can be exported and shared. It would also simply show that it is possible. Britain has historically been a world leader on HIV treatment and sexual health. Now let us be a world leader on this too. One of this Government’s key missions is to rebuild our NHS so it is there for everyone when they need it. Fixing HIV care and ending new transmissions must be an integral part of that vision. I am pleased that the public health Minister is already working on a new HIV action plan. I have seen at first hand the passion and determination of those working to make this happen—from campaigners to clinicians and MPs across the House. We now need that same determination from the new Government. The Government have a unique opportunity to make history, and I hope that they will seize it.

Order. May I remind Members that they should bob if they wish to be called in the debate? I also noticed that one or two Members arrived after the first speech had already begun, so they will not be allowed to speak. I think that those who want to speak will end up with about two minutes each, so I would be grateful if Members did not go on beyond two minutes and if they could desist from interventions, otherwise not everyone who wants to will be able to speak.

16:48:00

This is the second time that I have been called first in a debate in one day, so thank you very much for that, Sir Mark—I will pick my six numbers for Saturday night now. It is a pleasure to be here. I commend the hon. Member for Uxbridge and South Ruislip (Danny Beales) for leading today’s debate and for bringing his knowledge to the Chamber. Every new MP brings their own knowledge and particular interests, and I thank him for sharing his. It is also good to acknowledge these issues to help us support and promote positive living for those suffering with HIV and AIDS. There were 6,008 new HIV diagnoses in England, which is a 51% increase—a really worrying trend. I ask the Minister—it is lovely to see him in his place, as always—what can be done to reduce that figure? Whether people are more reluctant to go for tests or whether it is about the lifestyle that they are leading, it is clear that something needs to be done. The Government committed to achieving zero new transmissions of HIV in England by 2030, but if the number of new diagnoses continues to rise, that target will not be met. I want to refer to Northern Ireland’s only HIV charity, Positive Life, which has been instrumental in making a difference to the quality of people’s lives for over 25 years, after beginning as the AIDS telephone helpline in 1986. As a city centre facility, it now has a range of services that extend across Northern Ireland. In addition, it helps to prevent the increase in the number of in HIV infections through training, education and raising awareness, as well as campaigning and lobbying. In Northern Ireland, about 1,000 people were living with HIV in 2016. The figure is now up to 1,325, so there is still a need to address that and the 30% increase in eight years. The latest figures show that the rate of HIV diagnosis in Northern Ireland is falling, but there are more HIV diagnoses among people of a heterosexual orientation. This World AIDS Day, let us do more to remember those lost to HIV-related illnesses. Steps are being taken through the Government’s HIV action plan so that more can be done to end new HIV transmissions in England and across the whole United Kingdom. I ask the Minister: will he commit to ensuring that the devolved nations can play their part in ending new HIV transmissions by 2030? I know the Minister is committed to that, but I ask him again for the record.

16:50:00

It is a pleasure to serve under your chairmanship, Sir Mark. I thank my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) for securing this debate ahead of World AIDS Day on 1 December. With his background as the head of policy for the National AIDS Trust, he brings a wealth of knowledge and expertise to this debate. In the short time since his election to this House, he has made a powerful difference on this issue. I also thank the public health Minister for being here and the swift leadership that he has shown since the general election. With 105,000 people across the UK and more than 38 million people worldwide living with HIV, it is important that we take this moment to celebrate our successes in fighting the virus, but also to recognise the challenge that lies ahead. It is important to understand that constant action is required or we will fall back in our battle against HIV and AIDS. I agreed to become the co-chair of the all-party parliamentary group on HIV, AIDS and sexual health, because this is a fight that we can and must win. At this point, I place on record my thanks to my fellow co-chairs on the APPG: my hon. Friend the Member for Vauxhall and Camberwell Green (Florence Eshalomi), the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), and Baroness Barker for their leadership on this issue. AIDS is no longer an unrelenting reality that we have to endure, but a consequence of our collective failure to share the necessary knowledge, protection and medication with everyone who needs it. That some 38 million people are living with AIDS worldwide is a policy failure, not an inevitability. We can see the impact of sustained intervention over time. Since 2014 in the UK, there has been a 68% drop in new cases among gay men and a 12% drop in new cases among black African people, and there has been a 40% increase in the number of people on PrEP since 2021. In total, since the peak in 2014, there has been a 36% decrease in new cases, but we cannot and should not rest easy. The fight against HIV and AIDS is ongoing. There is good news in the data, but there are warnings too. More than 42 million people around the world have died from AIDS-related illnesses since the start of the epidemic. In 2022 the number of new diagnoses increased for the first time, predominantly driven by an increase in cases among heterosexual women—the highest number of cases ever in my constituency of Gedling. We must seek to understand why and tackle the root causes immediately because one life affected by HIV and AIDS is one too many. But we should recognise that the life with AIDS that people suffered through the 1980s is no longer an inevitability; the fear that came from the unknown can and should be expelled. Treatments have improved and now people can live a long life with an undetectable and untransmittable HIV diagnosis. We have reached this point because of the hard work of so many who came before us. I pay tribute to Terrence Higgins, one of the first people in the UK to die from AIDS. His legacy is the success that we see today. Sir Elton John led the way in breaking the stigma around AIDS, publicly stating that his sex life put him at risk and raising millions for AIDS charities. I also pay tribute to the scientists who worked to make drugs such as PrEP a reality and the activists who campaigned to keep AIDS on the agenda through the ’80s, ’90s and 2000s. We stand on their shoulders today. I hope we can do justice to their legacy.

Order. I ask Members to please try to keep to two minutes if they can.

16:54:00

Thank you, Sir Mark. I will simply agree with what both the previous speakers have said. I commend the hon. Member for Uxbridge and South Ruislip (Danny Beales) for securing this debate and for his work with the National AIDS Trust. I positively support its report, along with the Terrence Higgins Trust and the Elton John AIDS Foundation, “Getting on track”, and I am pleased that the Minister has engaged with that report already. As co-chair of the all-party parliamentary group on HIV, AIDS and sexual health, I will focus on the global issues. We have already heard that there were 1.3 million new transmissions last year, and in sub-Saharan Africa, 62% of those infections were among women and girls. I have three asks of the UK Government. First, I ask that they continue to be a major contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since 2002, the UK has committed over £5.4 billion, making it one of the largest donors, and it is extremely important that it continues to do so. Secondly, the UK needs to focus on expanding access to antiretroviral therapy—ART—for people living with HIV. ART is a lifesaving treatment that not only improves the health and quality of life of individuals but reduces the risk of HIV transmission. Thirdly, the UK needs to be a leader in confronting anti-LGBT+ legislation globally. We know that the risk of arrest and criminality leads people to hide their sexuality, avoid testing and eschew treatment, because they are evidence of so-called subversive or criminal behaviours. Such laws are an impediment to progress and undermine the efforts of the UK to assist health systems. We must stand up against them, and I hope the Minister will confirm that.

16:56:00

I thank my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) for bringing forward this crucial debate. I will start by commending campaigners and activists who have worked tirelessly to ensure that we have international awareness of HIV and AIDS. The legacy of racism surrounding the AIDS pandemic casts a long and enduring shadow for communities such as mine in Lambeth, and indeed across Africa and the Caribbean. Although the impact of the virus and our understanding of it has evolved, the legacy of racist attitudes towards AIDS continues to have consequences for black communities in the healthcare system. HIV-related racism and stigma increases vulnerability to infection in black communities, and those who are HIV-positive are less likely to come forward to be tested or to access treatment and health services. Last year, more than one in three HIV diagnoses in Lambeth was classified as late, meaning that the immune system had already suffered damage. Across England, 44% of diagnoses are late and women are 51% more likely to receive such delayed diagnoses. Early detection saves lives, offering effective treatment that ensures that those living with HIV can lead long and healthy lives and not pass on the virus once it is suppressed. People who are not infected are still at high risk because HIV stigma can prevent them from accessing information and education. Cultural taboos linked to sex and sexually transmitted diseases in black communities can also have an impact on people’s access to HIV prevention and education, which directly increases the vulnerability of those who are not infected. Racist assumptions around HIV and AIDS have also had consequences in other areas of the healthcare system. As recently as 2021, the NHS had a discriminatory blood donation ban on black donors due to flawed science around HIV. The ban had a direct impact on sufferers of sickle cell, an illness that predominantly affects black communities. Treatment is dependent on blood transfusions, particularly for a rare blood group such as Ro, which is common in black people. The legacy of those rules has resulted in a reluctance among the black community to come forward and donate blood. That is why I commend the work done by organisations such as the Terrence Higgins Trust, which makes a concerted effort to combat outdated and discriminatory policies and all the damage that they cause. I could not allow this opportunity to pass without mentioning the new Brixton blood donation centre in my constituency, which is opening in a few weeks. I extend an invitation to the Minister, and all Members, to come and visit the new clinic and to open their veins and donate. It is so important that we challenge the misgivings around blood donation and encourage people to donate. Ending new HIV cases is not just a medical issue; it is a social justice issue. We have to challenge the racism and discrimination that prevents individuals from accessing care, education and support.

16:59:00

It is a pleasure to speak in this debate secured by my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales). I wish to speak about the 1980s in Britain to reflect a perspective that may be more common in this place since the general election. I recently asked the Library what was the average age of Labour MPs first elected in 2024, and the answer is 43 years—it was quite a relief to hear I was below that. For so many of us in this place, the 1980s made us who we are. For those of us who are gay, either we or the gay people we knew grew up with the legacy of stigma and a deficit of self-acceptance. Thankfully, where we lacked a political language, there were ways to weave together the grief, fear, shame, anger and regret that was forced upon gay people by homophobia, some of which was on the part of the state, some of society, and some of the tabloid press in the era defined by Margaret Thatcher’s premiership. Too often the response of gay men was: “Run away, turn away, run away, turn away” because “the answers you seek will never be found at home The love that you need will never be found at home.” For many young gay men, they were the smalltown boys who Jimmy Somerville sang about, and they ran away to places such as London, Manchester or Bournemouth. One man who left for Bournemouth was John Eaddie. Until very recently, we have known very little about John. We know he was gay. We know he ran a guest hotel that was a haven to meet and drink in the late ’70s and early ’80s. We know he was charming and friendly. We know he was not the kind of guy to throw himself in front of the camera—in fact, he would be the one taking photographs. We know it was not in a big city but by the seaside where John presented doctors with the first signs of a mystery illness in 1981. We know he quickly deteriorated and ended up in hospital. We know that his carers in Bournemouth, baffled, sent him to the Royal Brompton in London, where his immune system was rapidly collapsing. And we know that he died in his tenth hospital day on October 29 1981. His cause of death, at the age of 49, was recorded as “pneumonia”. John’s death is in fact the first recorded AIDS death in Britain. His story remained a mystery for 40 years, and we only know now because of a research team, which involved Paul Brand, Nathan Lee and Mark Jordan wading through thousands of death records. I want to thank that remarkable research team, as well as Paul Brand for his help with parts of this speech. As the Member of Parliament for Bournemouth East, I am honoured to put the name of John Eaddie, a former Bournemouth resident, into the official parliamentary record. No longer, I hope, will he be known as “Patient Zero” or the “Brompton Patient”. As a gay man whose generation was being born as John’s was being devastated, I am honoured to remember John and his story, and to help alongside others to contribute to the eradication of the stigma of HIV and AIDS. Many of those who died of AIDS did not have children, and their older relatives are dying, so before this period passes into the past, we must tell their story. We must hold it here, thank the doctors and nurses in the LGBT community and allies who went far beyond every call of duty to care, and honour everyone who suffered and died, or anybody who lived in shame and died in secrecy. No longer will the last record of John Eaddie be in The Lancet medical journal, where even in that record there was no mention of AIDS as his cause of death, because it had not been invented as a term at that point. Known for much of my lifetime as “Patient Zero”, I believe we can now finally honour the man by his real name: John Eaddie. May he rest in peace.

17:03:00

I congratulate my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) on securing this debate to mark World AIDS Day. Colleagues have made important points about the huge progress, both medically and socially, that we have made as a nation over recent years, but of course there is always more to do. In 2023, there were 132 people in Exeter diagnosed with HIV and accessing HIV care. It is estimated that around 5% of all people living with HIV in England are undiagnosed, so there will inevitably be people in Exeter living undiagnosed today. I therefore welcome the continued roll-out of opt-out testing to identify and support those people. I want to touch briefly on two points. First, on the international picture, addressing inequalities in global health requires a country-led approach that puts grassroots communities in the driving seat. It is important, however, that such an approach includes an unflinching commitment to defending and extending human rights. The global HIV pandemic has demonstrated the importance of addressing human rights violations as a central tenet of driving down HIV rates. Today, UNAIDS releases its report into human rights and HIV/AIDS. The report, which includes a foreword by Sir Elton John, demonstrates that the world is not on track to end the HIV crisis, neither is it on track to meet the UN’s targets for societal enablers, which aim to reduce the social and legal impediments that limit access to lifesaving HIV services. LGBT human rights are increasingly under attack from authoritarian Governments and otherwise democratic Governments whose elected leaders choose to vilify minority groups for political gain. That is becoming a central tenet in the playbook of extremist forces, which makes it all the more important for the UK Government to take a global lead in advocating for human rights if we want to reach our commitments on eradicating HIV transmissions. Secondly, and very briefly, I want to use this opportunity to thank the many volunteers and activists across our country and around the world who have worked so hard to get us to the position we are in now. From caring for friends and relatives to protesting and setting up activist organisations, the fight against HIV and AIDS has always been led by committed individuals. In particular, I want to recognise the work of Nick Perry, a much-loved and admired resident of Hackney who sadly and suddenly died recently. Nick was a polymath, an expert amateur historian, a keen advocate for good planning and place, a volunteer for London Pride and, importantly, an HIV education advocate who volunteered with the Terrence Higgins Trust. I recommend to everyone his comedy stand-up segment at Nerd Nite London, available on YouTube, which tackles HIV issues and sexual health in a very accessible way. He was incredibly generous with his time and was a great mentor to me and many others, and will be very much missed by everyone he met. My condolences remain with his husband, Andrew Grace. People like Nick and many others in this country and around the world will always be the key to our collective ambition to end all new HIV transmissions. We must do everything we can as a Government to support them.

17:06:00

I thank my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) for securing this important debate. All the words we have heard today have been poignant and impactful. I want to speak about the impact of AIDS on women. In the UK, women make up a third of people living with HIV and just over a third of new HIV diagnoses. It is crucial that any strategy for AIDS does not forget women and their unique experiences of this disease. Often, women with HIV are some of the most disadvantaged members of society. The Terrence Higgins Trust estimates that almost half of women living with HIV in the UK live below the poverty line. It also estimates that over half of women living with HIV have experienced violence because of their HIV status. I spoke earlier today in a debate on tackling violence against women and girls, and this is yet another opportunity to highlight the actions we need to be taking to ensure that women in the UK do not have to live in fear. I also want to raise the importance of women getting tested for HIV, as it can often feel like there are too many barriers in place. We have made great strides in the treatment of the disease; it is vital that women can also access those treatments. It is also important to raise the fact that often, black, Asian and ethnic minority women face worse outcomes and experiences in our healthcare services than white women. That will no doubt also be seen in how those women access HIV care. I will finish by saying that we must strive so that all those living with HIV are able to do so with freedom from HIV secrecy, knowing that they are accepted and that HIV is not a label, and are free to pursue their dreams, faith and relationships free from stigma and discrimination.

I thank hon. Members for their brief contributions and for giving time for the Front Bench speakers.

17:08:00

It is a pleasure to see you in the Chair, Sir Mark, and indeed to represent the Liberal Democrats for World AIDS Day. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for his excellent introduction to this topic and for securing the debate. There have been so many brilliant contributions. I want to leave plenty of time for the other Front Benchers to speak, so I will not go through them all, but I am very impressed that in such a short time we have covered so much ground, and so eloquently. I particularly want to pick up on the speech by the hon. Member for Bournemouth East (Tom Hayes), who powerfully told us the story of John Eaddie, and thank him for that contribution. AIDS is one of the globe’s biggest killers, as we all know, despite being entirely preventable and treatable. In 2023, nearly 40 million people across the globe were living with HIV, 1.3 million of whom became newly infected within that year. Given that it is entirely preventable and treatable, we can aspire to bring that number right down to zero. In the United Kingdom the fight has been serious and ongoing since the 1980s, and yet since 2021 the numbers diagnosed have been increasing, while the numbers tested have been decreasing. We absolutely have to ensure that that is turned around rapidly. Testing is still 4% lower than pre-covid levels, and that has been driven by a drop among heterosexual men, where the testing rates are 22% lower than pre-covid. The most recent UK-wide estimates have about 5,000 people as undiagnosed and not aware that they are living with HIV. Again, that shows that the importance of testing—I entirely support the call for opt-out testing—is paramount to bring such people into the healthcare that they need and deserve, and to prevent the disease spreading. Internationally, good progress has been made, but the picture is still extremely concerning. I want to pick up on the inequality in that picture. Every week, globally, 4,000 adolescent girls—young women aged between 15 and 24 years—become infected with HIV; in 2023, 3,100 of those infections occurred in sub-Saharan Africa. Poverty and displacement drive those higher rates of infection, and there is a worrying link between conflict, sexual violence and HIV. That is something we need to address. I want to be brief, so to summarise the policy ask, the Liberal Democrats are keen to ensure universal access to HIV prevention, such as PrEP, and treatment. I have mentioned the importance of opt-out testing. We still need to work to eliminate the stigma and the discrimination linked to HIV, especially the racist element highlighted so carefully earlier. We press on the Government the importance of restoring the public health grant, which the Conservatives have cut by a fifth since 2015, to deliver better access to sexual health services. On helping globally, it is important that we restore, or at least set out the path to restoring, the 0.7% of gross domestic product for international aid, to enable issues such as AIDS to be prioritised in accordance with our requirements. With that, I will leave time for the other Front Benchers.

17:12:00

It is a pleasure to serve under your chairmanship, Sir Mark. As we mark World AIDS Day, we are called to reflect on the progress that we have made, on the challenges that remain and on the road ahead in our collective fight against HIV and the stigma so often associated with it, especially in the past. The UK has much to be proud of in that effort. Through the introduction of an HIV action plan, we set ambitious goals, such as an 80% reduction in new HIV infections by 2025. Remarkably, we achieved the UNAIDS 95-95-95 target back in 2020: 95% of individuals were living with HIV diagnosed, or presumed to be living with it diagnosed; 99% of them were on treatment; and 97% were achieving good viral suppression. Those figures reflect the dedication of our healthcare professionals and the effectiveness of our public health strategies. When diagnosed early, people with HIV in the UK can now expect a relatively normal life expectancy. The disease is no longer the death sentence it once was. The hon. Member for Uxbridge and South Ruislip (Danny Beales) spoke about that. Sadly, that is not the case worldwide. My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) highlighted the starkness of the global picture. Last year, AIDS-related illnesses claimed as many lives as did the sum total of all wars, homicides and natural disasters that ravaged our planet. In parts of southern Africa, in countries such as Botswana and Zimbabwe, more than one fifth of the adult population live with HIV. Such figures remind us that the global fight against AIDS is far from over. Troublingly, within our own borders, we are starting to witness a reversal of hard-won gains. A long and steady decline of HIV rates in the UK has suddenly and sharply risen in recent years. HIV diagnoses in England doubled from roughly 3,000 to a little more than 6,000 between 2020 and 2023, unfortunately reversing more than a decade of progress and throwing the Government’s goal to end HIV transmission by 2030 into some jeopardy. We must focus on what is driving that resurgence. One key factor is a worrying trend identified by the World Health Organisation: a decline in condom use, especially in younger populations. Between 2014 and 2022, a survey of nearly 250,000 adolescents across Europe found that only 61% of sexually active young men and 48% of young women in England reported using a condom during their last sexual encounter. The hon. Member for Uxbridge and South Ruislip talked about the success of PrEP, its greater availability and how it is an important tool in preventing HIV infections. It has undoubtedly saved lives. The Minister therefore has a complex challenge in how he will continue to promote lifesaving interventions such as PrEP while reinforcing the importance of safe practices such as the use of condoms. I am interested in the Minister’s plans to achieve that. Another part of the answer is an effective testing strategy. As the hon. Member for Uxbridge and South Ruislip said—to quote more of his speech—it is about testing, testing, testing. I know that the Labour party like to have the same word three times in a row. Successive Governments have been working very hard to reduce stigma and normalise HIV testing through campaigns such as the “I Test” programme, which helped to normalise HIV testing as something routine and beneficial, both for the individual concerned and wider society. Such campaigns have largely been targeted at communities with a higher HIV presence. The Conservative Government introduced opt-out testing, which has had a significant impact and is now available in 34 emergency departments across the country. It has identified hundreds of people who were previously undiagnosed or had been lost and followed up with treatment of HIV and hepatitis B and C. The identification of those cases helps the individual concerned and also helps to reduce transmission among the wider population. What plans do the Government have to expand the testing into more areas of the country and into A&Es across the country so that we can find out what other undiagnosed cases might be out there? Between 2019 and 2021, the estimated number of undiagnosed cases in England declined, but opt-out testing has suggested that there are more cases than we realise. Does the Minister have plans to re-estimate the number of cases of undiagnosed HIV that may be out in the community waiting to be treated? When one studies the statistics of new HIV diagnoses, it is clear that there has been a rise driven more recently by the migration of individuals who are HIV positive. I wonder what considerations the Minister has given to HIV testing for this population, and what plans he has to target measures to reduce HIV within that group. Finally, I want to talk about education, which has been and remains a key pillar in protecting young people from HIV and AIDS and reducing the stigma associated with testing and living with HIV. We must recognise the extent to which the pandemic disrupted health outreach programmes and traditional learning, leaving many young people without access to vital information. It is important that young people feel comfortable seeking advice and accessing resources. I would like to take a moment to acknowledge the tireless work of organisations such as the Terrence Higgins Trust, the National AIDS Trust and local sexual health clinics, who have continued to provide lifesaving services under incredibly difficult circumstances. However, those organisations cannot tackle the crisis alone. Indeed, with the Government’s new Budget, they face high charges for national insurance contributions. The Terrence Higgins Trust employs more than 200 people. What conversations has the Minister had with the Treasury about exempting such charities from paying national insurance on their employees so that they can continue their good and lifesaving work, rather than just paying more tax into this Government? We need to ensure that those charities have the funding and resources to expand their outreach, particularly in underserved and high-risk communities. On this World AIDS Day, let us reaffirm our commitment to ending this epidemic. Let us celebrate the progress we have made while recognising that there is still much work to be done. Let us ensure that future generations can live in a world that is free from the shadow of AIDS.

17:18:00

It is a pleasure to serve under your chairmanship, Sir Mark. I am extremely honoured to have the opportunity to speak today at the first dedicated debate on HIV and AIDS in this Parliament. I am incredibly grateful to my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) for securing the debate on a topic that is close not only to both of our hearts but to the heart of this Government. We are a Government who are committed to ending new HIV transmissions in England by 2030. With World AIDS Day fast approaching on 1 December, the debate is a welcome opportunity to highlight the importance of our new HIV action plan, which we aim to publish in summer of next year. Achieving that goal demands collaboration and that is why dialogue and engagement with every part of the system will be crucial as we progress with the development of the new plan. I am delighted to have the continuing support of colleagues from across the House, and like many speakers today I commend the engagement of fantastic charities and organisations such as the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation, among many others. I also pay tribute to all Members who have contributed to the debate. I assure the hon. Member for Strangford (Jim Shannon) that, as the Minister responsible for public health in England, I will liaise closely with my counterparts in Northern Ireland, Scotland and Wales to ensure that we are all on track to end new cases of HIV in our respective jurisdictions. My hon. Friend the Member for Gedling (Michael Payne) spoke powerfully, and the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) and my hon. Friend the Member for Exeter (Steve Race) both raised the issues of global inequality, stigma and the pervasive legislation that still exists in far too many parts of the world. I assure them and the whole House that this new Government will continue to be a major contributor to the Global Fund. Our obligations on the international stage are clear: we are not just about tackling HIV in this country, but around the globe. On human rights and anti-LGBTQ+ legislation, this Government and this country will always stand for equality, human rights and justice across the world, as well as at home. My hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) spoke specifically about issues within black and minority ethnic communities. I would love to come and visit the new clinic she mentioned; consider it a date. My hon. Friend the Member for Bournemouth East (Tom Hayes) made a lovely and loving contribution to the debate. On behalf of the British Government, I thank him for putting the name of John Eaddie on the record. John is no longer just a statistic; he is a human being who happened to die of AIDS. We pay tribute to John and to those who died after him, ahead of all the drugs, treatments and advances in technology that we now have. However, their death was not in vain, because we remember them and the sacrifices of their friends and families to support them in really difficult times so that we have a better world ahead of us today. My hon. Friend the Member for Sherwood Forest (Michelle Welsh) and the hon. Member for North Shropshire (Helen Morgan), who spoke for the Liberal Democrats, also contributed to the debate. I assure the hon. Lady that this Government are committed to public health and prevention and although I cannot circumnavigate the Budget process, we will do all we can to restore the public health grant across this Parliament and into the future, because public health and prevention matter. They are a priority for us all. On Monday, I had the pleasure of attending the launch of the voluntary and community sector report produced jointly by the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation, where I offered my reflections on its valuable recommendations. I welcome the report and its recommendations, and I look forward to developing the HIV action plan alongside such a vital sector. We remain committed to hearing from those whose frontline expertise, grassroots connections and powerful voices will ensure that our plan is not only ambitious but grounded in the lived experiences of those it seeks to support. Let me be clear: getting to zero new transmissions means smashing stigma. World AIDS Day is a stark reminder of how far we have come since the 1980s, but this year’s theme of tackling stigma starkly shows how far we have to go. It calls on all of us, not just as lawmakers but as members of our communities to reflect on the prejudice that people living with HIV have faced through not only a life-threatening illness but alienation, misinformation and discrimination. I have been thrilled to see the innovation and effectiveness of stigma-reduction strategies across the country. I am keen to build on that knowledge and work closely with the UK Health Security Agency as it continues to monitor stigma data through the “Positive Voices” survey report, to ensure that addressing stigma is a key priority for our new HIV action plan. The experiences of the 1980s should remind all of us that stigma thrives in ignorance and silence. That is why we are determined to address it head-on, as part of honouring the legacy and work of so many others who went before. For the avoidance of doubt, we will not be satisfied until the number of transmissions reaches zero, yet there remain differences in the rate of diagnoses between demographics. As the numbers move towards zero, we must work together to reach those communities that have not been captured thus far. That means including and empowering those voices, not essentialising them. It means cultural competence, innovation and collaboration. That is why we are hosting engagement sessions and roundtables in parallel with external stakeholders, including people with lived experience, the voluntary and community sector, professional bodies, local partners and others. We are working alongside UKHSA, NHS England and a broad range of system partners to inform the development of the new action plan, which will build on the progress made on the existing plan and guarantee that it is robust, inclusive and evidence-based. Central to that effort is the importance of testing. That is a message we cannot repeat enough. I apologise to the shadow Minister, but I am going to repeat it: test, test, test. Testing is the gateway to prevention, treatment and ultimately ending new HIV transmission. We know that HIV opt-out testing works well. Over the past 27 months, more than 2 million HIV tests have been conducted, reaching those who do not typically engage with sexual health services. Tomorrow, UKHSA will publish its opt-out testing report, providing us with the latest data. That will inform the next steps for the expansion of opt-out testing. We will also use that as a foundation to explore how our action plan can build on those successes—successes such as the national HIV testing week, yet we know that lower levels of testing persist among black African and heterosexual groups. We have seen that trend intersect with women, too. That requires tailoring our approach to reach those people living with undiagnosed HIV, who have been overlooked. PrEP plays a vital role in the combination approach. Breakthroughs in science and medicine mean that, with the right treatment, people living with HIV can now lead long, healthy lives. The PrEP road map was published by the HIV action plan implementation steering group in February this year, identifying barriers to access for under-represented groups. That road map will guide our efforts to improve access, uptake and the use of PrEP among those most at risk of HIV. In closing, I want to say that we are determined to reach zero HIV transmissions. On World AIDS day, let us honour those we have lost by recommitting ourselves to a future free from fear, misinformation and discrimination. The “Don’t die of ignorance” slogan is sadly as relevant today as it was on release. Together with science, compassion and unity we can achieve a future of zero new HIV transmissions, with stigma consigned to history.

Order. In the 20 seconds we have left, I leave it to Mr Beales to say a few words.

17:29:00

Thank you, Sir Mark. I will be brief, because I have to be. I thank the Minister and everyone who contributed. It is clear there is cross-party support for this action. The Minister will have our full backing in taking this plan forward. Question put and agreed to. Resolved, That this House has considered World AIDS Day.

17:30:00