AIDS, Tuberculosis and Malaria

Lord Cashman Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Cashman (Lab)]

My Lords, I thank the noble Lord, Lord Fowler, for initiating this extremely important debate and, indeed, for his long and distinguished record on these very important issues.

The Global Fund is a 21st century partnership. It works because it combines Governments, civil society, the private sector and people affected by these diseases. The genuine nature of this partnership ensures that there is unquestionable success. We should be proud that the UK contributed £1 billion to the fund in December 2013. This contribution will save a life every three minutes.

HIV/AIDS, TB and malaria disproportionately affect certain groups known as key populations. Despite progress within general populations accessing antiretroviral drugs for HIV treatment, key populations are being left behind in terms of access. TB disproportionately affects those working or living in overcrowded conditions, such as prisoners and labour migrants, particularly mining communities in South Africa. Also at risk are people living with HIV. They are over 20 times more likely to develop TB, and one in five AIDS deaths is from TB alone. HIV poses an increased risk to groups including young women, men who have sex with men, transgender people, who are often forgotten, injecting drug users, those in prison, migrant or mobile workers and sex workers.

Recently, the excellent report of the All-Party Parliamentary Group on HIV and AIDS, Access Denied, published last week, highlighted as a key issue the lack of political prioritisation of key populations. Problems happen, particularly in so-called upper middle income countries, when global funders withdraw support and this happens before domestic Governments are able to pay market prices for antiretroviral drugs. So, will the Government encourage the Global Fund to reassess its decision to withdraw funding from key population groups in middle-income countries unless there is clear evidence of how funding for services and treatment will be provided to key populations? Will the Government pledge to work with the pharmaceutical industry and multilateral organisations to make newer and more effective ARV drugs available and affordable to all, including marginalised populations and people living in middle-income countries?

The sad reality is that HIV/AIDS, malaria and TB do not discriminate. HIV/AIDS is the leading cause of death among young women of reproductive age in Africa, and the region’s young women are twice as likely to contract HIV as their male peers. This is partly due to their unequal status, which constrains women’s ability to negotiate condom use. It is therefore vital to develop a range of HIV prevention tools that can be used by diverse populations, such as female-initiated microbicides. Will the Government continue their support for product development partnerships and other approaches that are developing products targeted at such groups as women in low-income countries?

As I said earlier, sex workers are also at great risk from an increased number of sexual partners, greater exposure to sexual violence and the economic incentive to offer unprotected sex. Will the Government pledge their support for promoting health services and harm reduction globally as the most effective approach for addressing HIV and other diseases among sex workers and drug-using populations?

Much has been said in earlier debates about men who have sex with men, but the sad truth is that they are 13 times more likely to be living with HIV than the general population. The current slide towards criminalisation in certain countries of people accessing HIV services does no good whatever. These include countries within the Commonwealth, such as Uganda, where a Bill is pending. Therefore, I would be interested to know what the Government are doing to promote—we have to promote this; we cannot impose it—a change of direction as regards homosexuality within these countries. Will they follow the recommendation of the report of the All-Party Parliamentary Group on HIV and AIDS to significantly increase the funding of advocacy groups within these countries that need the resources, such as the Robert Carr network or the Stop TB Partnership?

Finally, and probably most importantly, will the Government desist from trying to prevent the Global Fund working in so-called middle-income countries, where the poorest and marginalised are those most in need and where the Global Fund must continue to work if we are to eradicate malaria, TB and HIV? Make no mistake, the weight and influence of the UK on the Global Fund board is significant. Many middle-income countries are facing a perfect storm of bilateral donors and the Global Fund pulling out of funding very rapidly before national Governments have the time, support or money to replace essential HIV funding and programmes. I thank noble Lords and look forward to the noble Baroness’s response to my questions.

Global Development Goals

Lord Cashman Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Cashman (Lab)]

My Lords, I too thank my noble friend Lord McConnell for this debate, and for the enormous dedication that he has given over the years to this important subject. I would like to bring to the debate my experience as a former member of the Development Committee of the European Parliament, as the European Parliament’s rapporteur on the mid-term review of the MDGs, and as the leader of the delegation to the UN on the post-2015 MDGs.

I shall start by going away from my text and saying that if we bring forward the achievable and the attainable, we shall leave behind the majority of those who look to us to ensure that no one is left behind. Arguably, the MDGs have raised awareness of ending global poverty as an urgent challenge and a priority for global action. Assessments of the progress made in attaining the current MDGs show that, in the new post-2015 framework, a strong linkage between poverty eradication, fighting inequalities—all of them—and the promotion of sustainable development, as well as a single and universal set of goals with differentiated approaches, are crucial.

Poverty reduction is uneven and inequalities exist within countries, let alone between countries. This represents a major challenge, especially with the dubious concept of labelling countries “middle income” according to their GDP rather than real poverty, gender and inequality indexes. Access to early childhood development, education and training of the highest attainable quality for every child, young person and adult is an essential prerequisite for breaking cycles of intergenerational poverty and inequality. Yet sadly, as has been said, little progress has been made regarding gender equality and the empowerment of women. Globally, women and girls constitute a majority of those living in extreme poverty. Gender equality and women’s rights are necessary conditions for the success of the post-2015 global development framework. It is staggering—indeed, shameful—that every day an estimated 800 women in the world die due solely to complications during pregnancy or childbirth.

Ownership of all the millennium development goals and the post-2015 development goals is essential. The EU and its member states, such as our own country, are the largest donors of development aid and should remain the driving force during the next phase of the negotiations under the UN, promoting in particular the human rights-based approach, based on equality, non-discrimination, participation and inclusion in the design and implementation of the post-2015 framework. A human rights-based approach is the only way forward. That is why I welcome the inclusion of the promotion of a human rights-based and people-centred approach among the SDGs proposed by the UN open working group, reinforcing the principles of the universality, indivisibility and interdependence of all human rights of all people, without discrimination on any grounds, starting with the fundamental right to dignity of all human beings, with particular attention paid to: the human rights of women and girls, including the promotion of universal access to sexual and reproductive health and rights; the protection of and respect for the rights of migrants and minorities, including LGBTI people and people living with HIV; and the importance of respecting and promoting the rights of disabled people.

Now is not the time to fail. That is why, sadly, I have to express real concern about the approach and attitude taken by the Government in advance of the UN September summit both at EU level and in New York. We have achieved much before because the EU took a single approach after long and timely discussions. That is not happening now. I am reliably informed—although I hope the Minister will inform me that I am reliably misinformed—that the Government’s intention is to reduce the number of goals proposed by the open working group, and to cluster them. That would not be helpful.

The UK Government are also not happy with the universality of the framework, which means that it would apply—this is extremely important—to all states and that targets would be fixed for every single state, including the United Kingdom. I cannot see the problem with such an approach: that which we demand of others, we should demand of ourselves and for ourselves.

To have weight in the debate at the UN, where there will be much opposition, it is important that the EU speaks with one voice on the issue. The United Kingdom Government are preventing that at the moment as they bypass the EU representatives in the negotiations in New York. It is one thing to complement influence, quite another to undermine it. I look forward to the detailed response of the Minister on these issues.

The draft conclusions are to be adopted imminently. They are very ambitious, especially when it comes to human rights and fighting inequalities. These conclusions need our support. However, I am again reliably informed that there are suggestions that the UK Government want to remove references to fighting inequalities. Sadly, I must end on this note: it is regrettable that on 25 November Conservative Members of the European Parliament voted against such an approach as I have outlined in a plenary session of the European Parliament in Strasbourg. I hope, indeed, that this is not a foretaste of what is to come.

India

Lord Cashman Excerpts

Wednesday 26th November 2014 Grand Committee

[Lord Cashman (Lab)]

My Lords, speaking on this subject gives me no satisfaction whatever because it is a subject that should have been left in the shadows of the history of the 19th century but which we are dealing with only now, in the 21st century.

As the noble and right reverend Lord, Lord Harries, said, this affects men, women and children every single minute of every single day. It is easy to run off the figure of 250 million people, but imagine half the population of the 28 member states of the European Union and then you have something approaching the magnitude of the issue with which we are dealing.

I spoke on this on many occasions in my 15 years in the European Parliament, not only on the petitions committee and the justice and home affairs committee but on the international development committee, and that is where we place that focus today. I will not refer to the cases to which the noble and right reverend Lord has referred. The most recent case is of the goat herder. In all these things, as I said in my maiden speech, we always have to use the power of the imagination: “What if that were me? What if that were my daughter, my mother, my father, my family? Would it be okay?”. If not, it cannot be right for another.

Let me refer to what others have said. The Indian National Campaign on Dalit Human Rights gives the following description of who the Dalits are in the context of caste system in south Asia:

“Historically, the caste system has formed the social and economic framework for the life of the people of India. In its essential form, this caste system involves the division of people into a hierarchy of unequal social groups where basic rights and duties are assigned based on birth”—

these are not my words—

“and are not subject to change. Dalits are ‘outcastes’ falling outside the traditional four classes … Dalits are typically considered low, impure and polluting”—

again, the issue of the goat herder demonstrates that forcefully—

“based on their birth and traditional occupation, thus they face multiple forms of discrimination, violence, and exclusion from the rest of society”.

The International Dalit Solidarity Network, with which I had the privilege and pleasure to work in the European Parliament, lists the following key issues affecting Dalits in the modern day. It is a sad list because it is not academic but a list of that which happens every single day. The list includes:

“Bonded labour in which a person is bonded by a loan advance taken against their work, resulting in a loss of control over labour conditions and terms of work … Violence and inhuman treatment, such as sexual assault, rape, and naked parading, against Dalit women serving as a social mechanism to maintain their subordinate position in society … The forced prostitution of Dalit girls. Originally a sacred, religious practice, the dedication of girls to temples has turned into a systematic sexual abuse of young Dalit girls serving as prostitutes for dominant caste community members and subsequent auctioning into brothels … Discrimination against Dalits in the educational system”—

an education system should be a mechanism to lift people up out of poverty, persecution and discrimination, but within that education system we see,

“segregation … in class rooms and harassment by teachers”.

Then there is manual scavenging—and yes, I will go into what that means. It is,

“a term used to describe the job of removing human excrement from dry toilets and sewers using basic tools such as thin boards, buckets and baskets, lined with sacking, carried on the head, which is a caste-based and hereditary occupation for Dalits”.

The list goes on to say that Dalits,

“are often limited from equal and meaningful political participation”,

but I am pleased to see that that is at last changing. Then, of course, there is the,

“non-implementation of constitutional and legislative measures to protect the rights of Dalits”.

It is interesting, as I approach the final canter of this six minutes, to look at what the International Development Committee in the other place proposed. It said:

“India has high levels of inequality—particular castes, tribes, and religious groups do less well than others because of entrenched discriminatory practices and despite laws against such behaviour”—

hence why we need cultural and educational change. They met groups of Dalits,

“including children, who were beginning to challenge social norms”,

but they are not hopeful that these changes will come during the lifetimes of these individuals. The committee encourages DfID to,

“place greater explicit emphasis on tackling inequalities throughout DFID’s programmes”.

That is what I ask the Government to report back on, if they can now. It is vitally important, as the noble and right reverend Lord said, that we deal with capacity building, reforming institutions and the accountability of the police. But at the end of all this, we also have to deal with the tricky notion of religion as an excuse or a reason. No religion can be an excuse or a reason imposed on another—or on 250 million—to diminish them and rob them of their civil liberties and human rights.