HIV and AIDS

Tuesday 10th December 2013 Westminster Hall

Motion made, and Question proposed, That the sitting be now adjourned.—(Mr Gyimah.)

09:30

[Pamela Nash (Airdrie and Shotts) (Lab)]

It is a pleasure to open this debate and to see you in the Chair, Mr Dobbin. I thank Mr Speaker for granting us the debate and my colleagues for attending this morning. Many of them have shown great support to the all-party group on HIV and AIDS, which I have chaired for two and a half years.

I am happy to see my hon. Friend the Member for Wirral South (Alison McGovern), in her newish role as shadow International Development Minister. I am also happy to see the Minister in attendance this morning; she has a strong personal commitment to the HIV response and has demonstrated that throughout her time at DFID. She has championed both the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNAIDS, overseeing a significant increase in funding to both, which the all-party group has been delighted to see.

Today’s debate is timely, not just because we recently commemorated world AIDS day, but because today is international human rights day. As we mourn Nelson Mandela, we remember him as one of the great advocates of the AIDS response. He summed up the challenges very aptly when he said:

“AIDS is no longer just a disease; it is a human rights issue.”

The universal declaration of human rights states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself…including…medical care”.

The virus has so far infected 58 million people, become the sixth biggest killer in the world and left 1.6 million people dead in the past year alone. However, it is not just the scale of the epidemic that makes it a human rights issue. It is a human rights issue because its effect on a country is dependent on that country’s wealth, and an individual’s social status still determines their risk of being infected and their ability to access treatment if they are.

HIV is the sixth biggest cause of death in the world, but it is the second biggest in low-income countries and does not even feature in the top 10 causes of death in high-income countries. The 1.6 million people did not die of AIDS last year because treatment does not exist; they died because the medicines were too expensive for them to buy, or because the stigma was too much for them to seek help in time. AIDS and poverty are now mutually reinforcing negative forces in many developing countries. We are 30 years into the epidemic, and AIDS is sadly still a major health and human rights issue, despite the leaps and bounds in progress we have made on prevention, testing and treatment.

One of the main barriers to fighting the epidemic, which stubbornly remains, is stigma. Last year, I took part in a Voluntary Service Overseas placement in Kenya to help parliamentarians and civil society there to strengthen their own all-party group on HIV and AIDS in the Kenyan Parliament. As part of that, I was lucky to work closely with Llina Kilimo MP, a much respected politician and campaigner on HIV and women’s rights. I remember her telling me that no one dies of AIDS. I was confused for a few seconds, but then realised that she meant that no one talks about dying of AIDS. When someone dies of AIDS in Kenya, the family will usually announce the cause of death as the secondary illness that was brought on by AIDS. Owing to the stigma attached, they keep their status quiet.

The best known example of that comes from Nelson Mandela’s own family. When his daughter-in-law passed away at the age of just 46, it was announced that she had died of pneumonia. It was not until her husband, Mandela’s son, died just a couple of years later that Mandela took the brave decision to announce to the world that his son had died of AIDS. In the midst of huge personal tragedy, burying his own son, he decided to use the occasion to show leadership on an issue that he feared would destabilise his country and damage the progress he had made in South Africa. He said at the time:

“That is why I have announced that my son has died of AIDS…Let us give publicity to HIV/AIDS and not hide it, because the only way to make it appear like a normal illness like TB, like cancer, is always to come out and say somebody has died because of HIV/AIDS, and people will stop regarding it as something extraordinary for which people go to hell and not to heaven.”

Mandela had already established his well known campaign 46664—named after his prisoner number on Robben island—a couple of years before he knew of his son’s HIV status. The campaign aimed to raise not just money but awareness, to get people talking about HIV and AIDS and to attempt to alleviate the stigma that too often stops people from seeking the treatment they need. Although there has been progress since Mandela’s landmark press conference in his garden following his son’s death in 2005, I fear that the stigma attached to HIV still prevails in Africa and across the world.

Mandela’s great work is not over. People are still dying from a preventable disease, and there are still 16 million people living with HIV without access to the treatment they require. We know that women, children and socially excluded groups are the people most affected by HIV, but one of the reasons for that is that they are least likely to have a political voice and are therefore not paid enough attention.

That might seem an odd statement, given the attention paid to the issue on world AIDS day recently, and the fact that many non-governmental organisations and some of the biggest ever global campaigns and organisations now provide treatment. However, we are fighting a losing battle for the political will to end AIDS in some of the countries most at risk, because of the stigma attached—not to being HIV-positive, but to talking about the matter at all.

The project in Kenya that I have mentioned was a follow-up to one carried out by my predecessor as chair of the all-party group, David Cairns, in Kenya two years previously. He helped the National Empowerment Network of People living with HIV/AIDS in Kenya— an umbrella organisation for HIV support groups—to set up an all-party group on HIV with Kenyan parliamentarians. However, that all-party group had not quite taken off.

When I was asked to go, I was concerned about the impact I could make; if David could not make a difference and set that group up, I did not see how I could. Surely, in a country as badly affected by HIV as Kenya, MPs would be falling over themselves to join a group that campaigned on it; it must be one of the biggest issues for their constituents. However, I found that HIV was not far up the political agenda—even just before the general election, when I was there.

What I am saying is not a criticism of the Kenyan Government, who have in many ways been at the forefront of the AIDS response, but politicians were not discussing HIV as a major issue for Kenya or talking about the next steps of their response to it as part of the general election campaign. With a few notable and brave exceptions, candidates and politicians told me privately that they did not feel they could speak about HIV. They were worried that the sensitive issues of HIV prevention would put voters off. A couple said that they were worried that voters would think that they were HIV-positive, and that that would damage their chances of being elected.

[Sir Peter Bottomley (Worthing West) (Con)]

In South Africa, when senior judge Edwin Cameron said he was living with HIV/AIDS, it became possible for a number of people in representative positions to be rather more open. There are also HIV choirs in townships around Cape Town. Those developments show that a way is beginning to be found of getting what everyone knows into the open. If things are brought out from behind the curtain, it is easier for people to take the action that will reduce the spread of HIV/AIDS, and there can be greater acceptance of people with the condition.

[Pamela Nash]

I completely agree. The problem is not unique to Kenya. In fact, I spoke at last year’s international AIDS conference in Washington, where I shared a platform with Ryuhei Kawada, who is a member of the Japanese House of Councillors. I believe that he is the first politician elected while openly being HIV-positive; I know that some have revealed their status later, but he was elected having already revealed his status. At last year’s event, he spoke passionately about his hope that he would be the first of many and that others would follow in his footsteps to try to relieve the stigma around HIV. It is clear that we need more public figures to reveal their status, but it is a big ask.

Let me be clear that the news is not all bad. I did not come here to spread doom and gloom. Truly excellent progress has been made in the global fight against HIV. I do not want to bore or bamboozle Westminster Hall with stats, but four recent figures from UNAIDS highlight the success so far. There has been a 33% decrease in new HIV infections since 2001, a 29% decrease in AIDs-related deaths since 2005, a 52% decrease in new HIV infections among children since 2001 and a fortyfold increase in access to antiretroviral therapy between 2002 and 2012. That last figure, in particular, is astonishing and shows just how far we have come. Such achievements should be applauded.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I congratulate the hon. Lady on securing this debate and on all her work. It is so important to keep ensuring that HIV is a priority in the world. Does she agree that, when countries have a high incidence of co-infection, it is important to have joint programmes to control TB and HIV/AIDS?

[Pamela Nash]

I completely agree. I believe that colleagues will touch on that subject today, so I will not go into much depth, but it is something that my all-party group has worked on along with the all-party group on global tuberculosis. I hope that the hon. Lady will join in with such campaigns in future.

We cannot get carried away with progress, however. Many good news stories exist, but we have not yet reached our goal of ending the epidemic, the very nature of which means that we must continually work to eradicate HIV; if we do not, all our efforts will be overturned as it spreads further and further.

I am delighted that the Government have increased funding to the key multilateral organisations that fight AIDS. I congratulate the Minister on her role in achieving that, but I must highlight a few areas where the Government could and should be doing more. Strategies to combat the HIV epidemic are intrinsically linked to each country’s human rights environment.

Young people aged between 15 and 24 account for 45% of all new infections, according to the United Nations Commission on Human Rights. Two recent studies of women in Uganda and South Africa found that those who had experienced intimate partner violence were 50% more likely to have acquired HIV than those who had not experienced such violence. A study conducted in Malawi by the Salamander Trust, which works closely with the all-party group, revealed that women living with HIV were terrified that they would face violence if they told their partner or family about their status. Men who have sex with men are also particularly vulnerable, partly because of punitive laws in many countries.

Likewise, failure to provide access to education and information about HIV and AIDS treatment and care and support services further fuels the epidemic. I know that the Minister agrees that those elements are essential components of an effective response, but what does the Department for International Development plan to do specifically to ensure that human rights are at the heart of the HIV response?

One way is to invest in grass-roots community groups. One organisation that is particularly in my and others’ hearts is Sexual Minorities Uganda—SMUG. Members will remember the tragic murder of its leader, David Kato, in 2011. David Cairns met David Kato during a visit to Uganda, and I remember him being deeply pained at his death.

To honour both the memory of David Cairns and the heroic bravery of David Kato in his fight against prejudice, the David Cairns Foundation donated a staggering £10,000 to SMUG to help to establish Uganda’s first health care clinic specifically for the LGBT community in Kampala. It is projects such as that that will sustain the AIDS response in a country where homosexuality is criminalised. The most vulnerable populations need a place to get tested and treated without fear of imprisonment or death.

I was pleased to see that DFID will be giving £4 million to the Robert Carr Fund for Civil Society Networks, a vital organisation that reaches global and regional civil society networks. Although such funding is, of course, positive and given that civil society activism will be the backbone of the sustainable response to HIV/AIDS, will DFID be doing more for grass-roots organisations?

I am cutting my speech short as I was not expecting such an attendance this morning and a few hon. Members want to speak, but I want briefly to discuss carers. HIV affects the human rights of not only those living with it, but also those who care for the ill and the orphaned. That effect impacts disproportionately on the poorest and most vulnerable in society. In 2005, Nelson Mandela said:

“Women don’t only bear the burden of HIV infection, they also bear the burden of HIV care. Grandmothers are looking after their children. Women are caring for their dying husbands. Children are looking after dying parents and surviving siblings.”

In sub-Saharan Africa, an estimated 90% of care for people living with HIV is done in the home by family or community-based carers. Voluntary Service Overseas highlights that inequality between women and men continues to fuel the pandemic. What is DFID doing to encourage the Governments with whom it works in partnership to adopt policies that recognise the contribution of home-based carers affected by HIV/AIDS?

I want to touch on harm reduction. I do not have the time to go into it in much depth, but I want to mention the upcoming United Nations General Assembly special session on drugs in 2016. Concerns have been raised with me that harm reduction practices for injecting drug users could be affected by the special session. The UK has historically shown great leadership in harm reduction over the years and in reducing the impact of HIV on injecting drug users. Would DFID therefore consider calling for a cross-Whitehall working group in the lead up to the 2016 special session, to ensure that the UK maintains its strong leadership on harm reduction policies across the world and that nothing happens to jeopardise it?

Before I conclude, I want to touch on a future challenge for the global response to HIV—access to medicines. I was pleased that DFID carried out a review of its position paper on HIV and AIDS. The review is more than twice the size of the original paper and is testament to the Minister’s and the Department’s commitment to the issue. I remain concerned, however, that it is missing some key elements.

I am particularly concerned about access to antiretroviral treatment. Those who have been here longer than me will know that that was a focus of the all-party group long before I became an MP, with the group conducting an inquiry in 2009 resulting in a report titled “The Treatment Timebomb”. The report effectively laid out the case that people living with HIV are now living longer—thankfully—but that the cost of treatment will therefore continue to rise to levels unaffordable for many unless something is done to ensure that intellectual property rights and patents do not infringe on a person’s right to health.

I appreciate that that presents a complex challenge to Governments throughout the world. DFID’s review mentions the challenge, but the little attention given does not reflect the magnitude of the issue. Without affordable medicines, the AIDS response could not have existed and most certainly would not be sustainable in future. Will the Minister tell us what steps DFID will be taking to tackle this fundamental human rights issue of access to medicines for HIV patients? Has she had discussions with other Departments that might have influence?

Rhetoric on HIV in recent years has spoken much of the end of AIDS being within our grasp—we have the means to do it. However, although it is true that we can now prevent people from being infected and that we can treat people living with HIV so that in practice they live a full life span, we are a long way off achieving the end of AIDS.

Recently, I spoke at the annual general meeting of Stop AIDS, which is a fantastic organisation working to secure the global response to HIV and AIDS. At the AGM, the non-governmental organisation ONE reported that we are getting close to a tipping point in the epidemic, which it defined as the total number of people newly infected by HIV being equal to, and eventually lower than, the number of HIV-positive people newly put on ARVs. That is truly excellent news, which demonstrates that we are on the right track to end AIDS, although we cannot be complacent.

We are still off track on some key millennium development goals for treatment and prevention. Funding is insufficient to control and ultimately defeat the disease. Much work remains to be done and, as we approach a new global architecture in the post-MDG framework, it is vital that that is recognised by the UK and other countries that lead the way in development.

To conclude, I reiterate that HIV is not only a medical issue, but a social and a human rights one. It is one of our key human rights concerns today. I look forward to hearing the contributions of my colleagues and the Minister’s response.

09:52

[Jeremy Lefroy (Stafford) (Con)]

It is a pleasure to serve under your chairmanship, Mr Dobbin. I congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) on her excellent speech and her leadership in the all-party group on HIV and AIDS. I apologise that I will have to leave before the end of the debate, to attend a Select Committee hearing, but I will follow the Minister’s reply and that of the shadow Minister extremely carefully in Hansard.

I pay tribute to David Cairns, who did a huge amount of work in the House on the subject, and huge tribute to Nelson Mandela for his leadership in this area, as in so many others. It is vital that we continue the battle. I lived in Tanzania for 11 years and remember, as the hon. Lady mentioned, the stigma that attached to the disease in the late 1980s and throughout the ’90s, and the courage shown by many people who came forth and said, “Look, we have to tackle this.” For that reason, a couple of years ago when my hon. Friend the Member for Mid Derbyshire (Pauline Latham) and I visited Nile Breweries, which was conducting a programme of HIV testing and treatment for the employees, she and I decided that we would publicly take an HIV test to encourage the workers at the factory to do the same, because some remained reluctant to do so, given the stigma of even taking the test.

I want to mention four areas in which we need to reinforce what we are doing and perhaps do more. The first is funding. The hon. Member for Airdrie and Shotts has mentioned the important work of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which we cannot stress enough, and I am delighted that the Minister has decided to increase its funding substantially. The hon. Lady quoted the statistics on the 29% fall in AIDS-related deaths since 2005; it is no coincidence that that is roughly the time during which the Global Fund has been operating. We see the same in malaria; I do not know the statistics for TB, but I am sure the same is true. Certainly, the number of deaths from malaria has fallen by a similar percentage during the time when the Global Fund has been operating.

The Global Fund is a hugely important multilateral fund, which has received very good ratings, for example in the multilateral aid review of the UK Government in 2010 and 2011. It is vital that we continue to support it. Certain issues have been brought up in recent weeks, and last year, but the current chief executive, Mark Dybul, is excellent and is tackling them. He is visiting the House next week and I hope to have the honour of entertaining him. I encourage other Members and colleagues to meet him. We must continue with the emphasis on maintaining and increasing funding. The Global Fund has not yet reached its target of $15 billion for replenishment. We need to encourage our colleagues internationally, in particular in Europe—Germany, France and other countries—to step up to the plate and ensure that the UK and the US can fulfil their commitments, because part of our commitment was conditional on others making commitments.

Secondly, we need to concentrate on the strengthening of health systems—the shadow Minister and I have discussed this on a number of occasions. Only through proper health systems in developing countries will we achieve the universal access to diagnosis, treatment and indeed prevention that is so vital. I am delighted that one of DFID’s new priorities is to reduce new infections in women and girls, which is only possible if we have strong health systems throughout the world. I want to hear from the Minister what DFID intends in this particular area—the Select Committee on International Development certainly hopes to launch an inquiry in the coming year.

Thirdly, as the hon. Member for Airdrie and Shotts rightly mentioned, we have to work with local groups. I am proud to say that I am an honorary member of the Kilimanjaro women’s campaign to fight against AIDS, which was launched in the early ’90s and has achieved a huge amount locally in the Kilimanjaro region of northern Tanzania and beyond, often on limited resources. The group is led by women and it works in education in support of families and the education of AIDS orphans. It did work that many other, much more substantially funded organisations were not able to do, because its work was mainly run by very committed volunteers.

DFID has an important role to play in support of such groups, not necessarily with massive amounts of funding, because sometimes the effectiveness of such groups is in inverse proportion to the amount of funding that they get. I remember one particular official group, which was substantially funded, that collapsed six months after the funding stopped, simply because it had become so reliant on it and was not prepared to continue the work once the funding stopped. It is vital that we support those groups, but sensitively, so that they are led perhaps not by expatriates going in, but by local people, supported by DFID.

Finally, there is the link made by the hon. Lady between HIV/AIDS and domestic violence and the broader issue of human rights—such as the fact that homosexuality is criminalised in, I believe, 42 out of 52 Commonwealth countries. We have to tackle such matters. Whatever might be said about us in the UK, we must take a lead. I am glad to see that the Government are doing so.

I will conclude by putting on record how important I believe it is to continue the fight. There is the tendency, as we saw with malaria in the 1950s and ’60s, once a battle seems to be largely won, to stop and relax, but it can come back with a vengeance to bite us, as with malaria in the’70s, ’80s and ’90s. We cannot give up on this. We must maintain our support, and I congratulate the Government and the hon. Member for Airdrie and Shotts on doing so.

09:59

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

It is a pleasure to serve under your chairmanship this morning, Mr Dobbin, and to have the opportunity to speak in this important and timely debate. I congratulate my hon. Friend the Member for Airdrie and Shotts (Pamela Nash) on securing the debate and making an incredibly powerful opening speech. It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who made an equally knowledgeable and powerful speech.

My hon. Friend the Member for Airdrie and Shotts poignantly—and rightly, at this time—highlighted the work done by Nelson Mandela in his lifetime to improve the situation for people with HIV and AIDS. He made the incredibly powerful statement:

“AIDS is no longer just a disease; it is a human rights issue.”

It is timely to think of that today, as it is international human rights day. It is an honour to mark that day with colleagues who feel equally strongly about these issues.

I want to focus on access to medicine and the human rights injustice that too many people still face in that regard. Hon. Members are already aware of the figures, but they are worth repeating: at the end of 2012, 9.7 million people worldwide had access to antiretroviral therapy in low and middle-income countries, compared with just 300,000 10 years earlier. We should recognise that achievement, but should guard against the complacency that the hon. Member for Stafford identified so poignantly.

Antiretroviral drugs have changed the way that HIV is viewed, from being a death sentence to being an illness. That achievement was propelled by a surge in donor funding and by the drastic reduction in the costs of first-line antiretroviral treatments, from $10,000 per patient 10 years ago to around $100 today. My hon. Friend the Member for Airdrie and Shotts referred to the Government’s recent review of their position paper on HIV and AIDS, “Towards Zero Infections”. I want to bring a few issues that remain of concern to the Minister’s attention.

Although remarkable progress has clearly been made in ensuring access to treatment for many, the World Health Organisation estimates that another 16 million people out of a total of 26 million are eligible for HIV treatment but lack access to it. Added to that is the fact that by 2050 it is estimated that over 50 million people will need HIV treatment. The situation is described powerfully in the excellent report by the all-party group on HIV and AIDS, “The Treatment Timebomb”. Millions of people who will need treatment in future will need more expensive medicines, as they will have become resistant to the basic HIV combination therapy; also—and this is welcome—people with HIV are living longer. Second and third-line treatments currently cost at least seven times more, and when the basic treatment stops working, getting access to them is a matter of life or death. That combination—more people needing more complex treatment—needs to be addressed now to avoid a potential crisis later.

The all-party group’s report gives a cogent argument as to how it is possible to make those medicines more accessible. Ten years ago, the basic HIV treatment cost $10,000 per person per year; today, thanks to generic production, the same medicines are available for $87 per person, enabling 3 million people to access treatment across the world. To avoid a treatment crisis, those kinds of price reductions need to happen again with newer HIV medicines. The report therefore urges pharmaceutical companies to co-operate by allowing generic manufacturers to produce HIV medicines cheaply specifically for developing countries, asking them to put their medicines into a patent pool for that purpose. That would also allow researchers to work on making HIV medicines suited to the developing world. Currently many HIV medicines are designed for a developed country market, and issues such as what happens when a patient needs to take HIV medicines in combination with TB medicines have not been considered—I know hon. Members have looked at that matter closely. There are also not many special HIV drugs for children because, thank goodness, not many children in the developed world have developed HIV.

At the request of the international community, the medicines patent pool was created. It negotiates with the patent holders of priority HIV medicines to sub-license their products to generic manufacturers to manufacture and sell them at a lower cost. Since last year we have seen a more encouraging uptake from pharmaceutical companies, from GlaxoSmithKline to Roche and Gilead Sciences, but there is still clearly a long way to go. Will the Minister outline what steps the Government are taking to ensure a much greater take-up by pharmaceutical companies? In the meantime, what alternative strategies are the Government pursuing to ensure that global access to medicines is being fully considered?

Although that issue was touched on in the Government’s review, it is a major challenge facing us. What steps are the Government taking to ensure that intellectual property rights and patent protections do not, as my hon. Friend the Member for Airdrie and Shotts aptly put it, prevent necessary treatments from being accessed by the millions around the world who are currently without the drugs they need and the millions who will need those drugs in the future?

The final issue I want to highlight concerns middle-income countries. “Towards Zero Infections” outlined plans to focus bilateral HIV funding on a narrower range of countries, in line with the Department for International Development’s 2011 bilateral aid review. It concluded that the UK should end bilateral programmes in 16 countries, many of them middle-income countries. That shift is based on the view that aid should be focused on low-income and fragile countries that are not able to eradicate poverty themselves.

The Government have decided to end their bilateral relationships with South Africa and India. But the fact is that three quarters of the world’s poorest people currently live in middle-income countries, as do 58% of people living with HIV; the projection is that that figure will rise to 70% by 2020. Three of the top five countries with the highest HIV burdens globally are middle-income countries, as are eight of the 10 countries with the highest tuberculosis burdens.

Middle-income countries also have far lower rates of antiretroviral coverage for people living with HIV than low-income countries, and much higher rates of multi-drug resistant tuberculosis. The concern has been expressed that withdrawing funding to middle-income countries too quickly could undermine the gains that have been made through scaling up access to reach key populations, which so far have prevented a global HIV pandemic. Will the Minister comment on the extent to which a more transitional approach has been considered—one that recognises the need to build countries’ capacities for the longer term?

Médecins Sans Frontières has warned of the consequences for middle-income countries of tiered pricing—the practice of selling drugs to different countries at different rates according to their socio-economic status. That is another reason why the middle-income label must be used with caution: it must not hide the fact that the majority of the poor live in those countries. MSF has voiced strong concerns about the potential consequences of those countries being locked into bad deals. I will highlight one example. Although generic competition brought the price of first-line HIV drugs down by close to 99%, from over $10,000 per person per year a decade ago to $120 today, tiered pricing leaves middle-income countries paying as much as $740 per person per year for the second-line drug combination lopinavir/ritonavir. That is over 60% more than what pharmaceutical company Abbott is charging low-income countries. What are the Government doing to address those concerns and ensure that we do not create a ticking time bomb?

To conclude, I thank my hon. Friend the Member for Airdrie and Shotts again for securing this debate and for the work that both she and the all-party group on HIV and AIDS do. Given events today, it is fitting to reflect once more on the words of Nelson Mandela, who we know experienced at first hand the suffering that HIV and AIDS can bring. He famously said:

“Poverty is not an accident. Like slavery and apartheid, it is man-made and can be removed by the actions of human beings.”

That poverty is a barrier to life-saving medicines for millions of our brothers and sisters. That is our call to action today.

10:09

[Jim Shannon (Strangford) (DUP)]

It is a pleasure, Mr Dobbin, to contribute to this debate, which I congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) on bringing to the Chamber. She has been a champion of the issue here and in the House, and it is clear from the questions being asked that there is interest in and compassion for those who most need help.

I thank the hon. Member for Stafford (Jeremy Lefroy) for his contribution. Not many people can say that they belong to the Kilimanjaro club, and I do not believe any other hon. Member can do so. I also thank the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for her valuable contribution.

It is good to make a contribution on such an important issue because MPs and parliamentarians have a role to play not just here at home, but internationally. The debate is about the international response to HIV and AIDS, and sometimes when looking elsewhere in the world, it is good also to look at home. HIV is prevalent in other parts of the world but, unfortunately, it is also an issue at home: during the past 12 years, there has been a 384% increase in Northern Ireland, which is a large increase. When focusing on the issue internationally, we must always remember what is happening in our own country.

More than 35 million people live with HIV/AIDS, and in the past year 2.3 million were newly infected. That is the magnitude of the issue. Every hour, 262 people die from AIDS. In a debate here last year, I and others asked what can be done to halt the epidemic, and the reason for this debate today is to ask what steps the Government are taking. Are they addressing the issue effectively?

There was an increase in the number of under-15-year-olds diagnosed with the disease last year, and although diagnosis is good because treatment can start, it is not good that more people are being so diagnosed. We must look at that issue. The hon. Member for Airdrie and Shotts referred to a large drop of 50% in HIV infection in sub-Saharan Africa and that is good news, which arises from steps taken by Governments internationally in the global war against AIDS, malaria and other diseases.

When addressing the international response to HIV/AIDS, we must remember groups such as the Elim church mission in Newtownards in my constituency, which works hard on issues such as health, education, house building, business, farming and orphans. It addresses such issues in Zimbabwe, Swaziland and Malawi, three countries where there has, unfortunately, been a large increase in the diagnosis of AIDS. In the last couple of years, I have had the opportunity to meet some young people from Swaziland who have AIDS, or are orphans because their mums and dads died of it. No one could be other than impressed by the smiles of those young people and their zest for life, which was a result the Elim church mission and many other groups and individuals from other churches making financial, physical and practical contributions to help such people and to give them hope and a chance in life. The hon. Member for Airdrie and Shotts talked not just about medical help but about the hope that can be given, and I too will focus on that.

When we saw and heard those young people, I thought that African choirs are some of the most wonderful. Ours are also good, but African choirs have a different flavour, especially those with young people. Their zest for life and interest in others impresses me. Their Christian belief sustains them, and makes one humble.

Just last month, the Global Fund to Fight AIDS, Tuberculosis and Malaria confirmed £12.07 billion to fight those diseases. The bigger countries have pledged to address the epidemic throughout the world, and that sum was an increase on the 2010 figure but falls short of the £15 billion that is estimated to be needed for the next three years. We have made a commitment, but it has not been significant enough to address the total issue, and we must look at that again.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend the Member for Airdrie and Shotts (Pamela Nash) on securing this timely and important debate. Given that last year, 320,000 HIV-positive people died from TB, which is the leading cause of death in people with HIV, does the hon. Gentleman agree that it is crucial that TB REACH be properly resourced in future so that innovative solutions are not sacrificed as we try to tackle these dreadful diseases?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. HIV cannot be considered alone; TB and malaria must also be considered because they incapacitate people who are HIV-positive. A joint strategy is required.

It has been disclosed that the Government will add £1 billion to the overseas aid budget in the next year due to an increase in Government spending. Will the Minister confirm that that money will be earmarked specifically for dealing with HIV/AIDS? We cannot ignore the overseas budget, and although some people may have concerns about increasing it, I believe that it is right to do so.

Will the Minister respond to the suggestion that the UK will deliver its contribution dependent on other countries doing their bit, and that if their pledges fall short—I hope they will not—the UK and USA may not deliver their commitment? Will she confirm that the Government’s contribution is ring-fenced and will be delivered, whatever amount other countries may deliver under the global health fund? At meetings and summits such as G8, Governments make commitments to respond to world disasters, but when looking back a year later, I sometimes wonder whether they actually delivered on their commitments. Delivery is important, particularly this year, and the present momentum of reducing HIV/AIDS must be maintained. The disease ravages those in third-world countries, makes children orphans, condemns mothers to sickness and destroys communities.

Previous speakers have referred to technology. Scientific progress has been significant. The hon. Member for Newcastle upon Tyne North referred to drugs and their availability. They can preserve life and communities. We must translate that into making a difference to the world’s population. I believe, as do many Members, that a person is measured by their compassion and interest in others. This great nation of the United Kingdom of Great Britain and Northern Ireland will also be measured by its compassion for others. I know that our Government are delivering physically and practically, and I hope the Minister, whom I have the highest respect for, will outline in detail what the United Kingdom will do in the global war against the HIV/AIDS epidemic.

10:19

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to serve under your chairmanship this morning, Mr Dobbin. Like others, I want to congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) for leading us in the debate and for the leadership she provides more generally in the House through the all-party group on HIV and AIDS. Like others, I want to pay particular tribute to her predecessor, David Cairns, for the positive and challenging work he undertook in the role.

The debate has thankfully given Members an opportunity to reflect on a number of points on international human rights day and to put AIDS in its important context—not only as a serious disease that confounded everybody when awareness of it emerged in the 1980s, but as an issue that challenges us at so many levels of policy and delivery. It challenges not only politicians, political systems, governmental processes and public services, but the private sector, and not least pharmaceutical companies and others. It is important, as we mark the progress made at a number of levels in understanding and getting to grips with the problem, that we acknowledge that a number of huge challenges are still present. Several Members have pointed out that we cannot let the significant progress that has confounded the worries and expectations of many years ago—there was almost a sense that it was impossible to counter the disease, and futile to try—lead to any sense of complacency. Progress will not move along on the wheels of inevitability. We should not assume that the momentum that is to be celebrated will be sufficient to take all else in its path; nor should we neglect the fact that some of the choices that can be made now and in the coming years could compromise some of that progress.

Rightly, the hon. Members for Stafford (Jeremy Lefroy) and for Airdrie and Shotts celebrated the signal importance of the global health fund. Sustaining that fund is hugely important. Yes, there are issues such as targeting to be ironed out, but the fund has had a signal impact. It has to be sustained, as does the commitment of all countries to it. We need to ensure, however, that the decisions about how it is managed and directed do not create perverse outcomes.

The hon. Member for Newcastle upon Tyne North (Catherine McKinnell) referred to the approach to, and emphasis placed on, the banding of countries by DFID and others. On one level, DFID’s categorisation of middle-income countries can be understood in terms of its rationale for prioritisation; but on another, it can condemn the many poor people in those countries to neglect, to their not getting the support they need. They are left facing higher prices than those faced by their counterparts in low-income countries, which is simply irrational. DFID has justified the rationale of prioritisation on the basis that the review would be all about buying results. We should not be in the business of buying a result that is bad for poor people in middle-income countries in the context of dealing with HIV/AIDS.

Many people have made the point that we should treat AIDS not just as a disease but as a human rights issue. That raises questions about not only health delivery and support, but other policies. The point was made that in many countries where there is a political difficulty in marshalling support for talking about HIV/AIDS, the criminal law on homosexuality is very regressive. As we talk to people in those countries—whether through the Commonwealth Parliamentary Association or the Inter-Parliamentary Union—we need address the AIDS question in the context of that debate, too.

I recall that when I visited Malawi a number of years ago, a politician—the then vice-president—was trying to talk about AIDS. He had broken a taboo, even by using the euphemism “the disease of the mattress”. He had to talk in very coded terms, but even that brought its own serious and adverse reaction. We have to support those who are trying to tackle the problem in those countries. We will not do that by saying, “Right, we have created enough momentum. That will look after itself.”

There has been progress on the patent pool, and I commend the leadership of companies such as Gilead and others. That poses a challenge to policy makers: how we make the most of those opportunities; how we encourage other companies to do more; how we encourage Gilead and others to make sure that more drugs go into the patent pool a lot earlier? As we deal with drugs that are needed for HIV/AIDS and other diseases such as TB and malaria, we also need to recognise that one of the major challenges is not only the supply of drugs but, in many of the developing countries, ensuring proper adherence. Systems are needed for that, but we also need to ensure that, as new and more specialised drugs capable of helping the young and the frail are targeted there, they are priced accordingly, so that there is no excuse for using anything else. However, we have made huge progress on this issue.

In 1985, I was on a staff exchange programme and worked for a number of months in Senator Teddy Kennedy’s office. The previous year, he had introduced and successfully passed in the Senate the first legislation that mentioned HIV/AIDS. However, even that had been a difficult and sensitive issue. It was time-limited legislation that provided research funding for one year. His challenge in 1985 was how to provide a second such piece of legislation. Even that was controversial. I remember sitting in meetings with him and his staff as they discussed how to frame a Bill that could also be subject to Senate hearings. The question was, how could they even conduct Senate hearings, because people did not want to talk about these issues? What would happen if there was discussion about prevention and condoms, for example? It was a highly sensitive issue. We have come a long way since that time.

Back then, Norman Fowler—now Lord Fowler—provided great leadership at Government level, and I was very pleased to see him presiding at events last week on world AIDS day, as he does so often. It is right that we recognise the quality of leadership that was shown here back then, but no less a quality of leadership is needed now as we face big issues and challenges. We need to address the questions that arise concerning the UN Special Assembly in 2016. There is the danger of complacency, and that mistakes might be made that will set back some of the work and progress that has been achieved. On world AIDS day, the Terrence Higgins Trust said that it is now providing advice and support to pensioners who are living with HIV/AIDS—something it never thought it would have to do. That is a mark of the progress that has been made. We need to celebrate that, but we also need to commit to ensuring that there will be no dropping back.

10:30

[Alison McGovern (Wirral South) (Lab)]

It is a great pleasure to serve under your chairmanship again, Mr Dobbin. I join other hon. Members in paying tribute to my hon. Friend the Member for Airdrie and Shotts (Pamela Nash)—not just for securing this debate, but for the excellent work that she has done as chair of the all-party HIV and AIDS group, one of the most active and effective groups in this place. She should be proud of that work, and her constituents should be proud of her.

I also pay tribute to all the other hon. Members who have spoken for their balanced and careful reflections. I know that the hon. Member for Stafford (Jeremy Lefroy) has had to head off to the International Development Committee, where he will no doubt do his good work in the effective way that I have witnessed at first hand. I will just note that he mentioned health systems, quite rightly. Those are a very important issue and I caveat whatever I say with my hope that the Minister will listen to her hon. Friend in that regard.

My hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) and the hon. Members for Strangford (Jim Shannon) and for Foyle (Mark Durkan) also raised serious and important points. Each of them reflected on different aspects of the issue, whether it was the shift in focus from both low and middle-income countries or the range of drugs available now and the importance of taking the widest possible look at that. They all reflected a sense of progress, but also the driving sense that there is still much more to do. I am sure the Minister would agree.

Given the scale of the global crisis that HIV/AIDS represents, it is vital that we continually examine the effectiveness of the action being taken, at home and abroad, both to ensure that there is treatment for those who need it and to slow and halt the spread of the disease. However, as other hon. Members have mentioned, today’s debate feels especially timely, for two reasons. First, and I suspect that my hon. Friend the Member for Airdrie and Shotts had this in mind when she applied for the debate, last week we marked world AIDS day, when we remember the 35 million people who have died from HIV/AIDS since the start of the epidemic; when we stand with those who live with the disease; and when we re-pledge our determination to end this scourge.

Secondly, today is the day when the world is coming together to remember the life of Nelson Mandela, so this debate seems particularly appropriate. Nelson Mandela had a particularly interesting interpretation of the word “retirement”. During his retirement, he campaigned tirelessly to stem the tide of HIV/AIDS, which he saw destroying lives and communities in his own country. On world AIDS day in 2000, he described it in this way:

“Our country is facing a disaster of immeasurable proportions from HIV/AIDS. We are facing a silent and invisible enemy that is threatening the very fabric of our society.”

Mandela fought against the prevailing attitudes and the stigma attached to HIV/AIDS, which resisted calls to fund antiretroviral drugs or to educate people on the need for safer sexual practices. He saw that HIV/AIDS was not only shortening lives and destroying families; the economic impact was also consigning many more people to poverty than would otherwise have been the case. The hollowing out of a generation placed a brake on economic development that could have reached across the country in the post-apartheid years.

South Africa continues to be haunted by AIDS, but thanks to Mandela and others who fought alongside him, things are slowly—albeit too slowly—starting to get better. Strikingly, earlier this year, Dr Olive Shisana, head of the South African Human Sciences Research Council, said that for the first time

“the glass is half full”.

There has been a dramatic increase in the numbers of people in South Africa receiving antiretroviral treatment, up to 2 million in 2012, and for the first time there has been a decline in the prevalence of HIV among 15 to 24-year-olds. That story—that there is progress, but still a long way to go—is also the story of HIV/AIDS across the world. Bill Clinton adopted the Churchillian phrase

“we are at the end of the beginning”

to describe the current situation.

There is good news. In most regions, the number of people newly infected with HIV is falling. Globally, it was down 33% in the period from 2001 to 2012. The millennium development goal of halting and reversing the growth of HIV has been achieved and in just one year, between 2011 and 2012, the numbers accessing treatment grew by 1.6 million, as has been mentioned. It is right to pay tribute to the communities, NGOs and politicians who have fought so hard to achieve that historic turnaround.

However, those glimmers of hope must not blind us to the continued severity of the situation and the requirement to do far more. Every year, 2.3 million people are newly infected with HIV, and of those, more than 1.6 million are in sub-Saharan Africa. Seven million people still lack access to antiretroviral therapy for HIV. Marginalised groups continue to be particularly prone to infection and to have lower levels of access to treatment. That includes women and girls. The reversal of the growth in new infections could be fragile. In particular, many nations in south-east and south Asia are seeing increases in the numbers of new infections.

Britain has a strong history of leading the fight against HIV/AIDS. Under the last Labour Government, we became the second largest bilateral donor in the fight against the disease and introduced long-term funding to strengthen health systems and services. I am pleased that, broadly, that legacy has been continued under the current Government and I welcome the additional £5 million of funding each year for UNAIDS—the joint UN programme on HIV/AIDS—that the Minister announced in the run-up to world AIDS day. However, I would like to conclude by asking the hon. Lady a few questions that I hope she can address in her winding-up speech.

Millennium development goal 6 has been an important spur in pushing for progress on HIV/AIDS and in that respect has been perhaps one of the more successful goals. What replaces the MDGs post-2015 could be vital in solidifying progress. Will the Minister update us on the Government’s view as to what form the next goal on HIV/AIDS should take?

The countries in which progress towards reducing HIV infections is weakest, or in which there is a deterioration, include nations for which DFID decided in its bilateral aid review to end programmes. They include India, Cambodia, Vietnam and Russia. Without reopening those questions or getting into the rights and wrongs of those decisions, will the Minister set out what work is ongoing to help middle-income countries and others in which the bilateral programme is ending to tackle HIV/AIDS, such as expert support from Britain?

Importantly, we know that one of the most effective safeguards against all forms of disease, in terms of both prevention and cure, is universal healthcare, free at the point of use. That is particularly true in the case of HIV/AIDS: community health advice and support can be an excellent means of preventing new infections. Will the Minister set out for the record DFID’s position on providing bilateral support for health care systems in which user charges are levied and what specific work is being done to ensure that HIV treatments are available free of charge in the nations with which DFID has a bilateral relationship?

As a number of hon. Members have noted, the Government’s review of their position paper on HIV/AIDS is limited, missing a number of key issues, including access to medicines. Can the Minister assure us that such issues will be dealt with as part of the review and, given that the consultation on the review ended nearly five months ago, tell us when she expects the outcome of the consultation to be published?

On global health fund replenishment, the UK pledged £1 billion, but in fact replenishment required $15 billion and it reached only $12 billion in the talks last week. What discussions are DFID Ministers having with other Governments to ensure that the global health fund reaches its $15 billion target?

Having set out those questions for the Minister, I will conclude by thanking most sincerely all hon. Members who have taken part in this important debate, which has shown once again, if it were in any doubt, this House’s commitment to ending the scourge of HIV/AIDS.

10:39

[The Parliamentary Under-Secretary of State for International Development (Lynne Featherstone)]

It is a pleasure to serve under your chairmanship, Mr Dobbin. I congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) on securing this important debate so soon after world AIDS day and just after the Global Fund to Fight AIDS, Tuberculosis and Malaria replenishment last week. I congratulate her on the important work that she does as chair of the all-party parliamentary group on HIV and AIDS, and on her powerful contribution to today’s debate, which was truly excellent. All who have contributed are part of the cohort who go out and fight the fight against HIV/AIDS because, as hon. Members have emphasised, it is such an important and ongoing cause.

When I came into post, I made HIV/AIDS one of my top priorities. When I was shadow International Development Minister—the post now occupied by the hon. Member for Wirral South (Alison McGovern)—I went to South Africa with Business Action for Africa, along with a Labour and a Conservative Member of Parliament, to look at AIDS projects. During that visit, we went into the townships around Johannesburg and saw the conditions there. The trip had a profound effect on me. Many hon. Members have raised the phenomenal work done by Nelson Mandela. I was in South Africa at a time when the treatment for HIV/AIDS recommended by the country’s leadership was to take a shower. We can see the effect of Nelson Mandela’s work from the way in which things have changed and the amount of Government-funded work that now takes place.

When I visited South Africa, only the big corporations such as SABMiller and Anglo American provided facilities for their own employees, and they did so to stop them dying, not from pure altruism. Many hon. Members have spoken of the stigma associated with HIV/AIDS. I went into a hospital built by Anglo American where people came forward and declared their HIV-positive status in front of other members of staff. That gave those members of staff, who were afraid of the associated stigma, the courage to declare themselves and ask for testing. That was one of the most moving experiences of my life. I say to all who take MPs on trips to enlarge, inform and develop them that that trip, eight years ago, may have been a reason why I made HIV/AIDS one of my priorities when I came into office. In addition, I grew up in an era when HIV/AIDS first became an issue. Being terrified by the AIDS prevention adverts and having many friends who died of HIV/AIDS long before there was any treatment for it, left its mark on me.

I will address the points that have been raised as I go along, after which I will try to address any that are not in my speech. There is much to celebrate. The latest UNAIDS figures show an unprecedented pace of progress in the global AIDS response. There are 1 million fewer new HIV infections each year across the world than there were a decade ago, especially among newborn children. We do a lot of work on preventing mother-to-child transmission, which is an obvious stop point, and that work is delivering results. Nearly 10 million people now have access to treatment. Although international assistance remained flat, low and middle-income countries increased funding for HIV, accounting for 53% of all HIV-related spending in 2012. That shows that we are moving towards a lasting response.

That is all excellent news, but, as we debated in Washington last week, we need to put renewed efforts into going the extra mile and achieving an AIDS-free generation. We cannot take our foot off the pedal. Risks remain that might seriously jeopardise the incredible progress we have made. Too many people are still getting infected; 2.3 million were infected last year. As many hon. Members have said, girls and women remain disproportionately affected by the virus. Infection rates in young women are twice as high as in young men. Although tremendous progress has been made on treatment scale-up with the change in the World Health Organisation treatment guidelines in 2013, at least 16 million people who are in need of treatment are not currently receiving it. Stigma and discrimination continue to drive key affected populations underground, which inhibits prevention efforts and increases the vulnerability of those populations to HIV. In 60% of countries there are laws, regulations or policies that block effective HIV services for key populations and vulnerable groups. I will return to that point.

The UK Government were delighted and proud to pledge £1 billion of UK funds at the fourth Global Fund to Fight AIDS, Tuberculosis and Malaria replenishment in Washington last week. The UK pledge alone will save a life every three minutes for the next three years, and it will deliver life-saving antiretroviral therapy for 750,000 people living with HIV. The hon. Member for Strangford (Jim Shannon), who is not in his place and has sent his apologies for having to leave, raised the issue of leverage. The UK contribution helped to leverage, and contributed towards, an unprecedented $12 billion replenishment total. That is 30% more than was pledged at the equivalent event in 2010, and 50% of those funds will go towards dealing with HIV and AIDS.

The UK now calls on all outstanding donors to step up to the plate over the period from 2014 to 2016 to ensure that the target figure of $15 billion is reached and there is maximum impact in terms of lives saved. The Secretary of State and I are telephoning other countries to lobby them. The contribution from one country—I believe it was Switzerland, but I will correct the record if I am wrong—tripled after my telephone call. That is the point of the lobbying effort across the world, which will not end with the pledging in Washington. We must continue that effort to ensure that we reach our targets. We are also working with recipient countries to help them realise increased domestic contributions in the fight against the three diseases. We were delighted by the political commitment of recipient countries at Washington and by the financial commitment of Nigeria, which pledged $1 billion to the national fight against the three diseases. The fight is becoming truly global, with equal partnership and purpose.

This year, we conducted an internal review of our 2011 HIV position paper, which we published last month. I thank STOPAIDS for its help; I see Ben Simms wherever I go in the world. Two years on, DFID is making good progress against its expected results. Treatment-related commitments have already been achieved, and the remaining targets set out in the HIV position paper are on track to be met by 2015.

Several hon. Members mentioned the shift in funding from bilateral to multilateral. Over the past two years, we have been sharpening our focus and working more to our comparative advantage in our bilateral programmes. As the 2011 position paper predicted, the balance between multilateral and bilateral funding has shifted and our bilateral efforts are focused on fewer countries where the need is greatest. The hon. Member for Newcastle upon Tyne North (Catherine McKinnell) asked what we were doing in the programmes where we are shifting the balance of our funding. We now have some exciting new programmes in southern Africa, which is the region hardest hit by the epidemic. Given the urgent need to reduce new infections, we have prioritised critical prevention gaps and we are moving towards complementary work to deal with those gaps. As hon. Members have said, civil society has been, and remains, an essential partner for DFID in addressing those gaps. We are proud to support other multilateral organisations, such as UNAIDS, to ramp up their efforts in the global HIV response. That will reach many more countries, at a much greater scale, than the UK alone could help.

As I have announced, we will increase our annual core contribution to UNAIDS by 50% to £15 million in 2013-14 and 2014-15. That will give the organisation an extra £5 million a year to support its critical role in co-ordinating the world response to HIV and AIDS. In total, our combined bilateral and multilateral contributions secure the UK’s place as a leader in the global HIV response and demonstrate our commitment, in providing a considerable share of total global resources, to universal access to HIV prevention, treatment care and support.

The review paper highlighted three areas of particular focus for the UK: being a voice for key affected populations; renewing efforts on reaching women and girls affected by HIV; and integrating the HIV response with wider health system strengthening, which hon. Members raised, and other development priorities. That includes tackling the structural issues driving the epidemic.

I shall refer to human rights, which many hon. Members raised. In countries with generalised epidemics, HIV prevalence is consistently higher among key affected populations: men who have sex with men; sex workers; transgender people; prisoners; and people who inject drugs. Over the years, DFID has spearheaded support to HIV programmes for key populations. They have been and they will remain a key policy priority for us. We will use DFID’s influence with multilaterals to be a voice for key populations and to push for leadership and investment. We will focus on evidence-based combination prevention services, such as condoms, HIV testing and counselling, and comprehensive harm reduction programmes.

Of particular importance are the programmes and initiatives we are supporting to reduce stigma and discrimination. Our ultimate vision for key populations is for their human rights and health to be recognised, respected and responded to by their Governments. The UK is proud to be a founding supporter of the Robert Carr civil society Networks Fund, through which we support those particularly vulnerable groups. Valuable lessons have been learnt from the fund’s first year and this world AIDS day, the fund announced a second round of grants.

[Pamela Nash]

Before the Minister moves on from the Robert Carr fund and key populations, will she clarify whether any DFID money will go to grass-roots organisations? As I said earlier, the Robert Carr fund operates regionally and I know that a lot of money goes through multilaterals. It would be good to have some clarification on how we are getting money through to smaller groups.

[Lynne Featherstone]

I will come back to that issue shortly.

Human rights was one of the key issues raised by hon. Members. The UK Government are at the forefront of work to promote human rights around the world. We regularly criticise Governments who violate those rights, including those that discriminate against individuals on the basis of sexuality. I have personally raised those issues with Ministers, Prime Ministers and Presidents in Africa. We take some of our lead in DFID bilateral countries from activist groups in the LGBT community, so that may take place behind closed doors due to the difficult, sensitive and dangerous nature of some of the work they do in countries where the law is such that they may face prosecution and for which they could face a backlash. I am committed to raising such issues with Governments across the world, as is the Foreign Secretary and many others across Government. Human rights is at the forefront of our work.

Women and girls are at the centre of our HIV response. Globally, the rate of new HIV infections among women and girls has declined, but the pace of decline is not as rapid as we would like and it is a critical area for renewed UK and global efforts. Gender equality and women and girls’ empowerment lies at the heart of DFID’s development agenda. Since 2011, each of our bilateral programmes has seen a greater focus on HIV prevention addressing the needs of women and girls. We are supporting research to improve outcomes for women and girls, including the development of female-initiated HIV-prevention technologies, and we are looking into how gender inequality drives epidemics, with a particular focus on improving what works for adolescent girls in southern Africa.

We know that in a crisis, girls and women are more vulnerable to rape and transactional sex. The highest maternal mortality and worst reproductive health is in countries experiencing crisis. Contraception, prevention and treatment of HIV and other sexually transmitted infections, and safe abortion are life-saving services, yet they are often ignored in humanitarian responses. That is why DFID is currently developing a new programme on sexual and reproductive health in emergency response and recovery, including services to reduce the transmission of HIV. We welcome the fact that the global health fund will also prioritise women and girls more in 2014 and we look forward to working closely with it on that.

In terms of integration with the wider health system, we know that for a response to be lasting, we must integrate HIV within other sectors and find concrete solutions to sustainable financing. We recognise that a strong health system is an important way to improve the reach, efficiency and resilience of services. The co-infection connection and the integration of HIV services with TB services, sexual and reproductive health services and the wider health system were raised. People living with and affected by HIV, including children and people with disabilities, need to be treated holistically and not just as a series of health problems.

We are also working with countries to ensure that they are in the lead role and increasingly financing their own national responses. In the end, that is the only way to sustainability. We are also working with the global health fund and others to look at market shaping. The hon. Member for Newcastle upon Tyne North mentioned tiered pricing—we term it market shaping—as a way of further reducing commodity prices not only for low-income countries, but for middle-income countries graduating from donor support, which many hon. Members mentioned.

I have tried to cover most of the points raised, but I have left a few things out. Integrated responses to tackling TB-HIV co-infection were highlighted in the HIV position paper review as a key area of current and ongoing effort. It will contribute to the global results to help halve TB-related deaths among people living with HIV by 2015. A cross-Whitehall group on harm reduction was called for. The UK Government remain committed to supporting harm reduction efforts to ensure that that goal gets back on track. DFID is currently liaising with other Whitehall Departments on the drafting of the Commission on Narcotic Drugs ministerial statement, and will remain engaged on that crucial issue in the lead-up to the UN special session on drug control in 2016.

Hon. Members mentioned access to medicines, which is vital. The access to medicines index, last published in November 2012 and supported by DFID, shows that companies have their own strategies for managing their intellectual property and supporting access to medicines. The medicines patent pool currently has agreements with the US National Institutes of Health, Gilead Sciences, ViiV Healthcare and Roche. The UK will continue to support actively that collaborative initiative to enhance access to more affordable treatment and to promote the development of appropriate treatment for children. The UK strongly encourages other companies that have patents for the new first-line treatment for HIV to consider beginning formal negotiations to enter the pool. The medicines patent pool idea was endorsed by the G8 and the UN General Assembly session on HIV and AIDS, to support the availability and development of new first-line treatments for HIV and AIDS.

In addition to funding for antiretroviral drugs through the global health fund, UNITAID and other agencies, DFID also works to make markets for antiretrovirals work better to reduce prices, increase the number of quality suppliers and enhance access. Our partnership with the Clinton Health Access Initiative has already contributed to secure price reductions of almost 50% on both first and second-line therapies for HIV, saving African Governments more than £500 million. That is sufficient to put an extra 500,000 people on AIDS treatment for three years. As has been said, that fall in price from $100,000 per treatment to $100 is the most incredible result. We need to keep pushing down those prices for as long as we can. In terms of civil society, we continue to provide funding for work at the grass roots through our civil society programme partnership arrangements and other DFID civil society grant awarding schemes.

I have only one minute, so I will reply to hon. Members by letter if I have missed any points. The UK and others made huge contributions last week in Washington. There is a great sense of excitement and common purpose in the world, leading towards the vision we all hope for—an AIDS-free generation—an historic moment. A sad truth of the HIV epidemic is that it is often women and girls who are most at risk of human rights abuses in developing countries and least able to get access to the services they need. Addressing gender inequality, stigma, discrimination and legal barriers remains our priority.