HIV/AIDS

Lord Crisp Excerpts

Thursday 5th March 2015 Grand Committee

[Lord Crisp (CB)]

My Lords, I, too, pay tribute to the noble Lord, Lord Fowler, for his leadership on this issue. It was needed right at the beginning of the epidemic, and he gave it, and it is needed again very strongly now and over the next few years. I am going to talk about the situation outside the UK. I have told the Minister that I am not expecting instant replies to the two questions I have, but I hope that they can be passed on to the Department for International Development.

This is, of course a global epidemic and it is in our interest to see that it is contained and managed globally as well as locally. As the noble Lords, Lord Fowler and Lord Cashman, both said, the UK is very influential in this regard. Globally, there has been amazing progress. The epidemic is coming under control in the sense that more people are going on to treatment than there are new infections each year. That is true even in South Africa, thanks to changes in the political leadership there. But it is still devastating and it will be for years to come, so there is much more to do.

In 2013, 35 million people were estimated to be living with HIV/AIDS, of whom less than half had been diagnosed; 13 million were in treatment; 2.3 million more received treatment; 2.1 million more became infected and 1.5 million died. This is an awful picture. In those countries that are particularly badly affected, HIV/AIDS affects everything about health and health services. In South Africa, there is 5% prevalence and there are huge costs to its health system. It will grow and be more costly over the next few years because the WHO has changed its guidelines about when to put people on treatment, and still many people are not yet receiving treatment. This is a big problem. Nevertheless, UNAIDS aims to see what it describes as the end of the epidemic by 2030. That will require increased funding until 2020, and it will decline thereafter.

There are economic issues as well. This is not just about human devastation, illness and death; it is also about the economy. Conservative estimates suggest that the gross national product of South Africa has decreased by at least 1% per year because of the illness of its people. I shall sum up this quick summary of the situation with the South African Government’s vision for 2030—in 15 years’ time—which reflects this reality. They aim to have life expectancy reaching 70 and a generation of under-20s largely free of HIV. That is a great vision from where they are, but it is also rather sad that is what we are talking about. This is a long march. It is a very long-term issue which needs, as I said, champions like the noble Lord, Lord Fowler, to keep the momentum up globally as well as nationally.

What are the key issues? The first is funding. The noble Lord, Lord Cashman, has already pulled out one extremely important point, which is that most people who are affected are now in middle-income countries, and the development agencies of the world, particularly DfID, do not give money to middle-income countries. Even the Global Fund, which is cash strapped, is having to prioritise the poorest countries. This is a wider issue about development because most poor people now live in middle-income countries. Therefore, we cannot think about this as being aid to poor countries; it is much more targeted.

The response of groups such as the International HIV/AIDS Alliance is to try to raise money locally. This is very difficult. I am proud to be the chair of Sightsavers, which works, for example, in India, where we can raise money because you can raise money for elderly people with cataracts or children going blind relatively easily in any society. It is much harder when you are talking about intravenous drug users or men who have sex with men. It is even harder in those countries than it is in our own country. That is the second big point about prejudice and discrimination against the groups that are most at risk. In purely health terms, this affects treatment and prevention and is very counterproductive economically and in health terms—but, of course, there are other profound ethical and human rights issues here that ought to be addressed.

The third issue that people who work in this area tell me about is the loss of priority that is coming to HIV/AIDS because, at the end of this year, we will move on from the millennium development goals to the sustainable development goals, which I support. Let me be very clear: I think that the sustainable development goals, which put an emphasis on the whole of the health system, are exactly what is needed for the future in low and middle-income countries, particularly in the light of things such as Ebola. I think the case is made by Ebola. However, it raises a very serious issue of transition from HIV/AIDS being central to international development to it not being in quite the same position, and how that transition will be managed. The All-Party Parliamentary Group on HIV/AIDS has just published an excellent report, Access Denied, which identifies these and other more detailed issues about problems in the supply chain, monitoring, pricing, R&D and so on.

What should Her Majesty’s Government do? There are many recommendations from that All-Party Parliamentary Group, but I shall draw out three. In asking questions, I want to congratulate the UK on its global leadership on this issue and, indeed, on development in global health generally. It is because DfID is so influential globally that the signals it gives on aid are fundamental. It is supporting the Global Fund. Indeed, it increased its support, and it needs to use its influence to make sure that there is continuing support from other countries. However, its recent decision to stop funding work on an AIDS vaccine is counterproductive. Will Her Majesty’s Government reassess the decision to stop funding an AIDS vaccine, as was proposed by the All-Party Parliamentary Group?

The second issue is that as the needs move to middle-income countries from low-income countries, the funding gap needs to be addressed. It is important not just that external parties such as DfID do something about this but that the countries themselves are encouraged to take up the slack. There were, after all, the Abuja agreements of 2003 and 2001, whereby every African Government committed themselves to spend 15% of their expenditure on health. Only six have yet hit that target. So there is a great challenge that should be put to the middle-income countries.

My second question is: what are Her Majesty’s Government doing to help facilitate continued access to funding for countries moving to middle-income status? That includes encouraging national Governments to play an increased part. My final point is not in the form of a question. The UK is also very influential on civil liberties, and it needs to argue the case about discrimination louder than it has. I know that that is difficult. I have spent a lot of time in Africa. I was recently in Uganda, where I came across a situation where Ugandan doctors were extremely annoyed—with the Americans, I am happy to say, rather than the Brits—because on the one hand Americans from various gay groups were arguing their case and on the other, Americans from various church groups were arguing their case. They said: “The last thing that we need is an American war on our territory”. They likened that to some other things that had happened earlier in their history.

It is difficult to intervene in any other country, but we need to take a stance as a nation about who we are as well as who our friends are and how we work with other people. There is a vital health case to be made here, because this is about health and the economy as well as people’s beliefs about society. The right to health is fundamental. It is also ultimately an economic case. Healthy populations can be productive and prosperous.

Finally, I support the call made by the noble Lord, Lord Fowler, at the end of his excellent book, where he says that there should be some sort of international convention based here in London—something that this Government or a Government formed after May should take up—on protecting the rights of people who are discriminated against in that way.