Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Tuesday 3rd December 2013 Lords Chamber

[Baroness Northover]

The noble Lord is right that a generation affected by HIV is growing up. He will also know that a lot of work has gone into trying to make sure that there is no mother-to-child transmission of the disease, and that is very important for these young people. The global fund is well aware that there is a young population whose needs it has to address.

[Lord Fowler (Con)]

I wonder whether my noble friend saw the BBC “Panorama” programme on the global fund last night, with the best tabloid title “Where’s Our Aid Money Gone?”. Over the past 18 months, I have been to more than a dozen countries looking at the HIV position. Is my noble friend aware that, without the help of the global fund and the President’s fund in the United States, the world would be in a desperate position, with escalating disease? Although there have been exceptions, overwhelmingly this money has been well spent and has resulted in millions of lives being saved. Would it not be nice if “Panorama” reported that?

[Baroness Northover]

My noble friend is absolutely right. Cambodia, for example, which was highlighted in the programme, has seen an 80% decline in malaria deaths, a 45% fall in TB and a 50% decline in HIV cases. I pay tribute to what my noble friend has done to highlight the challenge of HIV/AIDS and to his fight for the global fund, which has been transformative in this area.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Tuesday 4th June 2013 Lords Chamber

Asked By

[Lord Fowler]

To ask Her Majesty’s Government what action they are taking to support the global fund on HIV and AIDS, tuberculosis and malaria.

[Lord Fowler]

My Lords, this short debate is about the importance of the global fund. I saw the global fund at its beginning, when Richard Feachem was the director. Over the past decade it has developed into one of the chief means of combating HIV/AIDS, tuberculosis and malaria around the world. It has helped in the dramatic progress that has been made, particularly in the past five years, and that progress has been truly dramatic. In HIV, the number of people on anti-retroviral treatment worldwide has increased from 1.4 million in 2007 to 4.2 million today. In 2007, there were almost 3 million TB cases detected and treated; today the total is 9.7 million. In 2012, a cumulative 310 million nets were distributed, compared with only 46 million five years ago.

The result is that, with all three diseases, a record number of people are now receiving treatment. To give the example of HIV/AIDS, which I know best, well over half of the people in sub-Saharan Africa who need anti-retroviral treatment are now receiving it. Incidentally, that is probably a bigger proportion than for some countries now in eastern Europe—it just shows how the balances change—whereas for TB in sub-Saharan Africa, the figures for those being successfully treated are higher than for HIV.

Not all these improvements, it should be underlined, can be put down to the global fund. National Governments make a massive contribution themselves. I was in Cape Town a month or two ago and, to take South Africa as an example, it finances much of its own programmes. The years of neglect have been followed by an inspired effort by the South African Department of Health. The result is that, over the past five or six years, life expectation has already improved and increased by something like five years. Furthermore, we should never forget the massive contribution that the United States makes bilaterally through the President’s emergency fund—a fund started, incidentally, not by Bill Clinton but by George Bush, which will stand as a tribute and lasting memorial to him. If it was not for the United States, I think that the world would be in a terrible mess as regards these funds. So we can say, so far so good.

However, there is another way of looking at the figures. We can also look at the death toll from these diseases now, and we can look at the new infections that are taking place every day throughout the world, not just in Africa. The most recent figures show 2.7 million deaths from AIDS and TB-related causes, and 660,000 deaths from malaria and related causes. By any standard, that is a devastating loss of human life. Here we come to the crunch point. I pay tribute to the increases in financing that there have been, but if financing continues just at its present level, the prospect is that there will be many more new HIV infections and fewer TB patients receiving care. In other words, we risk going backwards. One reason for that is the growth taking place in the world population; another is the particular nature of HIV. For some diseases it is possible to give a course of treatment, for a patient to recover and for his place to be taken by a new patient; but HIV is not remotely like that. There is still no cure. It is a lifelong condition. Patients stay on that treatment and, other things being equal, the cost will rise as new cases come forward for treatment.

That is not to say that we should not seek further efficiencies in programmes. We should certainly do that. Incidentally, as far the global fund is concerned, in spite of some of the criticism that it has had, it actually has a very good record in this area. I remember seeing an example of that in Kiev in the Ukraine, where the global fund took the decision that the Government should hand over their responsibility in various aspects to an NGO, the HIV Alliance. The result was a dramatic reduction, an economy, in drug costs. The costs of the antiretroviral drugs which were being bought came down by something like 25 times.

We also need to persuade national Governments to increase their direct contributions to their own epidemics. It is certainly not enough for some countries to rely as heavily as they do on outside finance. Of course, when that happens it is fuel for those who argue—wrongly, in my view—that international aid should be cut back, but let us remember that this is not the easiest time to make that case and to ask Governments to add to their aid programmes. The fact is that however you look at it, it is very much in everyone's interests that the budget for the global fund is increased. The fund is a vital part of the world’s fight against three killer diseases. If we start to go backwards, that obviously affects the lives of millions of people around the world but, more, it also means that the epidemics continue to spread. That in its turn will mean even more money to combat them and bring them under control.

The global fund has estimated that over the next three-year period of 2014-16, it will need something like $15 billion—a substantial increase, certainly, on what is now being spent. However, if the result can be a decisive and irreversible improvement, that is a very considerable prize indeed for the world. No one seriously doubts the global fund’s figures; most significantly, they are not challenged by the United States, which is by far the biggest donor in the fund. That was confirmed to me last week when I was in Washington talking about these things.

What we in this country therefore now await is the British Government’s response. When I was Health Secretary, I harboured an ambition to make the United Kingdom a model of how a nation should respond, particularly, to HIV. We have made progress along that road but I think that no one would say today that it is a model. We spend, for example, far too little on prevention and on publicising not only the threat of HIV but the way in which it can be combated. However, we have maintained a good record in our contribution to the global fund. I hope that the Minister will now be able to put some more flesh on those bones. The US has set an example; we need also to set an example.

I have two last points. First, I very much hope that the global fund will continue to support the efforts to develop a vaccine for both HIV and TB. We have seen what a vaccine can achieve on polio and there are some encouraging signs, as in Thailand, that the prospect of developing a vaccine is not as far-fetched as some critics argue. The problem is that the development time for a vaccine is far in excess of the lifetime of any Government or three-year programme. It is nevertheless a goal which is most certainly worth pursuing. I say that in particular because of my second point. What stands in the way of so much progress in these areas is stigma and discrimination. A further effort is most certainly required there. Stigma infects gay and lesbian people, those with HIV and those with TB. It means that many people around the world are reluctant to come forward for testing. A vaccine would cut through all that. It is therefore, again, a goal which is worth pursuing.

If I may say so, tonight there has been a historic vote in this House. We have sent out a clear message that we in this country believe in equality of treatment for all. That was a massive message, which was underlined by the majority. I believe also that we are united, irrespective of which way we voted on that debate, on the criminalisation of homosexuality being abhorrent. I hope that that message goes out equally strongly, but I put it to the Minister that it would be even better if tonight she could set out the British Government’s plans to help the global fund fight one of the most important health battles that the world now faces. That is a historic battle and this country could make an important and valuable contribution to it.

--- Later in debate ---

[Lord Fowler]

My Lords, I thank the Minister very much for what she has said. I particularly thank everyone who has taken part in the debate. It has necessarily been a short debate, but the speakers have brought in virtually all the areas of the global fund: AIDS, tuberculosis and malaria. In addition, the point has been made very strongly about the stigma that attaches to a number of these areas and which stands in the way of testing and is therefore totally counter- productive.

I thank the Minister for her reply. I think I will need to look at it with a little more care. She went very rapidly at one stage when I thought she was getting to the point of pledging herself to doubling the contribution, but I do not think that quite came. I thought she made the case entirely for doubling the contribution, so I was not sure why she did not go that final bit, but there we are. I live in optimism.

In all seriousness, the pledge has been made a number of times and it is getting just a wee bit dog-eared. I do think it is rather important that if the Government want to set an example, get some credit for what they are doing and have some influence, they should make a firm pledge and make it stick. However, I thank the noble Baroness for her reply and I thank everyone who has taken part.

DfID: Tied Aid

Lord Fowler Excerpts

Monday 11th March 2013 Lords Chamber

[Baroness Northover]

The Afghan Government chose to gain their legal advice in the way that I indicated. Consultancies are subject to open competition, so the noble Lord can be reassured in that regard.

[Lord Fowler]

I agree with what my noble friend set out as her department’s general policy. I have a specific question about the statement by the former Secretary of State that new money, extra money, would be going to the global fund for HIV and other diseases. Will that pledge be kept?

[Baroness Northover]

I am going to have to write to my noble friend to clarify that. I know that the Global Fund had some problems, with which he will be extremely familiar. I also know that DfID was working extremely closely with the Global Fund, because it had been so effective in the past, to bring it back to that position. I have not had the most recent update. I will make sure that he gets it.

Treatment of Homosexual Men and Women in the Developing World

Lord Fowler Excerpts

Thursday 25th October 2012 Lords Chamber

[Lord Fowler]

My Lords, I strongly agree with everything that the right reverend Prelate the Bishop of Leicester has said and applaud the lead that he has just given. It was an exceptionally strong speech and one that deserves to be well heard around the country.

The trouble with this House is that you wait for weeks for a debate that you want to take part in and two come along on the same day. My noble friend spoke with great force and I congratulate him on two counts: first, on the debate itself, which is of crucial importance around the world; and, secondly, on choosing a subject that I and the noble Lord, Lord Black of Brentwood, can agree on after our slight difference of emphasis on the media.

The extent of discrimination against homosexual men and women is not really remotely in dispute. The figures speak for themselves, and many of them have been given already: 175 million people are living under conditions where they are at the risk of persecution on account of their sexual orientation, and 76 countries criminalise consensual, adult, same-sex relations, among them 42 of the 54 countries of the Commonwealth.

I want to concentrate for one moment on some of the consequences that that discrimination can have. As perhaps one or two Members of the House know, I seek to work and help in the HIV/AIDS area and will just remind the House of the position there. Some politicians talk, optimistically, about a cure, but the fact is that almost 2 million people a year die from AIDS. For every person put on treatment, two new people are infected. Hundreds of thousands of people do not get the treatment they need, or come to it too late for it to be fully effective

Consider what effect discrimination can have in that context. If there is the threat of criminal sanction, people do not come forward for testing, let alone for treatment. The result is that HIV spreads. Health providers are obviously less likely to offer their services if they can be accused of aiding a crime. The laws are often used by the police to prohibit HIV prevention activity. That is a disastrous position. I must add that it is by no means restricted to developing countries. The Culture Select Committee in the other place said that it thought that homophobia in football was a bigger problem than racism.

The worst problem in Europe is in Russia, where the treatment of gay and lesbian people can be discriminatory and severe, and where Madonna, no less, is being prosecuted. Her offence is calling for tolerance towards sexual minorities. I remember being in another country and talking to the organiser of a group who was hoping for better treatment. I said, “You must be on radio and television a lot”. “Oh no”, he said, “I am not that brave”. He feared the ostracism that he would encounter.

I give just one further example. Earlier this year, I spent a week in Ukraine, considering the HIV situation. At a meeting with groups representing men who had sex with men, sex workers and drug users, I heard a long list of complaints about police harassment and corruption, backed up by the courts, which would invariably accept the police story. I must have looked a bit sceptical until a worker with the excellent international HIV/AIDS Alliance intervened to say, “I can confirm it all; I worked for the police for 12 years”. That is the nub of the position. In Ukraine, there is now the prospect of a new law which would prevent essential health education and information aimed explicitly at the homosexual community.

In brief, five o’clock on a Thursday evening in a short debate may not be exactly the best time to start this debate, but the public should be in no doubt of the importance of the subject that my noble friend has raised. They should be in no doubt that discrimination against gay and lesbian people around the world is not just a major problem, it is an affront to everything that most of us feel is decent. We should also recognise that, in some countries, far from advancing, the position is getting worse. We need to take action against that.

Global Fund: AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Wednesday 4th July 2012 Lords Chamber

Asked By

[Lord Fowler]

To ask Her Majesty’s Government what plans they have for helping the development of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

[Lord Fowler]

My Lords, first, I very much welcome the number of speakers who have put their names down for this short debate, which I think speaks volumes for the importance of making progress in this area.

I speak as an enthusiastic supporter of the Global Fund. I saw it in its early stages, when Richard Feachem was director, and I pay tribute to all the pioneering work that was done then. The fund has already done vast good. It has an enormous canvas: HIV/AIDS, tuberculosis and malaria. Without exaggeration, it is one of the most ambitious health programmes that the world has ever seen. The lives of millions of people have been saved, but the bleak fact is that much, much more needs to be done. The challenge remains immense.

With HIV/AIDS, the world death toll is still 1.8 million a year, 30 or 40 years after the virus began its deadly sweep, first through sub-Saharan Africa and then through so much of the rest of the world. With TB, the latest figures show a death toll of 1.7 million, with the highest number of deaths in the Africa region. With malaria, there were an estimated 655,000 deaths in 2010, of which 91% were in Africa. Of course, these diseases do not fit into neat, separate boxes. Together, HIV and TB form a lethal combination, each speeding the other’s progress.

There is no question of the size of the death toll, but the added tragedy is that we are not being held back by a lack of knowledge of what needs to be done or what measures are necessary to save lives. When I was Health Secretary, dealing with HIV at the beginning of the crisis, there were no drugs to prolong life. I remember visiting a hospital in San Francisco, where there was a large ward full of young men simply dying from AIDS, with nurses being able to do absolutely nothing. Of course, the same was true here in London. Today is the exact 30th anniversary of the death of Terrence Higgins, the first person in the UK to be publicly identified as dying from AIDS, who has given his name to one of Europe’s most effective civil society organisations working in this field.

That was the 1980s, but today we have anti-retroviral drugs that are easy to take and able to ensure that a man or woman can live a long life. The means are there to tackle the disease, just as they are with TB and malaria. What is lacking in the world today are the resources that are necessary to take full advantage of the medical advances, and the political will to bring this about.

In its brief life, the Global Fund has done wonders. It has approved grants worth $22 billion for 150 countries. It has provided anti-retroviral therapy for an estimated 3 million people. It has detected and treated almost 8 million cases of TB between 2002 and today. It has enabled the treatment of 170 million cases of malaria. Of course, I acknowledge that there have been some problems in resources reaching the people for whom they were intended, although frankly these should not be exaggerated. When they have arisen, they have been tackled, and they continue to be tackled very effectively by the Global Fund and its excellent new general manager, Gabriel Jaramillo. The real characteristic is that money donated to the Global Fund has reached its target; that is not the problem.

The real problem lies with Governments. Some do not give anything at all and simply ignore the problem that is on their doorstep. I will give one example from the area I know best, HIV. One of the fastest growing epidemics in the world today is driven by injecting drugs. It is a problem in eastern Europe and many other countries. It is certainly fuelled by criminally imported drugs, but also by deadly home-made combinations. According to UNAIDS, only eight of every 100 people who inject drugs have regular access to sterile injecting equipment. Half the countries with epidemics centred on injecting drug users have no needle and syringe programmes at all. Yet all the evidence is that programmes such as clean needle exchanges work in reducing and almost eliminating infection. In Britain we started such a policy in 1986-87 and the result is that only 2% of new cases now come that way. I hope that the Minister will take the opportunity to underline the continuing support of the Government to this policy, given the comments that have been made outside this House.

That brings me on to a specific issue concerning the Global Fund. Ukraine, where I spent a week recently looking at the issues, has a massive problem of drug users injecting themselves. There are no government-run needle exchanges and no substitution programmes, but a great deal of discrimination and stigma. All prevention work is carried out by civil society organisations, notably the excellent International HIV/AIDS Alliance. It, in turn, is financed by the Global Fund. It has limits on its financial resources, so has decided to concentrate help on the poorest nations. We can see the reasoning behind that, but it means that help for poor, middle-income countries such as Ukraine will reduce and eventually be eliminated. The effect is to throw responsibility back on the Government of Ukraine, but frankly there is no sign whatever that they are ready to pick up the challenge and give that policy priority. We face the real prospect that the progress that has been made will be reversed.

That is the underlying fear in all three areas that we are debating tonight. Massive advances have been made by the Global Fund but the danger is that the potential to do more good and save more lives will be ignored as we walk on the other side of the road. In that respect, let me say this about the Government’s response. Like the previous Government, the coalition has been a firm supporter of the Global Fund. We are the third biggest contributor and no one can doubt the commitment of DfID and the Secretary of State, Andrew Mitchell—I would expect nothing less from the MP for Sutton Coldfield. However, the general position is not remotely as encouraging. We are going through the most difficult period in the fund’s history. At the end of last year it cancelled its 11th round of grant-making, which would have involved spending of $1.5 billion. It did that because of fears of inadequate funding. The result is that no new grants will be approved until 2014, although existing contracts will obviously be continued.

That position has caused dismay among civil society organisations. Again, it needs to be stressed just how much is done in all these areas by non-government organisations. They have filled a gap and without their work millions of lives would have been lost. In these circumstances what can this country do? The answer is that we should seek to take a lead to give an example that others might follow. The Secretary of State has made it clear that he is prepared to increase very substantially the Government’s contribution to the Global Fund for 2013 to 2015 by up to double—in other words, double the current amount of £384 million. That is a very significant promise that I wholeheartedly welcome. I urge that the occasion should now be found to make the pledge a firm commitment. By itself, the increased contribution will save lives but the hope must be that an announcement of that kind will unlock other funds from around the world. The Global Fund has already shown what it can achieve. The aim must now be to allow it to achieve its full potential.

Health and Social Care Bill: HIV/AIDS Programmes

Lord Fowler Excerpts

Wednesday 21st March 2012 Lords Chamber

[Baroness Northover]

I assure the noble Baroness that the current high level of care and commissioning will continue. The reason the Commissioning Board is taking responsibility nationally is that this is a costly disease to treat and its prevalence is varied around the country, so it makes sense if the board has overall responsibility for that. As the noble Baroness knows, public health has moved to the local authorities, which is why it is appropriate for prevention to be placed at that level. With regard to joining up care, as she knows, the health and well-being boards locally will do a great deal to ensure that they look at the needs of the population in that locality and that care is delivered appropriately in their local area.

[Lord Fowler]

My Lords, in preventing the spread of HIV, does my noble friend agree that the most important step taken in the process of the health Bill was the Government’s decision that free HIV treatment should be made available for everyone in this country? When I withdrew my amendment, it was on the understanding that the Government would introduce their own statutory instrument. When will that happen, and when does my noble friend expect the new system to be in operation?

[Baroness Northover]

I thank my noble friend Lord Fowler for all that he has done in this area, not least on this particular change, which we were very happy to announce we would be taking forward. The important thing here is the protection of our population. The House of Lords Select Committee had rightly flagged that if some overseas visitors who were not currently covered were left in that situation, there would be an increased risk to our population. I am extremely glad to say that we have extended treatment to cover that group so that we can look after our population. We are on course for the timetable that we laid out before, and this should be introduced in the autumn.

HIV and AIDS in the UK

Lord Fowler Excerpts

Thursday 1st December 2011 Lords Chamber

Moved By

[Lord Fowler]

That this House takes note of the report of the Select Committee on HIV and AIDS in the United Kingdom (HL Paper 188).

[Lord Fowler]

My Lords, I am grateful to the authorities for finding room for this debate on World AIDS Day. Perhaps I may first offer some thanks. I thank the committee, which was a mixture of old campaigners— I must be careful how I say that these days, but the noble Baroness, Lady Trumpington, is not here—and Members who were very much new to the area but who made a major contribution. I am delighted to see so many of the committee here, late on a Thursday afternoon, including my noble friend Lady Ritchie. I thank the clerks, Mark Davies and Matt Smith, for their invaluable work and tremendous effort. I also thank all those people who were witnesses, many of whom are the heroes of the struggle against HIV and AIDS—the clinicians, the Health Protection Agency, the department and voluntary organisations, without which, frankly, we would not be able to manage in this country.

It is 25 years almost to the week that we had our first debate on HIV and AIDS in Parliament. It was on Friday 21 November 1986. Reading that debate, I see that, as Health Secretary, I had the support of Michael Meacher for Labour and of Archy Kirkwood for the Liberal Democrats. I even had the support of Bill Cash—I have not often been able to say that in my political career. All the parties combined to make it an entirely non-partisan debate, and so it has remained—as, too, have many of the issues raised in it; public education, treatment and research are still the issues today.

However, there is of course one enormous difference between now and then. At that stage, AIDS was a death sentence. We had neither drugs nor vaccines. In the hospital wards, we found young men dying as doctors and nurses looked on helplessly. That was why we took the decision then to mount a very high-profile public education campaign using television, radio and press, while sending leaflets to every household in the country. If we wanted the public to know of the dangers, it was the only course open to us.

Of course, not everyone at that time agreed. They said that it would offend the public—there was little evidence afterwards that it had done that—and that the Government should stand well clear of such a controversial and, to them, distasteful error. My view and that of my colleagues on the special Cabinet committee that we had set up under the brilliant chairmanship of Willie Whitelaw was that that was not the case. Disease was disease, suffering was suffering, and we had a moral and human obligation to treat sexual disease just like any other and, above all, to try to prevent its spread.

The aim of our Select Committee has been to examine the progress that has been made in the 25 years that have intervened. The greatest change in every meaning of that word is the availability of effective drugs. Antiretroviral drugs have transformed the life expectancy of those with HIV. Provided that people are treated early, there is no reason why they cannot live long lives. In this country we are fortunate that such drugs are freely available, a position that even today after more than 25 million deaths worldwide is still not the case in many parts of the world. In Britain the drugs are there and the death toll has been drastically reduced. Perhaps that is why one of the most common questions that I get asked today is, “Is it still a problem?”. The answer is an unequivocal yes. It is not only a problem, it is a growing problem. The evidence that the Select Committee received on this was utterly clear. Today almost 100,000 people in this country are living with HIV, the number of HIV patients has trebled in the past 10 years, a quarter of those with HIV do not know that they are infected and continue to spread the disease, and although we have drugs to prolong life there is still no cure and no vaccine.

This point should be emphasised; those with HIV, despite the drugs, face a lifetime of treatment and, even worse, the threat of discrimination in jobs and normal social life. The stigma has not been removed. It is not consequence free. A few months ago I received a letter from a man who had just been diagnosed with HIV. He said: “Last year I was diagnosed with the disease and it almost drove me to suicide. I would not want someone else to go through the pain I have. I am now seeing a psychiatrist and talking through how to deal with the disease”. More happily he went on to say that he had now started the medication and his viral level was almost undetectable. That gives some indication of the kind of pressure and suffering that can be caused, even today, to those with HIV.

The real tragedy is that HIV is entirely preventable. Thanks to medical advance, very few babies in this country are now born with the condition. It is not like asthma or epilepsy. To be blunt, we have seen in the past decade a failure in our efforts to reduce the spread. One reason for that failure is clear enough; as a nation we spend more than £750 million a year on drugs to treat HIV, and in contrast the Government spend a miserable £2.9 million trying to prevent it. That is the failure of the policy and the direct and unavoidable challenge to this Government.

The basis of our report is that priority should be given to preventing HIV and AIDS in the United Kingdom. So far, the effort has been wholly inadequate over the past decade and a new priority must now be given to prevention policies if the epidemic is to be stemmed. Our belief is that HIV and AIDS remain one of the most serious public health issues confronting the Government at the start of the 21st century.

In principle I am encouraged by the Government’s proposals to set up a new public health body with a ring-fenced budget; it is an excellent idea, although we will obviously have to ensure that the detail of the proposal lives up to the promise. However, I say to them that it is essential that much greater priority is given to prevention in areas such as HIV. At the moment we have a health system that is financed to treat the casualties but is simply not resourced to prevent those casualties coming about. Before Ministers say that this is simply a plea for money, let me remind them what can be saved by successful prevention policy. It is estimated that a lifetime’s treatment costs between £280,000 and £360,000 for every patient. If we can prevent just 1,000 new infections, we are talking about savings of around £300 million. That is good news for the NHS budget, and it is exceptional news for the people spared a lifetime of treatment.

In entirely practical terms, I refer Ministers to paragraph 229 of our report, where we challenge the local procurement policies at present being pursued inside the health service and propose that antiretroviral drugs should be purchased on a national scale using the purchasing clout of the health service. The Government should reconsider their position and, in so doing, they would do well to read the debate in this House last Thursday, particularly the speech of the noble Lord, Lord Sugar, who made exactly that point about purchasing generally.

Of course, not everything costs vast amounts of new money. One of the undoubted reasons why HIV is spreading is that too many people are not tested; a quarter of the 100,000 with HIV do not know that that is their condition. That is obviously bad for the people who do not test, because the longer it goes on undiagnosed the worse the outcome for the individual. It is certainly bad for the country, because every undiagnosed person represents a public health hazard. It is a sure way of spreading the virus.

We have a series of proposals, but I shall pick out only three. Home testing kits are already available on the internet, but it is a trade that is unregulated and unchecked. The committee took the view that home testing was a sensible extension of testing generally, provided that such tests were accurate and under a licensing system. I am glad that the Government agree with that and I congratulate them on accepting it.

The second proposal concerns general practitioner testing. We should involve general practitioners much more and certainly ensure that people who sign up with GPs for the first time are tested. That point was made this week also by the Health Protection Agency, which points out that of the 680 people with HIV who died in 2010, two-thirds were diagnosed late.

The third area concerns prisons. I am less sure, to be frank, what the Government’s attitude is here, having read their response. We know that the incidence of HIV in prisons is above the average. It would seem almost an automatic step for prisoners to be tested for their own sake so that treatment can be given, and certainly for the health of other prisoners. I will welcome the Minister’s guidance on this. Overall, the aim of policy should be that HIV testing should be a normal part of medical care.

Let me return to 1986 and make a comparison between one feature that has improved markedly and another that has not improved to anything like the same extent. The good news comes from drugs. It was not entirely unanimous inside the Thatcher Government that we should introduce clean needle exchanges for injecting drug users. I could put it more strongly than that. There were fears that it might be seen as condoning criminality and that drug crime would rise. Nevertheless, we went ahead and the result has been consistently successful. Only about 2 per cent of HIV cases in the United Kingdom come from injecting drugs and we have received no evidence from the police that it has led to any increase in criminality.

I add this; we were set up certainly to look at HIV/AIDS in the United Kingdom, but we cannot ignore what is happening in the rest of the world—not only in sub-Saharan Africa but in countries such as Russia and Ukraine. There the HIV epidemic is driven by injecting drug users and is at an alarming level. In Russia, more than one-third of drug users are living with HIV; in Ukraine the position is even worse. Conceivably, our experience here might be of help. Can the Minister say what efforts we are making to make our experience available overseas?

The part of our experience that is less encouraging is that the stigma and discrimination that surround HIV testing have not remotely disappeared. We were told of examples in employment and even of graffiti being daubed on homes and people being forced to move away. I do not say that this is general but I do say that it occurs too often. Noble Lords will know, of course, the teaching of the Christian Church—and, indeed, of every other religion—of love thy neighbour. In that context, it is interesting to look at the Ipsos MORI poll carried out in 2010 for the National AIDS Trust. Respondents were asked whether they agreed with the statement, “If I found my neighbour was HIV positive it would not damage my relationship with them”. Thirty-three per cent strongly agreed with that, while 30 per cent tended to agree, but 23 per cent either disagreed or strongly disagreed. That position had actually got worse since 2007.

The stigma surrounding HIV is one further reason why the whole issue should be tackled early, and we should take relationship education seriously and not be dictated to by the bigots who say that it is all a plot to force explicit sex education down the throats of four year-olds. People who campaign on that sort of falsehood should hang their heads in shame.

It is interesting to see from the same survey that young people in particular are interested in hearing more about the reality of HIV and that many confess to ignorance in this area. In 1986, the campaign was “AIDS: Don't Die of Ignorance”. Of course, the challenge today is different, but no one can dispute that there is a challenge or that ignorance of HIV remains an issue. Frankly, I do not agree with the Government that no new campaign in this area is worth while. There is a real danger that we drift into worse problems by our complacency. Of course, I understand the restraints on spending. It may come as a surprise to the Front Bench that in Margaret Thatcher’s Government we also had restraints on public spending. What we did not have was a budget of £120 billion. Prevention, either against HIV or in any other area, is not one of the most costly programmes for the health service. We need a new prevention initiative. That is good financial investment for the health service, but above all it is a good human investment in that it can avoid so much avoidable suffering and distress.

--- Later in debate ---

[Lord Fowler]

My Lords, it has been an excellent debate and I thank everyone for taking part in it. I repair one omission and give thanks to our special adviser, Anne Johnson, who was absolutely first class in her advice.

I said at the beginning that we had the first debate on HIV/AIDS 25 years ago this month in the Commons, and today’s debate was very much in that tradition, with outstanding contributions. There was general agreement on the serious increase in HIV, the central importance of early testing and the importance of combating the stigma.

I thank the two Front-Benchers—the Minister and her shadow—for their contributions. On the Minister’s reply, to use the famous words of the noble Lord, Lord May, there were quite a lot of reviews in what she was saying, but I agree with her that a ring-fenced budget is infinitely preferable to one that can be raided and which we have had in the past. I am encouraged by what she says about charges for people from overseas and on home testing. I am not quite so encouraged by what she says about prisons, which we will have to revisit. As for what she says about a general campaign in getting this message over, I will say only that, as I count it, the noble Baroness, Lady Massey, called for one, as did the noble Baroness, Lady Gould, with all her experience, and as did the noble Baroness, Lady Tonge. The noble Lord, Lord Gardiner, agreed that there should be one, as did the noble Baronesses, Lady Masham and Lady Healy. For what it is worth, I think that there should be one as well, so I think she might find herself in a slight minority in this House.

The right reverend Prelate the Bishop of Wakefield made a quite outstanding speech on the work of the Church of England, to which I pay tribute. I also pay tribute to Bob Runcie, who was archbishop at the time of the 1986 campaign. I agreed with everything he said about charging for HIV treatment.

The noble Lord, Lord Lexden, made an important speech and rightly reminded us of the importance of Northern Ireland and the challenge there. The noble Lord, Lord Rea, talked about HIV not being a death sentence any more but certainly being a lifetime of medication. The noble Lord, Lord May, in a masterclass on the background, history and origins of HIV, made an outstanding contribution. I hope he is right in his predictions on the development of a vaccine. Above all, I think his message was that there is no reason to take the foot off the pedal at this point, which I hope that the Minister heard very clearly.

The noble Lord, Lord Gardiner, made a crucial point in passing about purchasing policy on drug costs. The noble Lord, Lord Black, underlined the vast importance of involving general practitioners in the work, which, as his example showed only too well, has not always been the case.

There will be future opportunities for talking about these things. If I could put in a commercial for the right reverend Prelate and the noble Lord, Lord May, we have an amendment down on testing for overseas visitors and we might conceivably put the Minister under rather more pressure than she was under this afternoon. I thank her and indeed everyone for an important debate on World Aids Day. I hope that we can renew our efforts to combat HIV, which seems to be the message that has come through from the whole debate.

Motion agreed.

Gaza

Lord Fowler Excerpts

Monday 13th December 2010 Lords Chamber

Asked By

[Lord Fowler]

To ask Her Majesty’s Government what action they are taking to alleviate the hardships suffered by people living in Gaza.

[Baroness Verma]

The UK has provided £27 million to the UN Relief and Works Agency this year, of which 30 per cent has been spent in Gaza to deliver essential services to the 70 per cent of Gazans who are refugees. We are also providing £2 million to support the Gazan private sector and funding UN and Palestinian Authority teams working to facilitate access for imports to Gaza. We continue to call on Israel to improve access to Gaza for aid and reconstruction materials.

[Lord Fowler]

My Lords, I thank my noble friend for that reply. As she will know, last month I made a visit to Gaza, the details of which are declared in the register of interests. Is it not part of the tragedy of Gaza that, although some goods are now going in more freely, severe restrictions remain on the import of construction materials that are necessary to build and rebuild homes and schools? While no one disputes the security problem, do not the Government agree that there is a danger that such a policy of restriction, which harms thousands of entirely innocent people, will help to recruit a new generation of extremists?

[Baroness Verma]

My Lords, I understand the noble Lord’s concerns. We recognise that ordinary Gazans are suffering—indeed, the deterioration of Gaza’s institutions and infrastructure is described by the UN as “de-development”. We continue to call on Israel to implement its 20 June announcement by allowing full exports and movement of people. Ministers have put that to Israel during their recent visits to the region and we are working with our EU partners to agree practical steps to improve access. That is having results, as Israel has agreed to limited exports from early next year. However, it is important that that translates into reality on the ground.

Public Bodies: Reform

Lord Fowler Excerpts

Thursday 14th October 2010 Lords Chamber

[Lord Fowler]

My Lords, I support the general policy put forward by my noble friend, but I want to ask about broadcasting policy, which is dealt with in this paper. What duties are being removed from Ofcom as proposed in the paper? In particular, why has the opportunity not been taken to abolish the unnecessary BBC Trust, which has few friends inside or outside the BBC, and certainly qualifies for inclusion? Why are we not bringing private investment into BBC Worldwide, which must be to the benefit of that company and was even supported by the previous Government?

[Lord Taylor of Holbeach]

The noble Lord makes some useful suggestions for the ongoing process of the review and I am grateful to him for them. They are not covered within the existing programme of change, but the Government intend to continue to test all government bodies against their standards. I note my noble friend’s comments and I am sure that I can take them back.