How society should react to developments in HIV/AIDS; Neil Gerrard

Mr Neil Gerrard MP Walthamstow, London

My view of how society should react will inevitably be personal and perhaps coloured by what I believe is politically feasible. Political arguments will reflect the views of the public, as MPs tend to do, especially when reacting to strongly voiced public views (after all, we are elected by the public).

I am not the Minister of Health; nor am I representing the Minister. I am a member of the All-Party Parliamentary Group on AIDS (APPGA) and have been the Group's Chairperson since May 1997. The makeup of the Group is: 100 members from the House of Commons and 50 from the House of Lords.

APPGA's aims

Issues for the future

There are many changes, such as treatment developments, occurring in the HIV/AIDS field, and these create both opportunities and problems. The issues include access (both within the UK and internationally) to treatment, economics of treatment and sociopolitical implications. Furthermore, following the recent Government white paper, huge changes are in store for the NHS, and there are other policy issues to consider:

Funding issues

The treatment and care budget has been increased by £23 million for 1998, and relatively few people are denied access to combination therapies. However, this doesn't mean that there are no problems. These problems of inequality seem to revolve around the two dominant social issues: where you live and who you are.

HIV and AIDS services have never been subject to conventional internal market mechanisms . So how do we safeguard funding in an area when the market is being unwound and all the moves are towards GP commissioning? Furthermore, how do we safeguard `specialist' services and, especially, how do we do so in areas that are not of high prevalence? At present, district-of-residence funding causes many problems, and opportunities may arise in the future for consortia, `hub and spoke' models and a variety of alternative solutions.

The pressure of drug budgets on other services needs to be assessed. (A separate but related issue is that of prevention budgets and where and how they are spent.) There is, for example, a fear in the voluntary sector that pressure on drug budgets may lead to cuts in other areas.

This raises questions as to whether we can continue to support services that are less in demand, and also what the pace of change should be. Are palliative care services, for example, likely to be needed on the same scale as previously. We may guess not but, considering the uncertainties about long-term efficacy of treatments, the question here may well be: should we close these services or remould them for future use?

Social issues

One major consequence of new treatments, in terms of people's view of the future, is the issue of returning to work - how feasible it is and what the barriers are. At present it seems to be an aspiration rather than an achievement. There are major barriers created (and not just for HIV patients) in the benefits system, in people's attitudes and in employer's actions.

So, how do we change people's attitudes? We need public and employer education and understanding . We need to attack prejudice and discrimination - and the repeal of Section 28 and the equalisation of the age of consent would be important steps along this road. Similarly, the issue of criminalisation of transmission is not just a problem in itself; it is also a possible source of public prejudice. These issues all have an impact on returning to work - and also on funding.

Drug issues

This is a difficult political area. There are well known and widespread problems surrounding intravenous drug use in some European countries and, to a degree, in Scotland. How do we deal with drugs? Is a punitive approach the answer?

There are confused messages at present in that there is a harsh attitude towards dealers and, at the same time, an independent campaign for the medical use of cannabis. Furthermore, there are problems, in relation to combination therapies, associated with drug use and lifestyles that militate against strict control regimens . There is an overwhelming need for sensible public debate on these issues.

International perspective

The public view of overseas aid is generally positive, but it is important to keep an international perspective on HIV/AIDS to the forefront. Are drugs the answer to the worldwide epidemic. If not, how do we encourage and sustain work towards a vaccine or a virricide? And what about millions currently infected? We may eventually have to face the fact that there may not be any long-term answers in these areas.

Need for a high profile

There is in HIV and AIDS an extremely wide-ranging agenda. There are areas where public and political support is clear, but many others where it is less so. This is one reason among many why it is so important to maintain a presence in the Houses of Parliament and to raise the profile of HIV/AIDS in the community.