Speech in the House of Lords on HIV/AIDS
I, too, congratulate my noble friend Lord Fowler on initiating this debate. I agree very much with what he said. I also endorse his remarks about President Bush's admirable contribution.
The recent increase in the incidence of AIDS in this country is very worrying and therefore the timing of the debate is particularly helpful.
At the outset I should declare an interest. I have been president and chairman of the Mildmay centre in Hackney, which we set up in 1986 as the first hospice for people dying of AIDS in Europe. As we found ourselves treating quite a number of Ugandan women and children, President Museveni of Uganda visited the centre and asked us to build a similar organisation near Kampala. Of course we readily agreed, not thinking how on earth we would find the money.
My noble friend Lady Chalker was very supportive. The Overseas Development Agency provided us with several million pounds to build a large outpatient and teaching centre, which continues to serve a large number of people, not only in Uganda but also in many other African countries.
I found attending a clinic in the centre to be a very harrowing experience. One would see about 90 children, all with AIDS, all orphans and all dying; 80 per cent of them had open TB; and many had scabies. It was not the usual type. Because they have no immunity it is a generalised rash and does not look like scabies, but is very distressing. Of course that can be cured quite easily. There was also shingles. I have never seen such terrible cases of shingles. Again that condition can be helped. One problem is looking after the staff of the centre. It is such a strain that we have to make sure they get regular holidays.
I want to look at how the incidence of AIDS can be reduced. There have been many attempts to that end, but none more successful than the Ugandan policy, which succeeded in reducing the number of new cases from 30 per cent to 11 per cent.
In order to be up to date, I obtained the latest figures by telephoning the two ladies in Uganda who have done such wonderful work there for many years. One is a real live matron—how we miss them in this country—Ruth Sims, and the other is the medical director, Dr Veronica Moss. They said that the incidence of AIDS in pregnancy has fallen even lower to 7 per cent.
The question arises: how has Uganda achieved this while other countries have not? I think that President Museveni is probably one of the most outstanding of Africa's leaders. When he realised what the problem was in the late 1980s, he decided that above all the country had to face the facts. Concealing the truth, he knew, was a recipe for disaster. So it has proved to be a disaster in several of the African states.
I was very interested by what the noble Earl, Lord Russell, said about the percentage of people that the plague carried off. I knew that the plague carried off about one-third of the people, but the same thing looks to be happening in some of the African states. Furthermore, a similar catastrophe appears to be in store for several Asian countries that pretend that AIDS is not their problem.
As the noble Lord, Lord Alderdice, mentioned, even today there was a dubious report about the spread of AIDS in Africa, stating that it had more to do with faulty medical treatment—including contaminated equipment and blood transfusion. I put more store by what Professor Michael Adler had to say about those papers. He is a distinguished doctor who has been involved in HIV/AIDS for many years. His view was that those propagating that view had produced no new data and that most of their analysis dated from the 1980s. Blood transfusions are now much safer; people are much more aware of the dangers; and people are more careful about medical interventions.
On the "Today" programme this morning, a senior doctor working in Kenya pointed out that 1.5 million Kenyan people have died of AIDS and 2 million currently have AIDS, but those people never see a hospital until they have developed the disease. He also emphasised that for the past 10 years in Kenya they have used only disposable needles and that all blood transfusion is doubly checked.
The World Health Organisation figures estimate that unsafe injections are responsible for only 5 per cent of HIV/AIDS infections. A United Nations unit called the Safe Injection Global Network has been established to promote safer practices, focusing mainly on hepatitis, which is much more easily transmitted in that way than HIV/AIDS. As a surgeon myself, I am very careful with the knife and needles not to incur any injury to myself or my assistants, but it is not AIDS that I am concerned about, it is hepatitis. It is actually quite difficult to pick up AIDS from a needle stick, but easy to pick up hepatitis. So the policy is, when operating on a person, to assume that everyone has hepatitis. That makes one very careful indeed.
Of course, it was not so long ago that surgeons did not need to wear gloves at all and, during the war, many of them did not. But we now tend to wear two pairs of gloves. Someone said that the only reason that surgeons wore gloves in the old days was so that they did not leave any fingerprints behind.
Experts have pointed out that if contaminated needles were responsible for the spread of AIDS, Hepatitis B would be spreading faster than HIV/AIDS in Africa and Asia. It is not. An Imperial College epidemiologist, Professor Roy Anderson, has said: "Understanding the root of infections is very difficult unless you do cohort studies which compare groups of people who get the disease with similar groups who don't get the disease".
When that was done for HIV/AIDS, two risk factors were identified. The first was sexual behaviour and the second was the presence of other sexually transmitted diseases, which may facilitate infection with HIV/AIDS. The number of injections that anyone has had does not appear to be important.
Another specialist has stressed that if the main spread of the disease was through needles, one would expect to find the disease in similar concentrations across all age groups. But that is not the case. It is overwhelmingly concentrated in the sexually active age groups.
President Museveni himself launched a sustained campaign based on preventing AIDS by encouraging faithfulness within marriage. He said that, if a person could not confine sex to within marriage, precautions should be taken on the clear understanding that they are not always successful in preventing AIDS. They are not all successful in preventing pregnancy either. Sperm are many millions of times bigger than the HIV virus. He emphasised that education was not enough; a change in behaviour was required. Recently, that was underlined when a young lady doctor who went to work in Africa had an affair and, tragically, returned home with AIDS. She was highly educated. I was struck by the suggestion of the noble Earl, Lord Russell, that perhaps attitudes to women should change. That comment is typical of the noble Earl. In his entry in Who's Who he lists one of his hobbies as uxoriousness.
Noble Lords have drawn attention to the tragedy that developing countries cannot afford the anti-retroviral drugs, which would relieve a great deal of suffering. It has already been pointed out that a single dose to a mother with AIDS during childbirth can protect the baby from developing the disease. But, sadly, that has stimulated some very chilling ethical discussions. Many argue that it is unfair to save a child who will be left with no-one to look after him. Clearly, much more effort must be made to find money from the wealthier nations to supply those necessary drugs. But simply attacking the drug companies is no real answer. In my own experience of working in Africa, not only in the Kampala centre in Uganda but also on a hospital ship with Mercy Ships, travelling to developing countries and staying in port for several months, doing the operations that people there cannot do and showing them how to do them, I was struck by the generosity of the drug companies. When the companies found out that some charities were using out-of-date drugs to economise, they offered to replace them free.
Reference has already been made to the great concern that we all feel about the recent, unacceptable increase in the incidence of AIDS. It emphasises how essential it is never to let up in the campaign to try to persuade those at risk to take every care to avoid contracting this fatal disease.
We all look forward to hearing from the Minister what the Government plan to do to turn the tide of the epidemic. As I know the Minister is aware, there is an urgent need to provide more resources to deal with those awaiting treatment in genito-urinary medicine clinics. I am sure that she is aware that the waiting time is now unacceptably high. We also need more resources for an effective screening programme for chlamydia, especially among young women.
I would also like to know how government publications, advertisements, videos and so on are being distributed throughout the country, and whether they are the ideal format. I have been impressed in the past with the BBC and other broadcasting companies who have incorporated those essential messages into their programmes—"Coronation Street", "The Archers" and so on. It is great that they do so. We need constant vigilance if we are to succeed in containing this plague.