Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Thursday 12th December 2013 Lords Chamber

[Lord Fowler (Con)]

My Lords, I congratulate my noble friend Lord Chidgey on his speech and I look forward to the maiden speech which is to follow in a few minutes. I should perhaps declare a new interest. Last week I joined the board of the International AIDS Vaccine Initiative in New York. I agree entirely with what my noble friend has said in introducing this short debate, in particular about the value for money that the Global Fund represents and, of course, the contribution that it is making to the fight against TB. I will not repeat his arguments because I want to come to this issue from a slightly different position.

Over the past 18 months, I have been looking at HIV and AIDS in different cities around the world. What has struck me is that when I explain this in this country, I am met with the response, “You mean, it is still a problem?”. It depends on what you mean by a problem. Last year some 1,600,000 people worldwide died from AIDS, while 2.3 million were newly infected, and for every person who was put on to antiretroviral treatment, two were infected. Some 36 million people around the world live with HIV, including 100,000 in this country, accounting for a drugs budget in the region of £800 million.

It may be true that Africa has the biggest problem, but more than 2 million people live with HIV in India, while in Russia and Ukraine there are major problems of injecting drug users, home-made drugs and shared needles. Of those with HIV, up to a quarter are undiagnosed and, all other things being equal, continue to spread the virus. Even when people are on antiretroviral drugs, many do not adhere to the treatment, storing up all kinds of problems for the future. So, yes, not only is there a problem, but there is an acute and urgent challenge to every Government in the world. Thanks to the Global Fund and to the President’s fund in the United States, enormous progress has been made. The United States Government in particular should be given credit for what they have done—of course, I agree with my noble friend—as should the Government here, who have redeemed the pledge of my right honourable friend Andrew Mitchell to increase their Global Fund contribution. We should also recognise, however, that over the past few years the overall global contribution has remained stable in real terms; it has not increased.

In no way do I deny the progress that has been made because it has been formidable and dramatic in terms of the number of lives saved, but I would suggest that the lesson is that we must not give up now. We should recognise what that means: we are talking about a lifetime commitment to people living with HIV. It is not a condition where, after treating a patient for six months, you can move on to the next one. That is one reason why the world needs to put far more emphasis than it has on preventing new cases of HIV. As I mentioned, I have joined the board of IAVI and did it for this reason. A vaccine gives the best hope for the future: you cut through some of the prejudice that surrounds testing and, from the financial point of view, it opens up the hope of reducing an otherwise constantly increasing bill. That was why—if I may say so to my noble friend—I was surprised and dismayed a month or two ago, before I joined the board, that the Government slashed the help from a hardly princely £9 million or £10 million down to £1 million.

I accept that there is, at present, no cure and no vaccine—which is exactly what I said back in 1986. That means we have to do two things. First, we need to keep up our contributions to the Global Fund. It needs to be underlined that, in the vast majority of cases, that has been money well invested, resulting in tremendous advances and the saving of lives. Secondly, we need Governments globally to engage with the key minority populations where the risk of HIV is highest. It is absurd, unjust and counterproductive that homosexuality is criminalised in so many countries in the world. We also need to treat drug dependence as a medical issue, not just as part of a so-called and unsuccessful war on drugs, and to introduce more clean needle schemes, which we did in this country in 1987. We need to engage with people such as sex workers, where the rate of HIV remains very high, and not simply pursue a policy of looking the other way. We also need to fight discrimination against transsexuals, which often forces them into sex work.

We have made massive progress, much of which is down to the success of the Global Fund, to which I pay tribute. However, we should also recognise that there is still a hell of a long way to go.