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Baroness Stern: My Lords, I would like to echo the remarks made by the noble Lord, Lord Brooke, about the noble Lord, Lord Fowler, and thank him for initiating this important debate.
The United Kingdom response in the mid-1980s to the HIV/AIDS problem is seen as a model in international circles. The noble Lord, Lord Fowler, was in the driving seat at that time and must take the credit for the enlightened and far-sighted approach that was taken. I remember receiving the leaflet he sent me and the rest of the population and thinking, "This is an unusually sensible document to come from the Government".
I wish to limit my contribution to one aspect only of this problem, but I hope to show a very central aspect—the prevalence, transmission and prevention of HIV in the prison systems of the world. In that context I declare an interest as a board member of Penal Reform International. Rates of HIV infection are very high in prisons in many parts of the world. Prisons have always been places where sickness is concentrated and from where epidemics have spread; and the HIV epidemic is no different.
According to the World Health Organisation, one can multiply the official HIV statistics of a country at a given moment by a factor of between five and 10 to get an actual estimate of the rate of infection in a country's prisons. HIV in prisons is particularly acute in eastern Europe and central Asia, where the rates of HIV infection are now increasing rapidly. In some of the new European Union states, HIV infections are also on a rapid rise in prisons. In Estonia, the first HIV-infected prisoner was diagnosed in 2000. Since then the number has increased by four or five every week. In Latvia, the number of HIV-positive prisoners increased by 58 per cent between 2000 and 2001.
There was a well publicised case of an increase at one prison in Lithuania. In 2002, 229 infected prisoners were being held there. Between May and July of that year 44 more infections were added because, it is said, they all used the same needles to inject drugs. Recorded cases of infections in prisons in Russia have risen from seven in 1995 to 30,000 in 2003. I strongly endorse the point made by my noble friend Lord Sandwich regarding the co-morbidity with TB. In some of the countries that I have mentioned, active TB affects 10 per cent of all prisoners.
The reasons for those high infection rates will be obvious to noble Lords. One reason is the nature of the population that prisons receive. People in prison come from the most disadvantaged sections of any society. They come to prison with ill health, with many untreated conditions and they engage in risky behaviour such as drug taking. Prisons are full of people who use illegal drugs. In Russia and Ukraine more than 90 per cent of HIV-infected prisoners are
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intravenous drug users. Secondly, the environment itself in prison is disease-producing, because of unprotected sex—consensual and forced—tattooing with unclean needles and injecting drugs with shared needles. It is not just those who enter prison as drug users who engage in that behaviour. Research shows that in west European prisons the percentage of prisoners who first start to inject drugs while in prison ranges from 7 per cent in some countries to 24 per cent in others. Research also shows that a quarter of Russian prisoners were tattooed in prison—two thirds with needles already used on someone else.
This is a crisis for many prisons and, as the noble Lord, Lord Fowler, said, we know exactly what to do about it. Therefore, it is vital that prisons are included in all national HIV prevention policies. It is also vital that harm reduction measures are accepted and that public health priorities are clearly asserted. But this is a real challenge that causes dilemmas and grave difficulties in prison systems all over the world.
Prisons need to take action to stop the spread of HIV. They need to stop prisoners taking such risks as unprotected sex or injecting with the same needle. However, we will all be aware of how easy it is to say that and how difficult it is to implement. To do those things, prison officials have to accept some harsh realities that they would often rather deny. However good their security measures are, however many sniffer dogs and body searches take place, drugs get into prison. In some countries with poorly paid prison guards corruption ensures a regular supply. Sex takes place in prisons the world over, so condoms should be available to prisoners easily and without embarrassment. I will not recite the long saga of getting prisoners access to condoms in the Prison Service of England and Wales. I understand that prisoners now have access, but that the method of giving them access is likely to be a deterrent to many.
Substitution, maybe a methadone maintenance programme, needs to be available so that those who inject drugs may move to a safer method. The provision of bleach and other disinfectants in prisons is basic and absolutely essential, so that shared needles may be cleaned.
Finally, there is the provision of needle exchange facilities. The Government are greatly to be congratulated on the move they took to bring prison health services in England and Wales into the Department of Health, and under the National Health Service. I know this has meant significant progress in taking forward measures that should have been in place since those early days when the noble Lord, Lord Fowler, was at the Department of Health.
I would like the Minister to reassure me that the rollout of the programme to provide disinfectants will continue energetically, the provision of condoms will be improved, and the possibility of needle exchange programmes, where the need can be proven, will at the very least be kept on the agenda. I would also like the Government to ensure that the question of HIV in prisons is part of their international development and human rights agendas.
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Those noble Lords who visit prisons abroad may well have seen the compulsory testing of prisoners that leads to a diagnosis but no treatment. This results in the segregation of HIV-positive prisoners in the worst and darkest accommodation, where prison staff do not go, and medical staff give treatment through a grille in the cell door without touching the prisoner. Compulsory testing and segregation of HIV-infected prisoners are condemned both by the WHO and the Council of Europe. It is heartening to see that many countries new to this problem are taking action to improve their treatment of such prisoners. Kazakhstan has taken the lead in central Asia by eliminating compulsory testing and segregation. Noble Lords may be interested to hear that the noble Baroness, Lady Massey of Darwen, who cannot be here today, has played a key role in educating medical workers in Kazakhstan about HIV prevention and treatment. Kyrgystan has initiated needle exchange programmes in its prisons, as has Moldova. There is much to do, and much good work to encourage.
I draw the attention of the House to the Moscow declaration of the World Health Organisation in Europe, entitled Prison Health as Part of Public Health, which calls for prison and public health services to work together,
Will the Minister ensure that this declaration will be wholeheartedly supported by the UK representatives at the next annual meeting of WHO Europe?
Finally, will the Minister ensure that all HIV prevention projects funded by his colleagues in the DfID include the prison system and prisoners in their scope, because hundreds of thousands of prisoners leave prison every year taking their infections with them?
Baroness Masham of Ilton: My Lords, I thank my noble friend Lady Stern for what she said about prisons. I agree with all of it.
I congratulate the noble Lord, Lord Fowler, on his choice of debate, because the increasing spread of HIV/AIDS needs addressing. It is devastating communities and mutilating families, especially in some African countries. I thank the noble Lord, who understands the many problems relating to HIV/AIDS. He was Secretary of State for Health at the start of the AIDS catastrophe, and I am sure the campaign warning people of the dangers of HIV/AIDS had an effect on prevention.
I am also sure, with the current increase of HIV and other sexually transmitted diseases, that there should be continued campaigns on prevention. We have a very dangerous situation at the moment, where many young women and men just do not care and have unprotected sex with many different partners. As sexually transmitted infections facilitate the transmission of HIV, it is possible that the rise in these may have played a significant part in the increase in HIV among gay men. All sexually
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transmitted infections have increased in England, Wales and Northern Ireland. That is why I asked the Government a few months ago whether there should be a national service framework—for this growing problem.
Something has to be done. People across the world did not take the advice that one partner was the safest option. The recent case of the man from Middlesbrough who had come from Africa and knowingly infected three women, and has now been given a 10-year prison sentence, might make a few people think. Should there not be clear legal guidelines, stating that it is a criminal offence to knowingly infect people with the HIV virus?
There is concern that the removal of dedicated funding for treatment and prevention of HIV/AIDS in recent years will place the investment in services over the past 20 years at risk. There should be a commitment to ongoing funding, not one-offs, to ensure the availability of appropriate treatment and care for those eligible.
Many people and organisations from Britain are helping and giving support to developing countries, and that is good. But we must not neglect our own people, living in our own communities. HIV/AIDS is a horrible condition. It complicates lives. The difficulties over confidentiality can make communication difficult. There are many problems which can arise for people whose health deteriorates, such as housing needs, social care, arranging meals, visits to hospitals, and companionship if people live alone.
A very unfortunate situation has arisen at the Mildmay Hospital in Hackney. This is a dedicated hospital for people with HIV/AIDS, giving respite, rehabilitation and hospice care. It founded a family centre for children and parents living with HIV/AIDS who needed support. The children had good play facilities and lunch, while the mothers had rest and treatment. The family care centre ceased to operate in 2002. Health authorities are no longer prepared to fund family admissions, arguing that this is not something they do with other illnesses. Health authorities withdrew funding for children infected or affected by HIV, on the basis that this is not a health issue. The Mildmay is concerned about the withdrawal of HIV-specific funding. It is being increasingly financially squeezed, as PCTs no longer give HIV priority.
As the Mildmay Mission Hospital does missionary work, it has two thriving AIDS centres in Africa: one in Uganda and one in Zimbabwe. Should we not be looking after our own people at home, as well as helping others? When I think of the smiling little faces of these children enjoying their play facilities and lunch, it makes me sad to think that some of them will now be isolated at home while their mothers lie resting, without the support that was so needed, which the Mildmay was able to give them.
I hope the Minister will be able to tell the House what progress the Global Fund to fight AIDS, TB and malaria is achieving. This has been a priority for the UK and I wonder whether the Minister can say which countries have supported the Global Fund and which have not.
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Last year, a parliamentary delegation from the HIV/AIDS group from India visited us in Parliament. It was good to meet them and to hear that, like us, they had a parliamentary group. With more than 4.6 million HIV-infected people, India has the second-highest rate of HIV infection in the world after South Africa.
HIV/AIDS is the biggest threat to global development and stability in our time—not only in Africa but also across the world. It is no longer simply a health issue; it is a human rights issue that cuts across all aspects of social, political and economic life.
Children orphaned and made vulnerable by HIV/AIDS experience a wide array of problems. In addition to the psycho-social distress of losing one or both parents, they may also lack food, shelter, clothing or healthcare. They may be forced to drop out of school or required to care for chronically ill adults or younger siblings. They may face discrimination, abuse or exploitation. Deprived of parental guidance and protection, they may themselves become vulnerable to HIV infection.
HIV is causing so many problems, it is encouraging when one hears that governments have accepted there is a problem with HIV in their country. Governments from all over the world must do all they can to prevent the spread of this deadly infection.
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