The next item is a statement by the Minister for Health and Social Services—World AIDS Day. I call on the Minister, Eluned Morgan.

Thank you, Presiding Officer. Tomorrow marks World AIDS Day, which is both a time to reflect and to look to the future. HIV and AIDS continue to be a major global public health issue, having claimed an estimated 36.3 million lives globally. The World Health Organization estimates that globally in 2020, 680,000 people died from HIV-related causes and 1.5 million people acquired HIV. Although there remains no cure for HIV, effective prevention, diagnosis, treatment and care are now available, enabling people living with HIV to lead long and healthy lives. The most recent estimate suggests that there were 105,200 people living with HIV in the UK in 2019. Of these, around 6,600 are undiagnosed, so they don't know they are HIV positive.

We've come a long way since the dark days of the 1980s—so memorably depicted last year in Channel 4’s It’s a Sin—when ignorance and cruelty towards people with HIV were rife. Much progress has been made since the World Health Organization established World AIDS Day in 1988, but there is still so much more to do. That’s why, in Wales, our programme for government sets out ambitious commitments to both develop an HIV action plan for Wales and to tackle the stigma experienced by those living with HIV. More action must be taken if Wales is to achieve the World Health Organization’s global target for ending new HIV transmissions by 2030.

Over the last five years, the Welsh Government, working with health boards, Public Health Wales NHS Trust and other partners, have made huge progress on improving access to testing and treatment in Wales.

In 2018, Public Health Wales published a comprehensive review into sexual health in Wales, which highlighted geographic variation in services and a need to look at a different model of service provision to meet demand. Since then, we've worked to improve access to services across Wales. For those accessing sexual health services for pre-exposure prophylaxis, which is now available across Wales, we've introduced self-sampling HIV to improve access to testing and free up clinic time.

At the start of the COVID-19 pandemic, when access to sexual health services was limited, we expanded an online sexually transmitted infection testing pilot that was taking place in three health boards in Wales already. Whilst it was expected that the new national online STI testing service would meet the needs of the known asymptomatic cohort, thereby freeing up the clinic services to see more complex cases, it's also uncovered a cohort of people who were previously unknown to services.

Providing the service online across Wales has made STI testing more accessible and more equitable, which has resulted in a previously unidentified group coming forward for testing. This has not only meant that more people are able to be tested and treated at earlier stages, reducing the risk of onward community transmission, but sexual health services have been able to focus on those who are more vulnerable in society. This service has been welcomed by both the public and health services, and it's necessary for it to continue in the longer term. I'd like to thank all involved in expediting its roll-out across Wales so efficiently.

Furthermore, I am pleased to say that as of 1 December, a new treatment, the first long-acting injectable treatment for HIV-1 infection in adults, will be made available through NHS Wales. This will be a valuable option for those people who are eligible and will mean people accessing this new treatment will no longer have to take daily medication.

I also welcome the opportunity to update you on PrEP, four years after its introduction in Wales. PrEP is an antiretroviral medication that, if taken correctly, can prevent HIV for those at risk.

I am pleased to say that this intervention has been very successful to date and that there have been no new cases of HIV among those receiving PrEP. Between January and October 2021, 1,301 people accessed PrEP. However, during the pandemic, PrEP use has declined. There are many possible reasons for this, but the Welsh Government will be working with partners, including the Terrence Higgins Trust, on a campaign to increase knowledge of PrEP in Wales, to encourage its use and to improve access to PrEP.

New HIV cases in Wales are on a downward trajectory. It is imperative that this downward trend continues. It’s also important that new cases of HIV are diagnosed early and that patients receive the highest standards of care. In 2019—. I apologise. In 2021, there were over 2,300 people resident in Wales who were accessing HIV care. This number will continue to grow as more people know their HIV status and can access effective treatment.

When on treatment, a person with HIV has an undetectable viral load, the person cannot pass on HIV and they can expect to live a long and healthy life. Despite this being the case for many years, there is still a lack of awareness generally among the general population, and there are still many misconceptions about HIV. HIV is a chronic condition. People with HIV should feel able to be open about their HIV status as they would be with any other condition, without the fear of judgment or being treated differently. We must eradicate stigma in the workplace, in schools and health and social care settings. I expect everyone to be fully informed on HIV and HIV stigma, and the Welsh Government will be working with the education and health sectors in order to achieve this.

My officials have established a task and finish group to provide advice and leadership on the development of an HIV action plan. The aim is to publish the plan in the first half of 2022. The plan will contain focused, measurable actions that aim to make a huge impact on prevention, diagnosis, treatment, care and stigma relating to HIV. As soon as the plan is agreed and costed, I will make a further statement about timescales for taking the recommendations forward.

As well as supporting the NHS to recover and move forward following the exceptional challenges over the last two years, it’s essential that we continue to act to maximise fairness for all and eliminate inequality, stigma and prejudice at every level of society. Working with partners across the health services and academia, as well as third sector bodies such as the Terrence Higgins Trust and Fast-Track Cities, which have a lot of knowledge and expertise, I am confident that Wales can lead the way. I look forward to updating you on further progress regarding these commitments in the programme for government, and our targeted efforts to reduce the transmission of HIV here in Wales.

Conservative spokesperson, Russell George. 

Diolch, Deputy Presiding Officer. Can I thank the Minister for her statement today? I agree with much of what's been said in the Minister's contribution. In the past few years, due to the fantastic work conducted by scientists and healthcare workers, we have seen HIV transmission significantly reduced, which has helped, of course, limit the detrimental impact the virus has had on a person's life. Figures show that HIV cases have dropped by 15 per cent in Wales since 2018, and this is testament, of course, to the expanded HIV testing and the effectiveness of HIV treatments. However, I did notice also that the numbers of those in Wales who are diagnosed late is well above the UK average, so of course, I welcome the HIV action plan that the Minister's outlined but I wonder if the Minister can provide some information on how the Government plans to address late diagnosis, in Wales in particular.

I think thanks to the amazing work over a number of decades, people living with HIV can do exactly that: they can live, and those with HIV can now live long and healthy lives with the medication even making it possible to reduce the disease to where it is non-transmissible. But as the Minister's pointed out in her statement today, there's still the issue of stigma around HIV, and I wonder if the Minister can perhaps just talk a little bit more in terms of the action plan in that regard, because it's certainly been my view from the small amount of research that I've done here that the stigma issue should be a central part of that plan, so I wonder if the Minister would agree with that position.

One of the key learnings of the COVID-19 pandemic is the importance, of course, of rapid access to effective treatment and new technologies. People living with HIV should be able to access any new innovation and technology in a rapid and a safe manner in order to help improve their quality of life, and it's great to see the new treatment I think that the Minister outlined in her statement today. I think it's an injectable treatment for HIV-1 infections in adults, if I've got that right; I think that's being rolled out soon, as I understand it, which means patients will be able to stop taking daily medications. I don't know if the Minister knows more about that, but it would be useful to know if with that new treatment, how often the injections have to be given, and will the treatment be open to every HIV positive adult in Wales.

Good to know a bit more about the development of the plan as well; the Minister mentioned in her comments about the Terrence Higgins Trust and Fast-Track Cities. Are these organisations going to be part of developing that plan? A bit more information in that regard.

And of course, finally, we know that we've got a large vacancy rate in terms of nurses in Wales—1,700 nurse vacancies—so of course, we want to help those living with HIV in Wales to live long and healthy lives, so we need to maintain a workforce to facilitate that. So, I wonder if the Minister will commit to developing a strategy in this regard for recruitment and retention of the HIV workforce, in particular in clinical settings, local government and the voluntary sector. Diolch, Dirprwy Lywydd.

Diolch yn fawr, Russell. I think it is important that we are very clear about how many people are affected by HIV in Wales; in 2019, we had around 2,378 people who had accessed HIV care. About 77 per cent of those were men, and you're absolutely right to focus on the need to try and ensure that we have early diagnosis. To do that, people need to step forward and come forward, and so getting rid of the whole stigma situation that you talked about is absolutely central to that. And it will be central to the plan that has been developed, and obviously, on that task and finish group, the Terrence Higgins Trust will be a part of developing that plan. The Welsh Government have already had several meetings with stakeholders and are developing specific actions to address education about HIV and the stigma experienced by those living with HIV, and the first meeting of that stigma group will be taking place before the end of this year.

You did talk about the new treatment that is being developed, and you're quite right that from January 1, NICE has approved this. That will be rolled out from January 1 in Wales and that will stop people from needing to take daily medication. So, that will be available to those appropriate for that medication, so obviously, that's a clinical call rather than something that I can be clear about here today. So, I do think it's important that we understand that actually, there is still a stigma in relation to HIV and AIDS, and one in eight who have AIDS and who certainly have HIV have never told anyone about their status outside of the healthcare setting, and about 18 per cent of people with HIV have avoided healthcare even when they needed it. So, we've got to crack this, and we have got to crack the stigma situation in Wales.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Deputy Llywydd. I'm very pleased that we as a Senedd have an opportunity to mark World AIDS Day. It's an opportunity to praise everyone involved with HIV Testing Week Cymru, which was co-ordinated by Fast Track Cardiff & Vale, and the aim was to break down the stigma that prevents people from taking a test. It then ties in to the target of preventing new HIV infections by 2030, and I'm very pleased and proud that Wales has been in the vanguard in being the first nation in the UK to commit to that target and also to ensure that PrEP is available on the NHS.

We in Plaid Cymru have a stated aspiration of bringing the target forward to 2026. It's very important that we are ambitious and, as the World AIDS Day message tells us, we don't need to just talk a good game, but we need to have plans in place in order to deliver against those ambitions. The aim in New Zealand is to eradicate by 2025. They have a similar number of people being treated for HIV as we have here in Wales, so that gives us an idea of what we could be aiming towards.

Can I ask, as a first question, what steps the Government has taken already to learn lessons from international good practice, such as using the three principles of staying safe, testing early and treating early, as they've done in New Zealand, in order to bring that target forward?

So, yes, we need to turn words into action. That's the demand of the Terrence Higgins Trust. We are very proud that we have that long-term ambition. It's important to have that in place, but I'd also be grateful to know what are the smaller steps that the Government will take on the road towards that target. So, can the Minister commit today, when the HIV action plan is brought forward next year, to include in that the steps year on year that will be taken to increase testing, to target resources and to tackle stigma that will then be part of a realistic plan to reach that longer-term target?

I'd also like an assurance on continued funding in the long term for a HIV testing programme and an STI testing programme through the post, which has been successful on a national level.

Turning to PrEP, access to PrEP, as we know, is crucial in bringing HIV transmission rates down and, indeed, to ending them, hopefully. During the pandemic, as we've heard, a decision was taken to prescribe and monitor people on PrEP through the Attend Anywhere platform. As you need a negative HIV test before PrEP is prescribed, clinicians could post HIV antigen tests into people's homes and then prescribe up to six months of PrEP and monitor patients online. Will the Government continue with that prescription and monitoring programme online in order for those who want to avoid clinics to do so? And to look at that from the other end of the telescope, how will the Minister ensure that, for those who prefer or need face-to-face services, they can access those services in order to ensure fair access to appointments? Everyone's looking at different ways of accessing that, of course.

Also a question on mental health services, which we know are so very important. A Positive Voices survey back in 2017 stated that those living with HIV in England and Wales are twice as likely to experience mental health issues as compared to the general population. So, what steps is the Welsh Government taking along with the Welsh health boards to ensure that the necessary mental health provision is in place?

And finally, I very much applaud the work done by Fast-Track Cities in Cardiff and the surrounding area, including that testing week that I mentioned earlier. I had a very beneficial meeting with them earlier this year discussing the possibility of expanding the plan to the Bangor area in north Wales, on the doorstep of my constituency. So, would the Government support the establishment of Fast-Track Cities networks in cities or other areas of Wales in order to build on the success of the programme in Cardiff and ensure that the whole nation can benefit from the good work done?

Thank you very much, Rhun. I'd also like to put on record my thanks for the work done by Fast-Track Cities Cardiff, and I do think that the testing week is something that will become very important in the history of HIV annually in our country. Like you, I'd like to see that being focused—it does make sense to focus on those areas where we know there are more cases than in other places. 

We're also keen to stop the transmission of HIV, as the WHO encourages us to do. Of course, if we can do that before 2030, that would be important for us to see and, of course, we will need to hear what this group that we have established will have to say on that. I think it is important that we do look at good practice in other countries. You talked about New Zealand, staying safe. Not developing this at the outset makes a lot of sense, so that's why giving people PrEP is a great help. We've given about 2,197 prescriptions for PrEP to about 1,300 people. 

I think you have seen our commitment as a party in our manifesto to tackle HIV. it's clear to see, and we're very eager to see that developing. That's why we will have to wait to see what this new partnership comes up with in terms of what they recommend as a strategy. I do hope to see a clear timetable for what they will suggest, and we will need funding to accompany that, of course. So, I'm looking forward to providing more detail on that once they've made their recommendations.

I do agree, in terms of mental health, that that's something we need to take seriously, and Lynne Neagle will be looking into that, and that will be an important part of her work.

And in terms of prescribing and monitoring remotely, that has been effective, as you said, but you are right—some people will want that direct contact, and so it's important that we do provide that service and maintain that. Thank you. 

Thank you, Minister.