AIDS Policy

1118

Commentary from Westminster AIDS Mr John Moore,

Policy

Secretary of State for Social Services, is

that the Government has expected decided against substantial changes in screening for HIV infection. He and other ministers are understood to have accepted the findings of Dr Joe Smith, director of the Public Health Laboratory Service, that screening new groups is unlikely to help control the spread of HIV infection. The Cabinet AIDS Committee, chaired by Mr Moore, is to publish these findings at the same time as it makes this announcement. At present only blood donors in England and Wales are systematically screened for HIV antibody. soon

to announce

suggestion has been the anonymous screening of patients attending hospitals. This step would improve knowledge of the extent of infection and so contribute to policies of prevention. But this proposal has run into ethical objections and doubts about its practicality. Doctors would be unable to provide advice and support to patients found to be HIV-positive. Statistically helpful information might be difficult to extract. Screening would show the age and sex of the HIV-positive person but if, for example, figures indicated a sudden rise in the number of HIV-positive women, there would be no means of finding out whether this was related to drug taking, or to some other factor. At the very least ministers want first to have the results of a study carried out by Sir David Cox of Imperial College. He has been asked to predict the likely spread of HIV infection and One

AIDS over the next 2-5 years. Cases of full-blown AIDS are said to be doubling every 10 months. The Government is expected to come under pressure to introduce screening for immigrants, servicemen, and prisoners, and for doctors and nurses because of their vulnerability. These proposals will be rejected, however, because there is no evidence to suggest that such screening would help stop the spread of AIDS-unless ministers are prepared to take the enormous step of isolating people found to be HIV-positive, an unlikely eventuality at the moment. Screening of immigrants would present considerable practical problems since it could involve three tests, which might mean detaining visitors for several days. Nor could there be any certainty even then since the visitor might have arrived in the "window period" when he or she was already infected but antibodies had not yet developed. There is still a strong and understandable reluctance to do anything that would drive people with AIDS underground. Ministers have decided not to make AIDS a notifiable disease: that might discourage rather than encourage people to come forward. This essentially cautious approach by the Government will increase the unease of some Tory backbenchers. 25 Conservative MPs met privately in the House of Commons last week to discuss the seriousness of the situation and whether ministers were being sufficiently decisive. The verdict was that the Government must do more. Sir Nicholas Bonsor, who called the conference, told The Lancet: "I have been concerned for some time that there is not enough knowledge about the AIDS virus among my colleagues and I wanted to wake them up to the extreme danger it presents to our civilisation". He invited a panel of

five experts, Dr Caroline Collier, an AIDS researcher for the Christian Fellowship; Dr A. Karpas, a research-worker at Cambridge University; Dr Wilson Carswell (United States), who has spent 12 years in Uganda carrying out research on control of AIDS in Africa; Mr Len Curran, principal psychologist at Wormwood Scrubs Prison and chairman of the Prison AIDS Advisory Committee to the Home Office; and Dr John Gallwey, who runs the AIDS clinic of the Radcliffe Infirmary, Oxford. Sir Nicholas reported that the meeting had demonstrated need for more research before the public could be confident. "There was an original splurge of publicity, but I don’t think it really penetrated deeply enough. I think people said to themselves that this was a problem for the homosexual community and drug takers and that they need not worry about this." a

Sir Nicholas also suggested ways of stepping up the campaign to stop AIDS spreading: "This may have to be by much wider screening so that we have better information. I think we have to consider what action we should take to identify AIDS carriers in order that people who deal with them know that they are. We have to decide what we are going to do about prostitutes, for example, who continue their trade knowing they are spreading this infection." Nor did Sir Nicholas believe the danger to the inmates of was being examined properly. "Obviously there is substantial drug taking and homosexuality and we have to decide how we can protect people from the undesirable activities of their neighbours. My view is that you have to have a compulsory screening of the prison population and you have to put the AIDS sufferers in one wing and everyone else in another. To give another example, I believe that in the United States all armed servicemen are screened and I think we should do the same. There is an obvious threat, in military terms, if the infection is spread in the Services."

prisons

Sir Nicholas favoured testing of all long-stay immigrants Britain. He is to discuss AIDS policy in prisons with the Home Office Minister, Mr John Patten, and Sir Nicholas will ask whether the criminal law is adequate to deal with people who deliberately try to infect other people with HIV. Mr Moore and his Health Minister, Mr Tony Newton, must contend with the beginnings of a Tory backbench campaign to persuade the Government to act more to

vigorously. Abortion Bill

Just as Sir Nicholas Bonsor is starting his campaign it looks very much as though Mr David Alton is concluding his. Politics is a rough old business. Procedural ploys and filibustering are time-honoured methods of stopping attempts at legislation, and Mr Alton’s private member’s Bill fell before such a tactical onslaught on May 6. His proposal now is unlikely to be put to the test of a Commons’ vote. If Mr Alton, given the energy and time he and his supporters put into the fight, cannot secure a Commons’ verdict on his measure, then there is precious little hope for other private member’s Bills in future. Even Mr David Steel was given government time to ensure the passing of the 1967 Abortion Act, which Mr Alton wanted to amend. JOHN LEWIS