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World AIDS Day
(30/11/2006)
Mr. Nigel Evans (Ribble Valley) (Con):
I am grateful for the opportunity to hold this important debate on the day
before world AIDS day. I have received apologies from the hon. Member for
Calder Valley (Chris McCafferty), who has done such great work on HIV/AIDS
on the Council of Europe and wanted to be present for the debate, but has
sadly had to return early to her constituency.
I intend to speak for no longer than eight
minutes in order to give my hon. Friend the Member for South-West Surrey
(Mr. Hunt) and the hon. Member for Walthamstow (Mr. Gerrard), the chairman
of the all-party group on AIDS, an opportunity to contribute to the
debate. I also speak in my capacity as chairman of the Commonwealth
Parliamentary Association virtual working group on HIV/AIDS, and I am
grateful for all the support that I get from the group.
Sadly, the problem of HIV/AIDS is not
declining. According to international AIDS charity Avert, there are 39.5
million people worldwide living with HIV/AIDS. That figure includes 37.2
million adults, 17.7 million women and almost 2.5 million children. Last
year about 3 million people died of AIDS, but 4.3 million more were
diagnosed with HIV this year alone. AIDS has now surpassed the Black Death
on its course to become the worst pandemic in human history.
Reading the news over recent years, one might
have been led to believe that AIDS was a problem only for Africa, but
other countries, including the United Kingdom, also have problems. In 2004
there were 58,300 cases of HIV/AIDS, but that rose last year to 63,500.
Some, such as the Terrence Higgins Trust, believe that the figure is
closer to 70,000.
I praise the Government for allocating £315
million, via the White Paper “Choosing Health”, to improve sexual health
services, but as the Minister knows, many trusts are operating under huge
financial constraints. The money was not ring-fenced, and much of it that
should have gone to sexual health services has been used for other
purposes, such as paying off some of the debts. In his talks with the
Secretary of State for Health, will he ensure that any future funding is
ring-fenced so that the money goes where it ought to go?
The Government promised a £50 million
advertising campaign to promote sexual health, but the money never
materialised. Only £4 million has been provided for a health campaign,
which recently started. Clearly, the Government need to reconsider what
needs to be spent to ensure that people, particularly young people, get
the information that they require to protect themselves.
On the international scene, with few
exceptions the picture is grim, but at least an increasing number of
services are being made available. Africa, as we all know, has been hit
hardest. Almost two thirds of all those who are affected by HIV/AIDS live
in Africa, although it contains only 10 per cent. of the world’s
population. During 2005 alone it is estimated that 2 million people died
of AIDS in Africa. Since the beginning of the epidemic more than 15
million Africans have died of AIDS.
I was privileged to attend the world AIDS
conference this year in Toronto and was appalled to hear first-hand of the
problems facing Africa and other countries, including India, where 5.2
million are suffering with HIV. At the conference I had the opportunity to
meet many groups and I applaud the work of the voluntary sector and
professionals, who do fantastic work in education and by ensuring that
drugs are getting through to the community, particularly rural
communities, encouraging people to come for testing, and working with
other agencies in countries that have a high prevalence of HIV/AIDS or in
their own communities, especially universities, helping to remove the
stigma.
I welcome the support of Bill and Melinda
Gates and Bill Clinton with their amazing foundation. They do so much to
help get drugs to the right people and to raise the profile of the issue.
I welcome the fact that the Department for International Development—I am
delighted to see the Secretary of State in his place, which shows how
significant he thinks today’s debate is—has given £1.5 billion since 1997,
trying to strengthen health systems in the developing world and over the
next three years has committed to a further £1.5 billion.
I welcome where the money is to be spent, but
I urge the Secretary of State to look at other areas where money is also
vital. Will he target much of the money at his disposal at helping to
provide vital drugs that are needed to combat the disease?
Cheap drugs, such as Neviraprine, which costs
as little as £6, prevents HIV from being passed from mother to baby. I
applaud this week’s articles in Metro that pinpoint Ethiopia, where
the drug has helped to provide protection for the babies of pregnant
women.
I urge the Secretary of State to ensure that
in the coming years Government funding is prioritised so that vital drugs
such as these are provided to patients. We must also look at other drugs
that could make such a difference to people’s lives. Microbicide cream
could make a huge difference to prevent the spread of AIDS. I welcome the
development of recent years and we are now in the final stages of that
drug being tested. For women across the world, particularly in Africa, it
will provide independence and empower them to make positive choices to
ensure their well-being.
Will the Secretary of State also work with
multinational businesses in this country so that all introduce positive
work practices for their work force in countries that suffer from the
pandemic? Some companies, such as Virgin, SAB Miller and De Beers, are
already showing a lead, but we must make sure that all companies that
operate within those countries provide a lead.
Mr. Andrew Mitchell (Sutton Coldfield)
(Con) rose—
Mr. Deputy Speaker (Sir Alan Haselhurst):
Order. It is not the convention of the House for the Opposition Front
Bench spokesman to intervene in a half hour Adjournment debate at the end
of the day, but I am sure that the House appreciates the importance that
he attaches to the occasion by his presence.
Mr. Evans: I, too, am delighted to see
my hon. Friend the shadow Minister in his place. We have had talks about
this issue and I know how deeply he feels about the problem, so I am
grateful for his presence here today.
Clearly, I could say much more about the
issue, but I want others to speak. When I attended the Commonwealth
Parliamentary Association conference in Nigeria recently I visited a small
township just outside Abuja called Lugbe where I met Sister Cecilia and
others who do fantastic work on the ground in a Catholic mission. I praise
the work of the Catholic Church and other Churches. She introduced me to a
lady called Pauline who lost her husband last year to AIDS. She herself
was infected and destined to die. She lived in a typical humble setting
and many thought that she would die soon. The drugs reached her and when I
talked with her she was smiling and grateful, but more than anything else
she displayed a vision of hope. Two of her sons beamed as they played
around their mother. Had she died, the children would have been known as a
cadet family, with the eldest brother looking after the youngest and all
helping one another. That would have been pitiful. At least now the
children have hope and the mother has a hope of seeing her children grow
up. In this case tragedy was averted and I wish Pauline and her family the
best of health in the coming years, but not everyone is so fortunate.
On world AIDS day 8,000 people will die of
AIDS and, more chillingly, there will be 12,000 new infections. That is
the scale of the problem we now face.
Mr. Neil Gerrard (Walthamstow) (Lab): I
will be brief so that I leave enough time for the Minister to respond. I
am grateful to the hon. Member for Ribble Valley (Mr. Evans) for
suggesting that he would welcome the presence of colleagues in this
debate. This is not a party political issue and never will be. I want
briefly to make three points, two on what is happening internationally and
one on what is happening in the UK. The theme of world AIDS day this year
is accountability. Organisations outside Parliament are asking us to be
accountable for the promises that were made at Gleneagles and other
international conferences, particularly on universal access to treatments
by 2010. We have made real progress in the past few years. Not long ago,
many people were saying that we will never be able to deliver anti-retrovirals
in developing countries. Although we did not meet the target of 3 million
people by 2005, the “3 by 5” campaign made a step change in the approach
to the delivery of drugs.
There are two specific issues apart from the
obvious one of finance. The first is that of drugs pricing. At the moment,
there are significant differences in prices for second line therapies.
That will become increasingly important over the next few years. Some of
the first line therapies that are now available quite cheaply will not be
as effective, and we will have to try to secure cheaper access to second
line therapies. Connected with that is the TRIPS—trade-related aspects of
intellectual property rights— agreement and the way in which that might
affect the supply of generics. The waiver was agreed at Doha, but no
developing country has yet taken advantage of it. I hope that through DFID
we can actively help developing countries to do so.
The second issue is that of the pattern of the
epidemic—that is, the growing danger of major epidemics in eastern Europe
and in India and China. If we get things right, we might stop those
epidemics becoming as generalised as they have become in many parts of
sub-Saharan Africa. It is partly down to money. However, to a large
extent, particularly in eastern Europe, it is not so much a question of
what the UK does to provide financial aid but of what we can do in working
with those countries on developing sensible policies, particularly those
where intravenous drug use is driving the epidemic and there is still
considerable resistance from many politicians to adopting policies of harm
reduction.
If we can have influence through our contacts
with politicians in some of those east European countries, we might be
able to make a significant difference in time to stop the further
development of mass pandemics in eastern Europe and in Eurasia.
Finally, I turn to the situation in the UK.
The hon. Member for Ribble Valley mentioned the statistics. We are still
experiencing a growing number of infections, although the Health
Protection Agency figures seem to show a bit of levelling off in 2005. I
hope that that is a genuine trend and that we will start to see a
reduction. All the evidence suggests that a major epidemic in the UK is
still possible. Although the figures for infections are relatively small,
the number of new sexually transmitted infections is evidence that a lot
of people out there are indulging in pretty risky behaviour. There is
still the potential for a significant increase in infection in the UK,
particularly in marginalised populations where men have sex with men, and
especially now in African communities. This is not the Secretary of
State’s direct responsibility, but there seems to be a contradiction
between what we are doing internationally in talking about universal
access to treatments and what we are doing domestically in denying
treatments to some people in the UK who are infected. That does not make
good sense on public health grounds.
I am deeply grateful for the leadership on
this issue that has been shown by Ministers in our Department for
International Development. We have had an important influence on what has
been happening internationally, and I hope that we will continue to do so.
Mr. Jeremy Hunt (South-West Surrey) (Con):
I start by thanking my hon. Friend the Member for Ribble Valley (Mr.
Evans) for allowing me to make a brief contribution to the debate.
I would like to express the thanks of the
whole House for the life and work of Father Angelo d’Agostino, a noted
AIDS campaigner who died in Kenya last week and whom the Secretary of
State has met. He was famous throughout the world for his work in founding
the Nyumbani orphanage in Kitui, southern Kenya, and for his work in
distributing anti-retroviral drugs in the slums of Nairobi. He will be
greatly missed, but his work will continue.
Echoing the comments of the hon. Member for
Walthamstow (Mr. Gerrard), I thank the Secretary of State for his personal
commitment to the battle against AIDS. I would like to thank him not just
for the achievement of Gleneagles and the universal access target, not
just for persuading the UN to adopt interim country-level targets—the
Secretary of State knows that I campaigned for them—but for putting his
money where his mouth is. The fact is that DFID is the second biggest
donor internationally in the battle against AIDS. By doing that, he
shows—and we show as a country—that we recognise that without progress in
the battle against AIDS, there can be no progress in development at all in
Africa.
I would be grateful if the Secretary of State
dealt with three concerns about moves towards universal access. First, I
have researched some figures that seem to indicate that the cost of
distribution of anti-retroviral drugs is up to five times higher through
the global fund as compared with the distribution through PEPFAR—the
President’s Emergency Plan for AIDS Relief. That is connected to the fact
that PEPFAR is quite happy to distribute anti-retrovirals directly to
non-governmental organisations, whereas the global fund tends to prefer to
distribute through host country Governments. That is obviously a great
concern and the effectiveness of the global fund will be incredibly
important in this battle.
My second concern is the continued lack of
availability of paediatric anti-retroviral drugs, which I know that the
Secretary of State has looked into. My third concern is how we are going
to meet the targets for universal access in conflict and post-conflict
zones—in countries such as the Democratic Republic of the Congo, where
there is little or no health infrastructure. I am not sure that we have a
strategy for determining whether we can achieve that and, if so, how best
to do it. It is a very important consideration.
I finish by urging the Secretary of State to
show the same commitment to achieving the goals of Gleneagles as he showed
in securing them. I am sure that he will show that commitment. The hopes
of a whole generation of Africans and, indeed, the hopes of the entire
House rest on his personal commitment.
The Secretary of State for International
Development (Hilary Benn): I begin by congratulating the hon. Member
for Ribble Valley (Mr. Evans) on securing this debate on the eve of world
AIDS day, and on the passion with which he spoke. I join him in paying
tribute to my hon. Friend the Member for Walthamstow (Mr. Gerrard), who
does great work chairing the all-party AIDS group. The hon. Member for
South-West Surrey (Mr. Hunt) played a really important part in securing
progress on interim targets. He argued the case and got us thinking about
it. He had a real impact. I also pay tribute to our absent colleague, my
hon. Friend the Member for Calder Valley (Chris McCafferty), who does such
a sterling job. I am also very pleased to see in his place the hon. Member
for Sutton Coldfield (Mr. Mitchell).
I undertake to draw to the attention of my
right hon. Friend the Secretary of State for Health the points that were
made about funding in the UK. I really hope that the central message of
this debate and world AIDS day this year will be not only about all the
things that have already been discussed, but about the importance of
tackling stigma and discrimination. That will be central if we are to turn
the tide of the epidemic.
We have heard the statistics. When we remember
that 15 million children have lost the love and care of those on whom they
relied most—one or both of their parents—to AIDS; when we know that a
child born in Zambia today has a 50 per cent. chance of dying of AIDS in
his or her lifetime; when we know that in Zimbabwe female life expectancy
is now just 34 years; and when we see that the epidemic is actually
growing fastest in eastern Europe and central Asia, with 90 per cent. of
cases in Ukraine in Russia, we know how much of a challenge we have on our
hands. Those are awful statistics, and behind every single one lies an
individual. I join the hon. Member for South-West Surrey in acknowledging
the exceptional work of Father Angelo d’Agostino, who he rightly praised.
I also acknowledge the efforts of the civil society organisations and
foundations that were rightly praised by the hon. Member for Ribble
Valley.
We are making some progress. We and others
worked jolly hard to get the commitments last year at Gleneagles, and at
the United Nations in June all Governments agreed to work towards
achieving universal access to treatment, care and support by 2010. One way
of measuring the progress is to acknowledge that there are now 10 times as
many people on anti-retroviral treatment in sub-Saharan Africa as there
were three years ago. That involves 1 million people. My hon. Friend the
Member for Walthamstow and other colleagues were right to point out that,
five years ago, that would have seemed like a dream. I remember that my
very first visit to Africa was to Malawi, where people were discussing how
they might provide antiretroviral treatment to just some of the
population. It shows what we can do collectively when we put our minds to
it. However, in Africa we are reaching only a quarter of those who need
treatment, and an even smaller proportion in Asia. So, it is progress, but
is it enough? No, it is not: we need to do a lot more.
The other thing that we agreed at the UN in
June was that countries should set out plans with ambitious interim
targets. Forty-four countries have submitted targets, and 20 have
submitted fully costed plans. What those countries need to do is very
clear and simple, in one sense. They need to build their health
infrastructure, and that involves building clinics, ending user fees,
employing doctors and nurses, doing the tests and buying anti-retroviral
drugs. Those are all things that hon. Members have mentioned tonight. The
countries in question have their own funds, but they need our support
alongside that. The UK is pushing hard for donors to get their act
together— that is why we worked so hard on the “three ones”—so that the
help that we give comes in a form that the countries can make best use of.
The commitments on aid made at Gleneagles were
important, as is replenishing the global fund. Hon. Members have
generously referred to the funding that we have made available, including
the £100 million going to the global fund each year. I will look into the
point raised by the hon. Member for South-West Surrey about the cost of
distribution under the global fund, because we need to ensure that every
single pound that we commit gets to work to make a difference on the
ground.
The hon. Member for Ribble Valley was right to
highlight the importance of preventing mother-to-child transmission. I am
pleased to tell him that a further £25 million of DFID support in Zimbabwe
will provide more services to prevent transmission from pregnant women to
children. We also support similar efforts in several others countries,
including Malawi, Mozambique and Zambia. It is also essential, as the hon.
Member for South-West Surrey said, that we work in conflict and
post-conflict countries, where the Governments are weak.
Zimbabwe is one example, and Burma is another,
of countries where we work with the UN, non-governmental organisations and
faith-based organisations. That helps to build the infrastructure that
they need.
We also need to take more steps to bring down
the price of drugs. The hon. Member for Ribble Valley was absolutely right
about microbicides, and that is why we have already invested £50 million
in their development. If that comes off, it will be a really significant
step forward, not least because it will put some control into women’s
hands. Many women have very little control over what happens to their
lives.
I share the concern that has been expressed
about medicines for children. That is why, in September, we helped to
found UNITAID, the new international drug purchasing facility. That
predictable, long-term funding aims to lower drug prices, and to get more
people on to treatment. UNITAID’s first board meeting in October agreed
$36 million to fund anti-retroviral treatment for up to 100,000 children
in 2007 and double that number in 2008, and approved $70 million to expand
second-line therapy—where first-line anti-retroviral treatment does not
work—to 100,000 patients.
I warmly welcome the Clinton Foundation’s
announcement at the UNITAID board meeting this morning of cheaper
treatments that will reach 100,000 children. Cipla and Rambaxy are
reducing the price of their paediatric anti-retrovirals to $60 a year,
which represents a 45 per cent. reduction. That is the good news from this
morning.
We have made a 20-year commitment to UNITAID,
as hon. Members are aware. We are also helping countries to use the
flexibilities under the TRIPS—trade-related aspects of intellectual
property rights—agreement. They are there, but people have to work their
way through them to deal with this public health emergency.
The other point that I want to come to is the
fact that although treatment is the priority for keeping people alive
today, if we are to achieve an AIDS-free generation—that is what every
single one of us wants—prevention is the key for tomorrow and the day
after. That will not happen unless prevention is directed particularly at
those who are most at risk: young people, women and young girls, men who
have sex with men, sex workers and injecting drug users.
We know that women make up almost two thirds
of the people living with HIV in sub-Saharan Africa. In some African
countries, young women are almost three times more likely to be
HIV-infected than men of the same age. Why? It is because of gender
discrimination, social restriction, violence, fear of violence and lack of
financial security. Women sell themselves for food or money because that
is how they keep themselves alive. That makes women much more vulnerable
to HIV.
We know that sex between men accounts for 10
per cent. of global HIV infections, yet UNAIDS reports that fewer than one
man in 20 who have sex with men can access the HIV-prevention services
that they need. We know that in Ethiopia up to three quarters of female
sex workers are infected with HIV, yet some donors debate whether it is
right to give them condoms. Some donors even place restrictions on working
with them. That is not sensible if we want to defeat this epidemic.
Injecting drug use accounts for a third of new
infections outside sub-Saharan Africa, particularly in eastern Europe. We
know that harm-reduction programmes work— needle and syringe exchanges in
particular—but less than 5 per cent. of drug users can access them. We
have to put that right and ensure that people are not harassed when they
are trying to use those services.
We know that condoms save lives, but they are
in short supply. Since 2001, the UK has paid for more than 1 billion
condoms. That amounts to the use of about 54,000 every hour, but in Africa
there are still only enough to provide eight condoms for each man each
year. There are 200 million couples with an unmet need for contraception.
That is not good enough.
Therefore, improving services is crucial to
achieving universal access. Supply is important, but so is demand. That is
why tackling stigma and discrimination really is significant. Stigma and
discrimination stop people accessing the services that they need and stop
them coming forward for counselling, testing and treatment. If, as happens
in Ukraine and Russia, police officers patrol needle exchange points and
arrest people, surprise, surprise, drug users do not go to use them. Some
women will not get tested because they are terrified that if their husband
or family finds out, they will be thrown out of the family home.
What we do know is that where there is greater
openness and honesty about HIV, progress happens. That is the case for
Brazil, Thailand, parts of India and Malawi, but it is not
straightforward, because in Lesotho although less than 10 per cent. of
women in their late teens are infected, the figure for those in their
early 20s rises to 40 per cent. We must keep on the case everywhere. As I
said a moment ago, many women and girls do not have control over what
happens to them. They need to be able to say, “If we’re going to have sex,
you’ve got to use a condom.” Men and boys need to respect women’s
decisions and to understand that no means no.
This is about changing culture and attitudes,
and we can do that only if we are honest about the nature of the disease
and what the problem is. Also, we must be honest about what works and in
giving people the information and services that they need to protect
themselves. Not all societies and not everybody finds it easy to do that,
because some people feel very embarrassed and we are not always good at
talking about sex. However, that is as nothing compared with the shame
that we should feel about the huge daily death toll. The truth is, as our
experience teaches us, that we can do something about it, and we have to
do something about it.
I am really grateful to the hon. Member for
Ribble Valley for giving us the chance to debate the progress that we have
made and what we have yet to do. Now is a good time to show that we are
serious about doing something on this issue.
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