HIV and AIDS

Debate between Baroness Featherstone and Pamela Nash

Tuesday 10th December 2013 Westminster Hall

[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.

HIV (Developing Countries)

Debate between Baroness Featherstone and Pamela Nash

Wednesday 19th December 2012 Westminster Hall

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

Thank you, Mr Bayley, for calling me to speak. It is a pleasure to serve under your chairmanship this afternoon.

First, I thank the hon. Member for Mid Derbyshire (Pauline Latham) for calling a debate on such an important topic so soon after world AIDS day. I also thank hon. Members from all parties for their thoughtful and important contributions to this debate on what I still regard as one of the priorities for all of us in this day and age. I sometimes feel that, with the advent of drugs that mean people can live with AIDS rather than it being a death sentence, a complacency has begun that somehow the situation is not as bad as it was. With the tantalising prospect of zero infections and zero transmissions just out of reach, we know that success can be achieved, but if any of us let up on our commitment to tackling the disease it will not happen. We must translate our commitment in Westminster Hall today to those around the world who have the power to take the fight forward, and we must keep going in that regard.

As many Members have said, there is much to celebrate. The latest UNAIDS report shows an unprecedented pace of progress in the global AIDS response, with 700,000 fewer new HIV infections each year across the world than a decade ago, especially among newborn children. The work to eliminate HIV transmission from mother to child is clearly delivering results. More than 8 million people now have access to treatment and, for the first time, countries are investing more money in HIV than is received from global giving, which shows that we are moving forward to a sustainable response. That is really good news.

Many people, including me just now, have raised the possibility of seeing an end to transmission—zero infections—but so much is still to be done, and there are risks that could seriously jeopardise the incredible progress we have made. Too many people are still getting infected, with 2.5 million new infections last year. Women remain disproportionately affected, accounting for 58% of people living with HIV in Africa, and I will come on to specific points raised about that in a moment. Some 7 million people still do not receive the treatment they need, and in low and middle-income countries work to address HIV in key populations—sex workers, men who have sex with men, injecting drug users and prisoners—is still almost entirely funded by international sources, which is an inadequate human rights response and is not sustainable. I will come on to some of the issues relating to human rights and homosexuality.

The context in which we work is changing; the dynamics of the HIV epidemic are changing and the patterns of resources are shifting. We must continue to adapt our ways of working to overcome those challenges, and we need a global HIV response that is fit for purpose. DFID supports, therefore, the strategic investment approach, which allows countries to make decisions about how to allocate resources most effectively and efficiently on the basis of national evidence. I am pleased that through the approach DFID and other members of the HIV community are embedding the principles of effectiveness, efficiency and equity. The focus will help to drive more and better results and improve value for money.

The decisions taken at the recent board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria demonstrate that efforts are being made to find new and more efficient approaches. The new funding model should better align with country processes, reduce transaction costs, and make a greater impact with investments. DFID is closely following its implementation to ensure that it achieves those aims.

Many Members have mentioned the issue of the global fund. We have committed £1 billion between 2008 and 2015, and that time scale has not been delayed but rather brought forward by one year. Regarding increasing our funding, we have stated that future funding increases are contingent on the global fund’s progress with reforms. I hear the exasperated, “But hasn’t it done enough?” We have committed to reviewing our position paper, and we will have the multilateral aid review update, which is due in the first half of next year. That will provide us with the evidence, but the intention is to make the increase. The global fund has moved a long way from the days when there were issues in round 11 and we had to suspend payments to the fund. With the fund’s replenishment planned for September 2013, the UK is committed to working with others to ensure that reforms succeed and, as has been mentioned, to using our influence with other donors to draw in more overall financing to raise the final total.

One of the deepest ironies of the HIV epidemic is that the people most in need of prevention and services are from communities that are most neglected and discriminated against. A human rights approach is, therefore, essential, and through our bilateral aid review process DFID’s country offices have been updating their HIV programmes, based on the latest evidence and on national responses. In Zimbabwe and other parts of southern Africa, where there is evidence of growing epidemics in key populations, we are exploring how we can pilot innovative approaches to prevention with sex workers, adolescents and prisoners. We have also given new funding for the Robert Carr Civil Society Networks Fund to support global and regional networks to improve HIV responses for key populations.

We also recognise that addressing gender inequality and ensuring women’s rights is also essential to achieve universal access. The Prime Minister appointed me as international champion for tackling violence against women and girls across the world, and that issue is a key part of my agenda. Violence against women and girls is one of the most systematic and widespread human rights violations in the world, and it materially and significantly increases the risks of maternal death and vulnerability to HIV and AIDS.

The issue of sex education has been raised. I recently returned from Zambia, and I was shocked to find that no one talks about sex there. Not only is sex education not taught in school, sex is simply not spoken about. One of DFID’s programmes there is about girls’ empowerment, and I went to visit the girls and asked them which of their life lessons—that is almost what they are—they liked the most. They had had only three lessons so they did not have many to choose from, but it was heartbreaking that they said that what they most liked was finding out about their own bodies. They had absolutely no idea about the changes that were happening to them.

[Pamela Nash]

I want to reassure the Minister that I witnessed a similar DFID-funded programme in Rwanda that was much further forward than the three lessons. I witnessed young girls being fantastically confident in talking about their own health issues. They had much stronger and brighter futures as a result of the programme.

[Lynne Featherstone]

That is the key point: education is vital. The girls were saying that the boys were already very jealous because they were not allowed to go to the girls’ meetings. The initiative was empowering them to feel confidence in their bodies and about their rights over their bodies, and the boys were beginning to be a bit more wary of them. It is a long process, and negotiating such relationships, even in this country, is not always easy.

Having said that about boys, there is also a lot of work to do with boys and men. I went to a gender-based violence clinic—a one-stop shop—where remarkable work was being done with bringing the men along. Where there had been violence, the men had to come in for counselling. They were invited in, and if they did not come they were invited again, by the police. If they still did not come the police went and got them—quite extraordinary. Of the 10 survivor women I talked to, five said that they were still with their husbands, who had changed. One of the men had joined a men’s network. Men who have multiple partners are a real threat, where the spread of HIV is concerned.

Many Members raised issues about Uganda and the homosexuality Bill. I went to Uganda before I moved to DFID, in my violence against women role. Where women are oppressed, there are often hideous homosexuality laws. I raised the issue with the Speaker of the House in Uganda. I would not say that what I said was taken in the best way, but I raised the issue politely, but firmly. It is important to be able to discuss matters, even when people disagree. The discussion was private and appropriate. The issue is a really serious one, and it is not uncommon in many countries across Africa and Asia. I am looking closely at what is possible and at how we move forward on the agenda. One thing we do is to support civil society and Ugandan groups. I met with groups when I was in the country, and there is a lot of fear of a backlash, so how we move forward is a delicate matter.

Oral Answers to Questions

Debate between Baroness Featherstone and Pamela Nash

Thursday 27th January 2011 Commons Chamber

[The Minister for Equalities (Lynne Featherstone)]

Policy responsibility for human trafficking rests with the Minister for Immigration. Combating human trafficking, including the sexual exploitation of women and girls, is a key priority for the Government. We are committed to tackling organised crime groups who profit from this human misery, and to protecting victims. Tackling organised immigration crime, including trafficking, is a high priority for the Serious Organised Crime Agency, of which the UK Human Trafficking Centre is now part.

[Pamela Nash]

I thank the Minister for her answer, and I appreciate that this subject also falls under the category of immigration. Given that the European Union directive on trafficking would ensure that the UK provided further protection and support for victims, does she agree that we should enter into that commitment without further delay?

[Lynne Featherstone]

We have said all along that we would look at what was happening in the European directive. The wording was decided on the 13th, and the member states are now deciding whether to opt in or not. When that has happened, we will take a look, and if there are further things that we think would be helpful, we will make a decision then.