AIDS, Tuberculosis and Malaria

Baroness Northover Excerpts

Thursday 11th December 2014 Lords Chamber

[The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)]

My Lords, I also thank my noble friend Lord Fowler for putting this issue once again on the Order Paper, for his passionate and informative introduction of it, and for his long campaigning history in this field. He makes the point that, although progress has been made, there is still much to do. I fully agree with that. I also congratulate him on the publication of his book AIDS: Don’t Die of Prejudice, as was noted by my noble friends Lord Lexden and Lord Avebury. The concerns he raises in that book and elsewhere—the noble Lord, Lord Cashman, and my noble friend Lord Lexden referred to this—about the discrimination and bigotry that surround this issue are, as noble Lords have indicated, of tragic significance.

Various noble Lords addressed the legal and societal barriers to human rights in this field. I can assure them that the Government are at the forefront of promoting human rights around the world. We regularly engage with Governments that violate these rights. We also support civil society groups that advocate for the relevant groups. I have just come from a meeting with Stonewall and the Kaleidoscope Trust. We explored how best to support voices in this area. I assure noble Lords that we will continue to engage in as effective a way as we possibly can.

Clearly, the level of prejudice is very striking. I saw that at first hand, when I visited South Africa recently. Representatives of the lesbian, gay, bisexual and trans -gender community told me of the difficulty they had, even in an environment where the law would seem to protect their rights, in accessing specialised services geared to their needs. I learnt also of the terrible plight of rape survivors in South Africa and southern Africa, about 30% of whom become infected with HIV, and who risk rejection from society. It is enormously challenging. AIDS, TB and malaria remain among the biggest causes of death and illness in developing countries. In 2013 alone HIV/AIDS killed 1.5 million people, malaria killed 584,000 people and TB killed 1.5 million people.

Progress has been made: new HIV infections are declining in many of the worst-affected countries; there has been a significant reduction in malaria incidence and deaths; and the world is on course to halve TB deaths by 2015, compared with 1990 levels. Clearly, the Global Fund has played a major part in this and that is why we are so strongly supportive of it. As my noble friend Lord Chidgey spelt out, since 2002, Global Fund-supported programmes have kept 7.3 million people alive with HIV therapy, distributed 450 million insecticide-treated nets, and detected and treated 12.3 million TB cases. These efforts to end the AIDS epidemic accelerated last year, with increases of 20% in the number of people being treated for HIV and malaria through Global Fund-supported programmes, and smaller increases in numbers being treated for TB. That is a truly remarkable achievement.

The UK has played, and continues to play, a critically important part in these successes. I can assure the noble Lord, Lord Collins, that we are very active in seeking others’ help; that is one of the reasons why we have used the help as we have, in order to lever the other assistance that needs to come in internationally. We worked with the Global Fund to develop a new funding model that prioritises investments in countries with low incomes and a high burden of disease—countries such as the Democratic Republic of Congo, where over 11% of all global malaria deaths take place. The model has increased allocations to these countries by 40%. It is worth noble Lords bearing that in mind, as we seek to tackle the high burden of very poor countries that the Global Fund has identified.

One year ago, the UK pledged up to £1 billion to the Global Fund for 2014-16, but our contribution does not end there. For example, last year the UK worked with the Global Fund and others to pool our procurement of insecticide-treated nets—the most effective intervention to prevent deaths from malaria—and used our market power to drive sustainable reductions in prices. Noble Lords rightly highlighted the challenge of cost here: that is saving $140 million over two years. The Global Fund is now rolling out similar approaches across a range of commodities. Savings will be used to enable the Global Fund to reach more people with life-saving interventions.

However, although these achievements are impressive —and I think they are worth noting, as noble Lords flag up what else needs to be done—clearly we are not complacent. Improvements are not uniform in all countries; we have heard that referred to in this debate. Resistance to effective medicines is indeed a growing threat and devastating rebounds can occur quickly if there is any let-up in prevention and treatment efforts.

One issue in particular that is concerning is the impact of the AIDS epidemic on women and girls. The noble Lord, Lord Cashman, referred to this. Every hour, 50 young women are newly infected by HIV. The infection rates are twice as high as in young men. The Global Fund, with UK support, has made a strong commitment to the health of women and girls, and we are very pleased that that is the case. It is increasing its own capacity and building capacity at country level to mainstream women’s and girls’ concerns into programme design. But the power dynamics within societies that underlie these problems will not be easily tackled, and we look to the Global Fund to redouble its efforts. Of course, programmes such as the use of microbicides are also relevant here, as the noble Lord, Lord Cashman, said.

There were a number of specific issues that noble Lords mentioned. The noble Lord, Lord Fowler, mentioned the AIDS conference in 2014. That happened to be held in the same week in July as the Girl Summit —which I hope the noble Lord was acutely aware of—and at which Malala spoke, among others, as I referred to yesterday. It was a stunning occasion and I was very glad to be able to be there. I was also happy to go to Australia; my noble friend will have to ask the previous Chief Whip about why I was not allowed to. Nevertheless, I was the beneficiary, therefore, of being able to attend the Girl Summit here, in Simon Hughes’s constituency. FCO colleagues from the high commission in Canberra attended the meeting in Australia on behalf of the United Kingdom. The noble Lord will know how committed we are in terms of the Global Fund and as far as tackling HIV, malaria and TB is concerned.

The noble Lords, Lord Cashman and Lord Chidgey, and my noble friend Lady Barker challenged us on lower-income countries. We support the Global Fund’s new funding model, which funds the most cost-effective interventions where the need is greatest, which is in the low-income, high-burden countries; but we do ask the fund to focus more heavily on key populations in the middle-income countries, where they are investing. I hear what noble Lords say; but it is also important that we all galvanise here, to ensure that Governments themselves—such as the Government of India, where the noble Baroness, Lady Barker, saw what she saw and I have seen it, too—step up to provide those services. They cannot simply be underpinned because we have the Global Fund; we must make sure that we are not neglecting the poorest in the poorest countries for the sake of those countries in which something more can, and must, be done.

The noble Lord, Lord Cashman, referred to harm reduction. Clearly, we are firmly committed to supporting harm reduction to reduce HIV transmission in injecting drug users. My noble friend Lord Fowler referred to that as well. The United Kingdom has indeed—no doubt, chivvied along by my noble friend Lord Fowler—led in this regard.

We are supporting market shaping, which I think we have spoken about before. The noble Lord, Lord Cashman, and my noble friends referred to ARVs. We are working with others to try to ensure that we have got reduction in prices, to get ARVs to as many people who need them as we possibly can.

My noble friend Lord Avebury and the noble Lord, Lord Collins, asked about bringing together TB and HIV. We are well aware of that as a co-infection and it is part of our ongoing work. In 2011, when we reviewed this, that was one of the issues we particularly focused on. As noble Lords will know, we are working through UNITAID, UNAIDS and also the Stop TB Partnership and are seeking further product development research and market shaping for TB vaccines as well as HIV drugs and diagnostic tools.

My noble friend Lord Avebury invited me to suggest what the Chancellor might do in the future—in the year, I think, beyond the general election—which is an interesting suggestion. I am afraid that I cannot foresee exactly what will happen in that general election, though perhaps he can. But he will know that the Department for International Development’s budget is ring-fenced until 2015-16, and therefore the commitment that he might have wanted to see in the Autumn Statement was already in place in terms of the funding for DfID.

I am extremely happy to meet Peers and CSOs in the way my noble friend Lady Barker suggested, and if the noble Lord, Lord Collins, wants to join, I am very happy to talk about that and our support for research. I hear what noble Lords are saying about drug-resistant diseases. I have a personal interest in this issue, in that one of my children is currently being treated in hospital for such a thing. It brings into focus exactly what Jim O’Neill is saying. Looking at this whole area will be exceedingly important.

The Global Fund has made a fantastic difference. We have been a major support of it in terms of tackling TB, malaria and HIV. We will continue in that way. We welcome people’s engagement in ensuring that we are focusing as we should. We listened carefully to what noble Lords are saying but they should not doubt our commitment in this area.