The Parliamentary Under-Secretary of State, Department for International Development (Baroness Verma) (Con)
My Lords, I join all noble Lords in thanking the noble Baroness, Lady Barker, for securing this debate. I also thank all noble Lords for their excellent contributions. The noble Baroness referred in her opening remarks to the pioneering approach of my noble friend Lord Fowler in ensuring that the debate around HIV/AIDS had considerable resource at a time when it was very difficult to discuss such matters.
As the noble Lord, Lord Collins, rightly said, UNAIDS estimates that nearly 16 million people are now on treatment but, despite this significant progress, 1.2 million people are still dying every year because they lack the essential drugs and prevention services.
As noble Lords have mentioned, the Access Denied report raised important issues. The UK remains committed to addressing these issues, getting to zero and ensuring that no one is left behind. The scale of the UK’s financial commitment is testament to this. We remain the second largest international donor on HIV prevention, care and treatment and over the period 2014 to 2016 have pledged up to £1 billion to the Global Fund—a commitment that is yielding real results, with the Global Fund providing more than 8.1 million people with life-saving treatment.
As noble Lords have said, no child should be born with HIV, and when this happens it is a clear failure of health systems. In response to this, the UK spent £360 million in 2013-14 investing in strong and resilient health systems. With considerable UK support, the Global Fund has reached 3.1 million women with services to prevent transmission of HIV to their babies.
The APPG’s report expresses concern over the affordability of second and third-line antiretroviral drugs. As a number of noble Lords raised that point, I want to assure them that the UK is heavily investing in tackling this important issue through our support to the Global Fund, UNITAID, the Medicines Patent Pool and the Clinton Health Access Initiative. Our support to the latter has helped secure more than $1 billion-worth of procurement cost savings. These savings have been reinvested to allow millions more to access treatment.
The report also highlights the importance of viral load testing. The cost of viral load testing remains a major challenge, and so my department is supporting a deal with Roche at $9.40 per test, a 40% reduction for many countries. In low and middle-income countries, this equates to an average price cut of more than 40%. While the agreement is by no means the final answer, it does represent an important step.
A number of noble Lords referred to middle-income countries. We agree with the report that the withdrawal of international financial support must be sensitive to the needs of key populations. At present, approximately 50% of the Global Fund’s resources are targeted at middle-income countries, and we continue to use our place on the board to encourage such countries to focus on key populations. At the same time, we must remember the needs of lower-income countries, which simply cannot afford to provide universal access to HIV treatment and HIV prevention services on their own.
It is clearly unacceptable that every two minutes an adolescent girl is infected with HIV and that 1,000 young women are infected every day, the vast majority of whom are in sub-Saharan Africa. DfID—my department—puts the empowerment of girls and women at the heart of everything we do. Nearly 60% of Global Fund resources are invested in programmes that reach women and children, and we have committed more than £100 million to programmes to tackle gender-based violence.
Sadly, stigma and discrimination continue to drive key affected populations underground—populations such as men who have sex with men, sex workers, prisoners and injecting drug users—inhibiting prevention efforts, increasing people’s vulnerability to HIV and reinforcing barriers to accessing medicines. Tackling such stigma, and securing evidence-based HIV prevention and treatment for key populations, remains one of the UK’s HIV policy priorities. The UK is therefore proud to be a founding supporter of the Robert Carr civil society Networks Fund, through which we support these particularly vulnerable groups.
We are also one of the world’s leading funders of research and development into infectious diseases. In 2014-15, we spent at least £86 million on health research. The innovative new Ross fund gives us an opportunity to continue this important investment, developing, testing and delivering a range of new products for infectious diseases which affect the poorest and most vulnerable people in the world.
A number of questions were raised, and I will endeavour to answer as many of them as possible. If I run out of time, I promise to write to noble Lords. I will start by giving noble Lords a personal commitment. I have spent as much of my life as I can remember fighting all kinds of discrimination. For me, any form of discrimination needs to be tackled head on. My role gives me a really privileged position from which I can push hard. I work with the noble Baroness, Lady Barker, and we share some common areas which need a cross-party political response. I hope that, where noble Lords feel they can offer support, they will undertake to come forward. These issues are not for any one political party; they are for us all to come together on.
The noble Baroness, Lady Barker, and other noble Lords asked whether the Ross fund was new money or whether it was robbing Peter to pay Paul. It is a new fund—a new £1 billion research initiative that will focus on malaria and other infectious diseases. It will report regularly to a cross-government assurance board. I do not have enough detail to give much more information at the moment, but as more details come forward I will be very happy to share them with noble Lords who are interested.
A number of noble Lords mentioned the difficulties that middle-income countries will have if funding is taken away. I hope I have demonstrated that we do support those countries—50% of the funding goes there—but we need to ensure that we focus very much on the low-income countries with high burdens. Where the key groups are in middle-income countries, our support must be directed and targeted to them. However, we support the Global Fund’s new funding model, which will focus where the need is greatest. We are pressing the fund to ensure that marginalised groups in middle-income countries are prioritised and that innovative mechanisms are developed to address their needs.
The noble Lord, Lord Collins, spoke about giving assistance to middle-income countries. One area in which we offer programmes is working with the Governments of middle-income countries to ensure that they know how to target those key populations.
The noble Baroness and others asked where HIV sat within the overall strategy. It is a high-level strategy and we do not name every disease. However, I hope it reassures noble Lords that we remain the second biggest international funder of HIV prevention, treatment, care and support. We are not reducing our presence, but we need to focus on how to make others join their pledges and deliver with as much enthusiasm and commitment as the UK.
My noble friend Lord Black and other noble Lords rightly highlighted the issue of paediatric treatment. Besides our contribution to the Global Fund, we have provided €60 million annually to UNITAID to continue its pioneering role in paediatric HIV diagnostics and treatment.
My noble friend—along with my noble friend Lord Fowler and the noble Lord, Lord Cashman—also highlighted the link between the criminalisation of homosexuality and the spread of HIV. We continue to urge all states with laws that criminalise homosexuality and discriminate against people based on sexual orientation or gender identity to urgently review their laws. I was proud to chair a round table on LGBT issues at the Commonwealth Heads of Government Meeting in November. It was really encouraging to see that the meeting was so well attended. I can assure noble Lords that, in my role, I am determined to ensure that we work towards much more inclusive communities. Wherever I go, the issues around inclusive responses and challenging those countries are always on the agenda.
I think that I am fast running out of time. As I have said, approximately 50% of the Global Fund resources go to middle-income countries.
My noble friend Lord Patten talked about stigma, as did other noble Lords. Given the sensitivity of this issue in some countries, our approach to LBGT rights is strongly guided by local civil society in each of those countries. We work on a case-by-case basis, building bottom-up pressure for change.
I have got the message to say that my time is up, so I would just like to reiterate my thanks to the noble Baroness, Lady Barker.