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HIV/AIDS (Africa) (05/04/05)
Ms
Sally Keeble (Northampton, North) (Lab):
I am grateful to have secured this Adjournment debate about HIV/AIDS
orphans and vulnerable children in sub-Saharan Africa. This has been an
historic day in the middle of a remarkable week, and I am particularly
pleased to be able to speak on an issue on which Labour has set the agenda
not just for the country but for the world. It is this Labour Government
who have led the world in tackling debt relief, global poverty, trade
reform and HIV/AIDS and who have, more recently, been leading the debate
on the future of Africa. Those are policies that have resonated around the
country, with young and old, and around the world. They have been a
hallmark of the values that we in the Labour party hold dear, and a
shining beacon of Labour's achievements and of the kind of world that we
want to create.
The group
that I want to talk about, however, is one for which there is still a
desperate need for support. We will all have our images and memories from
the past four years of this Parliament. Certainly for me, the saddest ones
were of the HIV/AIDS orphans whom I saw and met in sub-Saharan Africa. A
whole generation of children are growing up without parents and, so often,
without hope. On a personal level, I found that to hold one of these
little children, so very fragile that the wind could blow them away, was
one of the saddest experiences of my whole life. To see them growing up
alone in their huts in the African countryside or on the streets of
African cities, children who have literally been abandoned to fend as best
they can in a harsh, cruel world, is tragic. There is a whole generation
of these children: some 12 million now, some 25 million by 2010. Whatever
happens to HIV and AIDS—and there are signs that in some places infection
rates may, thankfully, be slowing down—the number of orphans will rise
inexorably.
One
person described that generation to me as the brick wall that Africa is
heading for, and quite apart from the human tragedy, these children are
also a massive social and development challenge. They will grow up mostly
without health, without schooling, without social skills, often with
illness and with high levels of crime and delinquency. My hon. Friend the
Minister knows the statistics; they are horrendous, so I will not recite
them.
This
evening I want to press my hon. Friend on what the Government are doing
about the orphans and vulnerable children within their overall HIV/AIDS
strategy and to press for funding for community-based services. I am
grateful to a number of agencies for their help, support, advice and,
indeed, inspiration over the past 18 months. One is World Vision, whose
work for HIV/AIDS orphans I have seen in Lesotho, South Africa and
Ethiopia. Another is UNICEF, which arranged for me to see HIV/AIDS orphans
work in Mozambique, and has provided advice and support. Another is NCH,
which has provided advice on child care policies; often HIV/AIDS work
focuses on health care, whereas work with orphans and vulnerable children
needs to be guided by sound child care policies. SABMiller has also
provided valuable insights from its experience in sub-Saharan Africa.
Most of
all, I want to pay tribute to the community-based organisations that do
such remarkable work in the most difficult circumstances to look after
these children. The Kenyan Network of Women Against Aids, which cares for
some 1,300 children in Nairobi, provides food for children five days a
week—including teenage girls, to keep them from prostituting themselves
just for the price of a meal. It provides meals during the week, but at
weekends it cannot, so the children do not eat at weekends. Yet that
organisation, which advises the Kenyan Government, receives international
delegations and has, I believe, organised events for the UK Government,
does not have secure funding. Children in my constituency twinned with
KENWA—the Kenya Network of Women with Aids/HIV—and sent the orphans gifts
last Christmas, which was a most heart-warming experience.
There is
also Kuvumbane in Mozambique, which supports 900 women with HIV/AIDS and
about 2,000 orphans. It is based in Xai-Xai, the capital of the province
of Gaza, just three hours' drive on a tarred road north of Maputu, so it
is not a remote project, yet it has no regular funding. It has occasional
supplies of food from the World Food Programme and teams of volunteers,
most of them completely unpaid, to provide community-based care, but with
no equipment at all.
I went
out with that organisation recently and saw a family of orphan children
living in a hut on their own. The thatched roof had been damaged, so the
rain came in and the younger children had coughs and colds. They also had
fungal disease on their heads. The youngest was only a year old when his
mother died a year ago, and we can only imagine what his prospects are. I
met another family of five children whose father had died a couple of
years ago. When I arrived, their mother was lying down, desperately ill
with AIDS. She managed to stand up and speak briefly and we could but
wonder at the horror for those children of watching their surviving parent
die.
I shall
remember for a long time the plight of another young woman. She was not a
child, but she was very young to be dying such a horrible death. Her
parents had died. Her aunt had died. She had no siblings and her own baby
died at a year old. When I arrived, she was lying on the floor of her hut
moaning. She could not drink and was in complete agony. A volunteer was
with her, the only person to be there at her death; but there were no
painkillers to ease her suffering and give her more dignity in dying—no
mattress, no pillow. Nothing. The lack of resources for community care is
horrific.
There are
several projects in Zimbabwe, in Harare and Bulawayo, which probably do
not want to be identified, but where people have thought through with the
greatest attention sophisticated strategies for child care. They shelter
children from abuse by the police and take them off the streets. They help
them with memory books so that they can come to terms with the loss of
their parents. Most of all, they feed children—not enough to satisfy them,
but it keeps them from starving.
People
who undertake such work have commitment and are enormously dedicated, with
the insight and thought to care for children, but they completely lack the
resources to put care services in place. I know that my hon. Friend the
Minister can point to the policies of the Government, their support for
the UNICEF framework and the money to implement policies. It is true that
the UK Government have led the way in combating HIV/AIDS with financial
resources, support for the use of anti-retrovirals, the allocation of
funds for orphans and in pressing for a more co-ordinated approach to the
UNICEF framework, but there is an issue about delivery. The best
intentions in the world will fail if they are not efficiently implemented
and monitored, and there are some difficulties with that.
Of the
£150 million that the Department for International Development has set
aside for HIV/AIDS orphans and vulnerable children, £85 million is being
spent through the Department's African country programmes. Some of the
money is going into budget support for Governments to advance their
national orphans and vulnerable children plans. Having spent some time
looking at the work in six of the sub-Saharan countries most affected by
HIV/AIDS, it is not at all clear, with the exception of South Africa, that
there is any capacity to deliver programmes. There are not even
departments to run them. Even if there are central Government departments,
there are no regional or local structures so that policies and resources
can cascade down.
To say
that is not to belittle those countries. Complex services are needed and
they are difficult to deliver. After all, only under the Labour Government
have we had a Minister for children and co-ordinated children's services
across Government. In Kenya, the department with lead responsibility for
children is the equivalent of our Department for Culture, Media and Sport,
and children's services are very much a junior partner. In Lesotho, the
First Lady has responsibility for such services. I had long discussions
with her. She is an inspiring woman with a deep commitment and a profound
understanding of what is needed to bring about change in her country, but
she is not actually in government and has no departmental resources. The
situation in Zimbabwe is desperate; for example, in Bulawayo, the second
city, there are fewer social workers than there are Zimbabwean social
workers in the social services department of one outer London hospital.
If the
money is to deliver services, there must be some clear accounting for how
it is spent. Providing a form of words to fit the policy requirement
simply will not deliver the services on the ground that children need.
Perhaps what is needed is a kind of barium meal for the international
community's financial systems, which would trace the money that goes from
the British taxpayer to the delivery of services for the orphans and
vulnerable children in sub-Saharan Africa.
As my
hon. Friend the Minister knows, I have put a proposal to him for a funding
stream structure that could provide financial support directly to the
community-based services concerned. In practical terms, that would provide
support where it is most needed: at the community level where the caring
takes place—food for the feeding schemes, hygiene items for the
home-visiting schemes, school fees or, where school is free, money for
school books and uniforms, and money to re-thatch hut roofs. The
organisations that carry out those activities operate well below the radar
of national and international Government agencies, but they are able to
provide the small-scale interventions that make all the difference to
enable children to have some reasonable prospect for the future.
Such a
proposal would also have two other important functions—first, to develop
and systematise community care programmes. That is desperately important.
It is better understood in the communities that I visited in Africa than
it has ever been in the UK that children belong in their own homes, not in
residential institutions. What is needed to keep them in their own homes
is, as I said, a complex network of small-scale interventions.
Such
interventions include, for example, help with getting birth certificates,
so that children can get Government grants for free schooling, which is
the kind of thing that I saw the volunteers of Kuvumbane do for the
children in Mozambique; protection of their property rights, so that they
can keep ownership of their parents' homes, which is often the first step
to being able to provide them with a secure life after their parents have
died; help with food and clothing; and home visiting by an adult. Home
visiting also includes providing the help, psychological support and
counselling that children need when they are grieving the loss of their
parents. That is something that we do not often think about, because we so
often think about how to feed children who are hungry, rather than how to
comfort them when they are mourning. Those are very hard services to
develop and deliver, and they may have to be provided from the base up,
rather from central Government down.
The other
big purpose that such a funding stream would achieve is to support African
civil society. In a number of cases, the organisations that I have visited
group together into some kind of network, but they very much lack the
resources to develop and to extend their work and impact through their
countries.
The
amounts of money needed for such activity are quite small, and I fully
recognise that it is impossible for the UK Government to provide
individual grants at such a small scale and localised level. Arguably, the
level is too small even for the country Governments. It is the kind of
function that, in this country, local government would undertake, and
could be managed by a group of organisations—indeed, some organisations
have expressed an interest in doing so.
Half of
everything that we know, we learn in the first five years. We in this
country recognise, in providing services for our own children, that those
early years are when we must put in the investment if we are to influence
the adults of the future and the shape of society in future.
The
wheels of the international community may be grinding on this issue, but
they grind extremely slowly. Those children cannot wait for the money that
has been earmarked for them to trickle down. I press my hon. Friend the
Minister to give a commitment on this, and he can do so in the certain
knowledge that after the election, a Labour Government will continue to
transform not just this country, but the wider world and lead the
international community in development policy, as they have done in the
past eight years, thus ensuring that the otherwise lost generation of
HIV/AIDS orphans and vulnerable children will inherit a very different
world.
The Parliamentary
Under-Secretary of State for International Development (Mr. Gareth Thomas):
I congratulate my hon. Friend the Member for Northampton, North (Ms Keeble)
on securing the debate and on the way in which she continues to campaign
on the issue. I appreciate the number of oral and written parliamentary
questions that she has asked on the matter and the considerable amount of
travel that she has undertaken to investigate it, especially in Africa. I
am also aware, from meetings that she has had with my right hon. Friend
the Secretary of State and me, of her considerable knowledge of the
challenges that we and the international community more broadly face when
trying to scale up support for those orphaned by the terrible epidemic.
I also
join my hon. Friend in paying tribute to World Vision and UNICEF,
especially, with which I have held several conversations about the AIDS
epidemic in general and specifically about how we should respond to the
orphan crisis. I also join her in paying tribute to the organisations that
she met on her travels in Africa to examine the issue to which she
referred, and, indeed, to the National Children's Home and SABMiller.
The sheer
scale of the AIDS pandemic is well know to all hon. Members. The number of
people affected is truly staggering and, as my hon. Friend said,
increasing each year. However, the matter that clearly concerns us today
is the tragic plight of children affected by AIDS. The increasing numbers
of poor children who are living with HIV, or orphaned by AIDS, cannot fail
to move us, as the example that she cited in her opening remarks made
clear. I visited the Dukhathole township in Germiston, near Johannesburg,
in May 2004 to see a project that we are funding, which Christian Aid and
the Anglican Church are running, so I know about the scale of the
challenge in just that one township. Support is being provided to those
who are helping orphans and vulnerable children to access primary
education and helping people to claim benefits to enable the provision of
healthy food and reasonable-quality lives. Remarkable women in the
township support orphans, and grandmothers and other relatives, by looking
after orphans and other vulnerable children. I completely accept the
fundamental point behind my hon. Friend's speech: we need to do more.
My hon.
Friend also talked about the social cost of AIDS, with many families
losing one or two breadwinners. The number of children orphaned by AIDS is
expected to grow from 12.3 million in 2003 to 18.4 million in 2010, and
those figures are just for Africa. The risk of the AIDS epidemic taking
off in a truly alarming way in Asia is fast gaining more international
attention. The orphans crisis in Africa could perhaps become a significant
problem there.
My hon.
Friend has rightly focused the bulk of her remarks and campaigning work on
sub-Saharan Africa. Already more than a third of households in Uganda are
caring for at least one orphan. It is estimated that, by 2010, some
50 million children in Africa will have lost at least one parent and that
nearly 40 per cent. of those losses will be as a result of AIDS.
There
have always been orphans, of course, and in Africa they have always been
cared for by their extended families. However, the effect of the AIDS
pandemic is undoubtedly stretching the ability to cope in many communities
to breaking point. Orphans need caring for, so carers have to find extra
resources from somewhere. As the number of orphans rises, less well-off
carers have to make sacrifices. Children, most often girls, are taken out
of school and families have to make do with less.
Increased
poverty has a marked impact, not only owing to the immediate effects
caused by poorer nutrition and poorer health, but also over the longer
term. Children who are poorly nourished early in life will never reach
their full potential. Poorer children often do not go to school. Evidence
shows that, especially for girls, lack of education is associated with a
higher risk of being both poor and of HIV infection. Hunger and poverty
may lead orphans to exchange sex for money or food, so comprehensive
sexual health services are thus fundamental to a truly effective and
comprehensive approach. As my hon. Friend said, if we do not act to
improve the opportunities for orphans and vulnerable children, poverty
will continue to be transmitted down the generations, with millions denied
the chances that they deserve.
The
Government made their intention clear in the strategy on AIDS in the
developing world, which we published in July last year. We have committed
£1.5 billion of taxpayers' money over the next three years to tackling the
HIV/AIDS epidemic, of which £150 million has been set aside for action to
help orphans and vulnerable children. We shall also help orphans and
vulnerable children through the doubling of our support for the Global
Fund to Fight AIDS, Tuberculosis and Malaria, bringing our total support
to some £250 million through to 2008. HIV/AIDS orphans will also benefit
from the additional funding of £36 million over four years that we
provided to UNAIDS—the Joint UN Programme on HIV/AIDS—to support its
global leadership work. That work focuses on the pandemic as a whole, but
HIV/AIDS orphans are clearly part of that response. We are also providing
additional funding of £80 million over four years to support the United
Nations Population Fund's HIV prevention and sexual and reproductive
health work with women. That, too, will help the fight against AIDS in the
longer term.
My hon.
Friend will know that our right hon. Friend the Prime Minister has said
that the fight against HIV and AIDS and our work to highlight the needs of
Africa will be the centrepiece of our presidencies of the G8 and the
European Union. During 2005, we shall focus on two areas. First, our aim
is to co-ordinate more effectively the money that is available for the
fight against AIDS and to leverage in more of the resources necessary to
fight AIDS in general, as well as to deal with the specific problem of
HIV/AIDS orphans. Secondly, we want to maintain HIV prevention momentum
and to ensure an adequate focus on balanced prevention strategies such as
microbicides and vaccines to reduce HIV incidence globally. Again, that
will help to provide further support for HIV/AIDS orphans in the long run.
Looking
ahead, in September we will host the conference on replenishment of the
global fund, back to back with a broader AIDS funding conference to
examine the needs of other parts of the international system. UNICEF will,
no doubt, play a key role—my hon. Friend rightly mentioned UNICEF's
crucial role in the fight against AIDS. Its strategic framework, which the
UK was one of the first to endorse, provides guidelines for the global
response to those issues. At the global partners forum in December in
Washington, I was able to set out our initial thinking on how we will
spend the £150 million that we have committed to children affected by
AIDS. We are committed to spending £44 million of that support through
UNICEF over the next three years.
Part of
our funding will go towards supporting national Governments' analysis of
the extent of the problem and their planning of an adequate response.
To date, 17 African countries have completed comprehensive national action
plans to support children affected by AIDS. My hon. Friend rightly said
that national action plans are welcome, but we must monitor how they are
delivered on the ground. She was also right to focus attention on
developing countries' capacity to respond to the challenges of HIV/AIDS.
Whereas once the high price of anti-retroviral drugs constrained our
ability to respond appropriately to the epidemic in many developing
countries, the issue now is whether there are enough nurses, doctors and
other workers to provide support on the ground.
Ms
Keeble:
Does my hon.
Friend accept that although we have cheaper anti-retroviral drugs for
adults, the same is not true of drugs for children? Getting the price of
paediatric medicines reduced is also a major issue.
Mr.
Thomas:
I accept
that absolutely. I would not want to suggest that we do not want to see
more action to reduce drug prices further. I simply say that I think that
my hon. Friend's point about capacity and the need to train up more people
to help to provide support to orphans and vulnerable children, and more
broadly to those who are HIV positive or have full-blown AIDS, is
absolutely right.
In the
context of the drugs that we can provide and are available at present to
help children living with HIV, one of the things that we have been able to
do to provide support through the £1.5 billion that we have set aside is
to invest in trials of cheaper drugs. The particular one that I am
thinking of is co-trimoxazole, which could halve the death rate for HIV
infected children in Africa.
We have
invested also in a new research programme to examine the provision of
anti-retroviral treatment for children in areas where money, health staff
and transport facilities are in short supply. We are already providing
support to a range of civil society organisations, including organisations
based in the UK—I gave the example of Christian Aid, which we are
supporting in South Africa, which works with the Anglican Church there.
There are other such organisations. We have recently increased our funding
for those organisations with which we have long-term relationships. We
have asked them, in a sense as part of their response to receiving the
extra money, to prioritise additional work on HIV/AIDS issues.
My hon.
Friend has brought forward a particularly interesting proposal. I am
grateful to her for her recent letter, setting out her proposals to
support the civil society response to children affected by AIDS in
sub-Saharan Africa. I can assure my hon. Friend that as a result of her
letter we are considering seriously her idea seriously. I have asked my
officials to discuss it with other partners, including the UN and UNICEF
in particular, to explore whether are additional things that we can do in
line with the idea that my hon. Friend has identified.
This is,
as my hon. Friend has alluded to, a difficult area in which to reach the
right partners in a sustainable way. There are real issues about how we
provide support to community-based organisations that seeks to scale up
support that is sustainable and allows the development of capacity on the
ground.
It is
right that we continue to prioritise the bulk of our funding on HIV-AIDS,
so as to scale up the ability of Government to provide effective responses
to the challenge in developing countries. However, I recognise that there
are too many HIV and AIDS orphans in developing countries, particularly in
sub-Saharan Africa, who are not getting the support that they need now.
For that reason, my hon. Friend's proposal is timely. We are considering
her idea seriously. We are discussing it with partners. I hope that she
will be willing to discuss the idea further with us at the Department,
when our thinking has developed and after the election has taken place.
I believe
that the £1.5 billion that we have made available over the next three
years to scale up our response to HIV and AIDS orphans has set a template
for others in the international community to respond to. I believe also
that our replenishment conference for the global fund and our broader AIDS
funding conference will help to scale up and to leverage additionally our
funding for those members of the international community and those
multilateral organisations that are playing such a key role in the fight
against AIDS. HIV/AIDS orphans must continue to receive attention from
Members of this place. My hon. Friend, as I have said, is a doughty
campaigner on this issue. I look forward—
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