Item 5, a statement by the Minister for Health and Social Services on the draft HIV action plan. I call on the Minister, Eluned Morgan.

Diolch yn fawr. I am very pleased to present this HIV action plan to the Senedd. This delivers on our ambitious programme for government commitments that we made to develop an HIV action plan for Wales and to tackle the stigma experienced by those living with HIV.

Even though we've made significant strides in many HIV-related areas in recent years, there remains much to be done. This action plan sets out 26 ambitious but achievable actions for implementation by 2026, which we think will go a long way in helping Wales achieve the World Health Organization's target of zero HIV infections by 2030, and, crucially, adopting a zero-tolerance approach to HIV-related stigma. I think the latter is specifically significant; we've come a very long way since the dark days of the 1980s, when ignorance and cruelty towards people with HIV was rife. There is absolutely no place for ignorance and intolerance in modern society, and the actions in this plan aim to stamp out this intolerance.

Now, over the past five years, the Welsh Government, working with other partners, has made great progress in improving access to testing and treatment in Wales. And I think that Wales can be proud of the significant reduction we've seen in new diagnoses of HIV. Between 2015 and 2021, new diagnosis of HIV decreased by 75 per cent. A significant factor in this achievement can be attributed to the commitment by Welsh Government to provide pre-exposure prophylaxis, PrEP, for all for whom it is clinically indicated, and that's been done since the summer of 2017.

Despite the challenges that faced sexual health services throughout the COVID pandemic, access to HIV testing was maintained, both through face-to-face consultations, and through the rapid deployment of online testing. And this blended model of access to HIV tests has resulted in more people being tested for HIV between January and March 2022 than in any previous quarter. The online service that was implemented in May 2020 has exceeded expectations in terms of the expected number of tests requested, making sexually transmitted infection testing, including HIV, even more accessible, which reduces stigma. The success of this model is recognised in the action plan, and I'm pleased to announce today that the Welsh Government will be providing annual funding of £3.9 million for the continuation and development of this online testing platform going forward.

This action plan has been co-created by a range of key stakeholders and is the product of many months of collaborative working with my officials. In the autumn of 2021 we established an HIV action plan working group, chaired by Dr Marion Lyons, a senior medical officer in Welsh Government, with a vast amount of experience in the field of HIV and sexual health. The group consisted of a diverse range of stakeholders, including those from the community and voluntary sector, healthcare professionals, academics and, importantly—very importantly—people living with HIV with personal lived experience.

The 26 actions are underpinned by three core principles: that there should be zero tolerance of HIV-related stigma; that all plans for implementation of new initiatives and services will be informed by, or developed with, people living with HIV. Alongside this, there will be a recognition of contextual differences by sexuality, ethnicity, age, gender and location. All new initiatives and services will be subject to ongoing monitoring and evaluation to make sure that they meet the actions and principles laid out in the plan. The group was clear that no-one should be left behind, that inclusivity and diversity should be encouraged and celebrated, and that all the communities we serve should be an integral part of the dialogue, the debate and the decision making on HIV going forward.

The 26 actions are focused on five key areas: prevention, testing, clinical care, living well with HIV and tackling HIV-related stigma. In addition, there are five key overarching actions. Firs, establishing Wales as a Fast Track Nation. Building on the great success of Fast Track Cardiff & Vale, the first fast-track collaboration in Wales, which has been a highly successful in involving local public bodies, increasing collaborative work, and producing new initiatives, including GP support for HIV testing and an advocacy network, both of which have attracted non-statutory funding. The aspiration of the plan is to make Wales a Fast Track Nation, with networks throughout Wales that would collaborate to help achieve Wales's ambition to have no new HIV cases by 2030.

Secondly, recognising the importance of, and increasing the involvement of voluntary and community groups. This action plan has been developed with partners such as Pride Cymru and Terrence Higgins Trust, whose work builds on the legacy of Cardiff AIDS helpline and Cardiff Body Positive. In addition to their work, the work of third sector HIV groups like PrEPster, National AIDS Trust, Positively UK and CHIVA, the children's HIV association, have all been vital in the fight against HIV in recent years. All of these organisations will remain instrumental in the fight against HIV in the coming years.

Thirdly, funding and developing an all-Wales sexual health case-management system. This system will be transformative in the way that sexual health data and intelligence is collected and the way in which trends are monitored. Fourthly, health boards and trusts will be required to report annually to the Welsh Government on how the actions from the HIV action plan are being taken forward and are making a difference. And lastly, establishing an action plan oversight group, which will monitor the impact that the delivery of the action plan has made.

I'm hugely grateful to those partners and stakeholders who have co-created this plan. The plan will now be subject to a 12-week consultation period. I encourage as many people as possible to contribute to this process and to respond and comment on the proposed actions. I firmly believe that, by accepting and implementing these actions, we can make a significant difference to the lives of people living with HIV and in protecting current and future generations from the virus. I look forward to reading the consultation responses and to bringing the final plan back to the Senedd later in the year. Thank you.

Can I thank you, Minister, for your statement today? Of course, it was very interesting to read the plan when it dropped into my inbox this morning. I very much welcome the plan today, and, of course, as a nation, we've made huge strides, haven't we, since the fight against HIV back in the 1980s? And as a very young person in the mid 1980s, I just about remember some of the issues around the stigma at the time. And that remained the case for some time afterwards. But I think we've made huge strides in fighting that, but, of course, there's more to do.

Now, the English HIV action plan and the Scottish HIV elimination plan both include annual reporting to Westminster and Holyrood. It wasn't mentioned in your plan today, but is it your intention to bring forward annual progress reporting to this Chamber here? Certainly, I would support that, because I think that would maintain the momentum and increase that accountability that I think we need.

Will Wales meet the UNAIDS 95-95-95 target by 2025, which is, of course, a global target set? I just wanted to check that that is your intention, Minister. I don't think it set out that in the plan.

In the testing section, there is a very important commitment of an anonymised seroprevalence study undertaken by Public Health Wales for HIV and blood-borne viruses. This will, of course, ensure that we know if a version of A&E opt-out testing would work in areas like Cardiff and potentially Wrexham. So, can I ask why that doesn't appear in the plan as an action in its own right?

Unlike England, there's no focus on partner notification—current and previous partners—of those diagnoses, and statistically that's the most impactful focus for testing, as I understand. It does go unmentioned in the plan, so I wonder, Minister, would you outline if you intend for the plan to do this? In the report, there are no targets for sexual health clinics to ensure that all their services offer a HIV test. So, this could be a good tool to implement, as I feel it would, of course, increase testing and reduce health inequalities as well. So, I wonder if, Minister, you could look to implementing this, as it would be good, perhaps, to include this as a key performance indicator for sexual health clinics.

You mentioned, Minister, that you want to introduce HIV education into the school curriculum, which I very much welcome, but I would like, perhaps, a little bit more clarity on that. To which age groups will this be introduced? I think it's important to understand that. I think there are a few issues around here to consider in terms of what age of children this will be taught to and when this will be introduced. Will HIV education become part of the same general teaching about STIs that is already in place, or will this be taught at a more in-depth level?

I think I saw in your press release, Minister, there's a mention of £3.9 million for further development for online testing. Does that sum include the—? Is that sum included for the full finance available to deliver the actions within the plan, or do you anticipate further funding being made available?

But, overall, Minister, I very much welcome, and of course I would encourage people to come forward and get tested, so we can eradicate infection and break the stigma. Thanks, Minister.

Thanks very much, Russell. Certainly, when it comes to reporting—and obviously, this is a consultation, so there's an opportunity for people to throw in their ideas beyond what has been set out so far—but, certainly, in terms of monitoring, we are very clear that there's going to be an oversight group to make sure that the 26 actions that have been set out are actually monitored and they are taken seriously. If you would like me to come back and to report to the Senedd, and, of course, I'd be more than happy to do that, because this is one of our key manifesto commitments—. This was absolutely central to our manifesto, and so any opportunity that you are happy to give us to demonstrate how we are delivering on our manifesto commencements, of course we are happy to do that.

I think in terms of the targets that have been set out by international organisations, yes, we're very much in keeping with those targets that have been set out, and, certainly, if it comes to partnership notification, I think we've got to be a little bit sensitive here. We've got to make sure that we're sensitive in terms of respecting privacy. What we don't want is for people not to come forward if there's going to be an issue, but, again, I'm happy to take a lead from experts who can tell me what the evidence shows us is the best way to behave in that space.

When it comes to sexual health clinics, of course HIV tests are available, and when it comes to education in the school curriculum, I of course will be working closely with the education Minister, who I know will want to ensure that we're taking an age-appropriate approach to this, and he'll, I'm sure, be taking a lead from the experts in that space. So, I think Jeremy Miles is better placed to inform about how exactly that will work into the school curriculum.

When it comes to the money, I've set out that we've got £3.9 million—that's for all testing, not just online testing—additional funding, but, of course, that's on top of what we already spend in each individual health board. So, we don't give the money to health boards and ring-fence it at the moment, but this money is ring-fenced; this is additional money that is ring-fenced, but that's on top of what is already being done by the health boards across Wales.

May I thank the Minister for this statement? I'm also looking forward to seeing what kind of responses there are to the consultation that's now ongoing. This is very important and, on the face of it, it is the fruit of partnership working, as we should see happening in Wales, where different organisations who want to see us making ground in this area have been involved in its development. We were at risk, I think, of slipping back from trying to hit that target of having no more new cases of HIV in Wales by 2030. My party had suggested that we could be aiming even higher and looking at 2026, something that the Terrence Higgins Trust had welcomed. Even 2030 started to look out of our reach. But I hope that this report will bring us back on track, as it were, and that we will certainly be able to aim towards that target.

There are a number of elements of the work that will be done, or is being recommended, that are eye-catching to me, specifically the creation of Wales as a Fast Track Nation. Some good work has been done, led in Cardiff and Vale, and I do know that other parts of Wales, north Wales, for example, have been very keen to make progress with work of this kind. I wonder whether I could have more details from the Minister on the capacity that she wishes to see built for implementing this Fast Track Nation ambition. The hope, I know, in north Wales was that there would be resources available to ensure that there was an individual who could lead this work, who would be employed to push the boundaries of what can be delivered in north Wales. I wonder whether there's any more meat on the bone in terms of the kind of resources that we could expect to see and how those resources could be used on the ground.

I will briefly cover the issue of stigma. I'm pleased to see such an emphasis placed on the need to tackle stigma. We know how much of a problem this was back in the 1980s, as was demonstrated by that excellent series It's A Sin, and it's shocking to think of the stigma that existed then. But that stigma is still there, I see it with my work on the cross-party group on infected blood, where those who are HIV positive still experience stigma. So, I welcome that commitment.

I will draw the Minister's attention to some research that's been done recently on stigma even for those people who take PrEP. Now, can I have an assurance that tackling stigma will go back even to that point so that people who do take PrEP don't need to be concerned that they will experience stigma for trying to prevent HIV infection in the first place?

And one very specific question—and forgive me if the answer is in the report, I haven't had an opportunity to go through it in detail as of yet—PrEP has been available through sexual health clinics, and there have been calls for ensuring that it is available through community pharmacy, for example, and that, in a way, would be a means of tackling stigma, because it's possible that some people wouldn't want to go to sexual health clinics in order to access this treatment. So, I wonder whether there is a change of direction in terms of policy in that regard so that it can be accessed more easily.

Thank you very much, and, of course, we want to see and ensure that we do reach that target by 2030, and, if we can do it more quickly, then certainly I'd like to see that as well. It depends to what extent the public comes with us on this journey. One of the reasons, and one of the things that I hope will emerge from the fact that we are giving this such great attention today and over the coming months, is to raise awareness in terms of the fact that things have changed and that new medicines are available, which mean that we can get rid of the stigma. We can get rid of the idea of that someone with HIV's life is at risk. It's not. They can get treatment, and certainly in terms of the stigma—

I think it's really important that people who are taking PrEP—of course, they shouldn't face any stigma, and of course we will ensure that that is the case. But the way to do this is to bring the public with us, and I am very, very keen to make sure that we raise public awareness of the fact that the world has moved on a huge amount since the 1980s, and people who receive that antiretroviral therapy can and do live long and healthy lives, and the viral load in their blood is reduced so significantly it means that they can't transmit it to their sexual partners. It's really important that that message gets across, and we mustn't be scared of saying that out loud. 

Certainly, in terms of a Fast Track Nation, I think there are great models here in Wales already, and certainly the model here in Cardiff and the Vale has been vital. I do hope that we will see those models developing across Wales ultimately. Of course, it makes sense to target some areas more quickly than others, but what I do hope in terms of resources is that health boards on the ground will make the difference and that they take responsibility. It's important that we don't do everything centrally. There is additional funding, but they have to take responsibility. If this doesn't work, the problems will come to the health boards ultimately anyway, so it makes sense for them to target this quickly as well.

Diolch to the Minister for today's statement. Having worked closely with the Terrence Higgins Trust and Fast Track Cardiff & Vale, I know that today's statement is welcome news to all the charities and organisations who have pulled together to help create the HIV action plan. Access to data when it comes to HIV and STIs in Wales is really very difficult and needs improving. A new data surveillance system is desperately needed. From the figures I was able to obtain, there are approximately 2,800 people living in Wales accessing care for HIV, and, in 2021, 1,303 people were prescribed PrEP through NHS services. Ninety-nine per cent of those receiving PrEP are men, which is fantastic and has been a real game-changer. But my anxiety is that this isn't on the radar of the majority of women in Wales. We have a real opportunity to create a culture where women feature front and centre in team Wales's response to HIV, where we are offering HIV tests on a routine basis to women, where no woman leaves a sexual health clinic without being given the choice of a HIV test, where all women are aware of the HIV prevention drug PrEP and can make informed decisions about whether it is suitable for them, and where women living with HIV are included in research efforts and supported to have the best quality of life possible. Will the Minister make sure that the HIV action plan works for women also?

Thanks very much, Buffy. I think it's really important, the point that you make, because we know that HIV affects men, women, trans people, all kinds of people, and I think it's really important that we recognise that and we say that, again, out loud. That's why we've ensured that this plan is very inclusive and that no-one is left behind. What we find is that women are generally more comfortable getting engaged either with their GP or with the sexual health services for their sexual health needs, whether that's for contraceptive care or for a sexual health screening. Now, we recognise that there is a small minority of women who haven't engaged with these services, and we hope that the online testing services may be a mechanism through which those women who perhaps are more reluctant to come forward to have a face-to-face test with their GP or their sexual health clinic can do so in a different way. I do think that, actually, the pandemic has been transformative in that sense and has led to an increase in testing. I think the other thing, of course, is that women quite often get tested when they have antenatal testing. So, there are 48 new diagnoses in Wales, and, of these, around 10 of them were identified as female. So, it's really important that people bear in mind that women absolutely get HIV as well.

Finally, Altaf Hussain.

Thank you very much, Deputy Presiding Officer, and thank you, Minister, for this action plan. HIV home tests are available throughout Wales, with the tests being posted to a laboratory, and the person will receive their results usually in around 72 hours.

There is, however, an alternative test available, which allows a person to test themselves at home and receive their results in around 15 minutes. Waiting for an HIV result can be terrifying, and some people don't feel comfortable visiting a clinic, for a number of reasons. These 15-miniute tests are around £15, but, according to the Higgins trust, these tests are free in certain parts of England and Scotland where it is locally funded. With the current cost-of-living crisis, for some people, especially those in lower income categories, these can be unaffordable. The mental stress HIV can cause is truly awful. Will the Welsh Government consider funding a scheme in Wales that will allow people to access a free 15-minute home test, as this could encourage some more testing as people can test themselves discreetly without the added stress of visiting their local clinic, waiting days for a result, and the fear of judgment and stigmatisation? Sorry, my throat is bad.

[Inaudible.]

Thank you.

Thank you, Altaf. Certainly, we're aware that that opportunity to do online tests and make sure that you get those delivered to home—I think that does open a new opportunity. In terms of the 15-minute tests, obviously, if people come back to us on that in the consultation, then that's something we'll have to consider.

You suggest that HIV testing can be terrifying. I don't think it's as terrifying as it used to be, because we know there are things we can do if you do have HIV. And again, lets get back to just keep on repeating that—HIV, you can now get help for it and live a normal life. And that is the message we absolutely need to give. Free HIV testing is already, of course, available in Wales, and will continue to be, certainly as we roll out this programme.

Thank you, Minister.