HIV and AIDS

Baroness Barker Excerpts

Monday 18th January 2016 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government what assessment they have made of the report of the All-Party Parliamentary Group on HIV and AIDS Access Denied.

[Baroness Barker (LD)]

My Lords, I thank noble Lords who are about to participate in this debate for their patience. Normally when one does that, it relates to a matter of minutes, but in this case noble Lords have had to wait seven weeks. We were originally due to discuss this matter at the beginning of December, but we were bumped—I believe that is the term—because of events in Syria. I will return to that at the end of my speech because there is an interesting point to be made.

However, there is an upside. It means that we waited over the Christmas and new year Recess and one of the more enjoyable things about new year is to open newspapers and discover what has been released under the 30-year rule. This year, it was fascinating to read about everything that the noble Lord, Lord Fowler, did 30 years ago when as Health Minister he had to walk in and explain to Mrs Thatcher why we should spend money to deal with this controversial disease that affected people whom we did not particularly like and so forth. Some of us have long suspected that he was something of a hero in the way that he persuaded one of the most formidable right-wing politicians in the world to do the right thing for public health. I want to look at this report today in that spirit.

The report was compiled by members of the All-Party Parliamentary Group on HIV and AIDS—some of us went to India and others went to South Africa—to look at this key question of access to HIV medicines. It is fair to say that there has been a tremendous success story in the world of HIV in the past 10 years or so. Because of international agreements by Governments and the pooling of resources, we have managed to curtail the impact of this deadly disease in an amazing way. In 2015, we reached a milestone of 15 million people on treatment compared with fewer than 1 million 10 years ago. It is estimated that nearly 16 million people are now accessing anti-retroviral treatments. HIV-related deaths have fallen to 1.2 million in 2014 from 3.2 million in 2005. Modelling—we have to model these things—suggests that nearly 74 million people have avoided acquiring HIV and 36 million HIV deaths were avoided between 1990 and 2013. That is an amazing global public health success. But across the globe, 60% of new infections are among young women, and HIV remains the leading killer of women of reproductive age. Noble Lords will appreciate that the report covers a number of large and in some cases very technical issues, and I will have to skate through just a few of them and hope that other noble Lords in the debate will follow me in.

The aim of the sustainable development goal is to end AIDS as a public health threat by 2030. To do that—to bend the curve of this epidemic—the bulk of progress has to take place over the next five years. If we do not manage to prevent young people, particularly women and girls across the developing world, from contracting the virus, infection rates will get ahead of us. The question for us, as a country that has led the international success to date, is: how will we manage to do that in times of austerity?

I want to highlight some of the things we need to do that emerge from this report. First, we must ensure continued access to affordable treatments. The success that has come about in the past 10 years has partly been due to the work of the Global Fund, but it is also because generic drugs are now widely available across the developing world. As noble Lords will know, the development of new drugs is a very risky business. That is why in highly developed countries it is a long and expensive process, although one of the most interesting things that came out of our evidence sessions is that there is no real relationship between the cost that drug companies attach to new drugs and the cost of producing them. They simply make a market decision about how much money they can make from new products.

However, those generic suppliers have managed to do wonderful things. They have managed to get the cost of the drugs to maintain a person in India for a year down from something like $2,000 per annum to $100 per annum. Those drug manufacturers told us that is now impossible to get those costs down even further. Some parts of the pharmaceutical world need more help. There is no great market for paediatric pharmaceuticals. Therefore, drug companies cannot put any more money into getting the costs of those drugs down. They look to Governments and international players for help in finding ways to make sure that they can keep the supply of those drugs coming.

The second thing is to focus on R&D. This Government have a proud record of making contributions to international research and development. Indeed, in the past few months there has been an announcement from George Osborne that there would be funding via the Ross fund for research into new diseases. It is not clear whether that funding will be in addition to existing HIV funding. Will the Minister commit to making a statement about the transparency of the different parts of funding that DfID and the Government are involved in? This is not a time to start robbing Peter to pay Paul. We have to be absolutely clear about the totals of funding and the projected outcomes.

The third thing that I want to focus on is the replenishment of the Global Fund. As a partnership between Governments, the voluntary sector and the private sector, the Global Fund has done truly remarkable work. One reason why it is so effective is that it focuses much of its work on women and girls. We know that the Government a few years ago led the way internationally by making a commitment of almost £1 billion into the Global Fund. The Global Fund replenishment is due shortly. Will the Government continue to give an international lead to funding that replenishment? It is so important and the most effective way in which to tackle this problem. We need to keep the pressure on other developed countries to continue with their funding and not to let it be dissipated.

I have a final question for the Minister. Middle-income countries have been de-prioritised in terms of UK Government direct aid. We understand the reasons for that. When we were researching the report in India, we heard lots of arguments about how India is now a successful economy that no longer needs to receive UK aid. But as noble Lords are aware, the poorest people on earth live in middle-income countries and the people most marginalised in those societies and most at risk fear greatly that their needs will be missed. I wonder whether the Minister will commit her Government to work with other international donors and funders to find new mechanisms to support those middle-income countries, as they transition away from direct aid from larger countries such as ourselves to a new order in which their own health systems and political systems are better equipped to deal with this ongoing issue. Finally, will the Minister explain to noble Lords where HIV will sit in the DfID strategy from 2016? It seems that it is being folded into a much broader remit on sexual and reproductive health, and there is some considerable concern out there that it is being deprioritised.

If we do not continue to fund public health initiatives such as this one around the world, desperate people will become the migrants that Europe has to help. Please can we maintain what to date has been a very successful track record and not be pushed away from that by the politics of the moment?