HIV: Women and Girls

Diane Abbott Excerpts

Tuesday 12th April 2016 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Let me first say what a pleasure it is to serve under your chairmanship, Ms Buck. When we first met 30 years ago, giving out leaflets on the streets of Paddington, who would have guessed that I would be my party’s spokesperson on development, but you would be a member of the august Panel of Chairs?

Let me congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing this important debate. Let me say a word about the position of women and girls in the UK and remind the House that the part of the population with the most disproportionate incidence of HIV/AIDS is African women. The reason they have that level of infection is because if people think the level of stigma in the population as a whole against HIV and AIDS is bad, for men who have sex with men in the African community it is so much worse. It is all about stigma, so anything we can do in this Chamber to break down that stigma will save lives not just in the global south, but in communities in some of our constituencies.

As we have heard, the number of women and girls living with HIV continues to increase in every region of the world. As a group of politicians, we should pause and think about what that means to people’s lives and hopes. This is not just abstraction and about position papers; it is actual people’s lives. Last year I was privileged to visit Uganda on a wonderful trip, organised by the Aids Alliance and Stop Aids, to meet the men and women working on Uganda’s HIV/AIDS response at Government level, at non-governmental organisation level and at grassroots level. It was an amazing trip.

I visited 10 different projects in all during my time in Uganda, but three stand out. One was a project involving the Lady Mermaid Bureau and Crested Crane Lighters. This was a project for female sex workers—actually, we could not consider those women victims. We went to the market where they plied their trade. They spoke to us about their fears, their experience of police harassment, their hopes, their efforts to get information and protection to younger sex workers, and their hopes for their children. This is the sort of grassroots project among a marginalised community that is so important to fund and support if we really are to roll back HIV/AIDS in those communities.

I also met the Uganda Youth Development Link, which is a genuinely young persons-led project—the chair was 28 years of age. It is a network of young people from 10 to 30 living with HIV/AIDS, and they pointed out that one of the problems with HIV response in the global south is that it does not reach young people: it is not reaching under-18s; the work is not being done in schools. In what are very young societies, if we are not focusing on under-18s or doing the work in schools, we are not doing what we need to do to reach the goal of eradicating HIV/AIDS.

I saw many projects in Uganda, and my trip brought it home to me that, in the end, it is not about what we say here in this House. It is not even about what the big NGOs and the UN can do. It is about communities and empowering people—particularly women and those in marginal communities—to offer leadership and to roll back this scourge.

We have made a great deal of progress on HIV/AIDS, but it is important that we do not roll back on that progress now that our goal of eradicating altogether is within sight. I hope the House will forgive me if I remind it of Labour’s record on this issue. We have continued to be a champion in the AIDS response, leading the first global promise to deliver universal access to HIV treatment, care and support by 2010 at the 2007 Gleneagles G8 summit.

The Government are to be applauded for their contribution to the Global Fund, which has disbursed $27 billion on programmes for HIV, TB and malaria, and programmes supported by the Global Fund had saved 17 million lives by the end of 2014. However, there is a concern about bilateral spending and the absence in the Government’s programmes and policy of a specific commitment on HIV/AIDS. Commendable as the Global Fund and the Government’s support for it are, bilateral aid for HIV continues to be important to meet the gaps that the Global Fund cannot fill and to equip affected communities—whether it is the young people or the brave and vibrant sex workers I met in Uganda—with the skills, tools and information they need to help the Global Fund to meet its goals.

Sadly, it would appear—I am content to be put right by the Minister—that UK bilateral funding for HIV has been decreasing, and many are concerned that it may come to a complete end. I would stress to the Minister that we cannot end aid dependency or stop thousands of lives being lost to AIDS month by month in regions of the world if we do not equip communities, including marginalised ones, with the tools to tackle and treat HIV/AIDS.

We need to build the capacity of communities to demand their rights. Ending AIDS by 2030 requires investment in communities and support to demand their rights, and the evolution of the Global Fund clearly demonstrates the value of such investments. There are still challenges in ensuring that key populations—for example, LGBT populations or sex workers—have a voice, but the Global Fund has developed strong human rights principles and places a value on the inclusion of those populations in governance structures. That evolution is driven by the affected communities, but it needs strategic bilateral funding.

As colleagues have said, the sustainable development goals have committed to ensuring that no one is left behind. The UK Government, in their new aid strategy, have committed to leading those efforts. Delivering on that promise, however, will require ensuring that those who are most marginalised, vulnerable and excluded can benefit from efforts to deliver the SDGs, including the goal on ending AIDS. The Global Fund cannot achieve that alone.

We have to consider the practicalities. I saw in Uganda last year that condom use—which is not a high-tech medical intervention, but a vital one—in the global south has gone down. There has been an increase in new infections, and under-18s are not yet a target group. Forty per cent of the Ugandan population are under 30 years of age. That very high proportion of young people is true across the global south, and one challenge faced by groups seeking to work on HIV/AIDS is the rise of vicious anti-human rights legislation on homosexuality and the LGBT population. In Uganda, we found that that was a major obstacle in the communities that needed to be reached.

I will mention one more group that I met in Uganda. Icebreakers Uganda is a youth-led LGBTI organisation that we visited in Kampala. Think what it means to be an LGBTI organisation in a country that has passed legislation that could end up with people losing their lives for admitting to being LGBTI. Despite the challenges, the organisation offers services in 14 districts in Uganda, runs a 24-hour service and has a house and centre for men who have sex with men. Due to the punitive legislation and criminalisation, the organisation has to be very careful about how it works, but it continues to work.

I commend the Government for their contribution to the Global Fund. It is unfortunate, as we have heard, that we have only promised 80%, not 100%, of what we should be providing. I stress the importance of making HIV/AIDS a specific goal and a specific issue in relation to women and girls. The Government cannot expect to be taken seriously in their concern for women and girls if the issue of HIV/AIDS is not only high up the agenda, but explicitly so in the speeches that are made, on the Department’s website and in the availability of funding.

--- Later in debate ---

[Mr Swayne]

I hope that I will be given the chance to get there, and that my statement today will be regarded as something of an explicit statement in lieu of what Members have not been able to find on the website, but that is a question we might come back to.

As I was saying, this has to be our main effort if we are going to have any prospect of getting to zero: to zero new cases, zero deaths and, as the hon. Member for Hackney North and Stoke Newington and my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) pointed out so importantly, to zero stigma and discrimination—a vital part of the equation.

How are we going to achieve that? I believe that the proper principle is to deploy our resources where the need is greatest, where the burden is greatest and where the resources are fewest. I have to reassure my hon. Friend the Member for Finchley and Golders Green in respect of his perfectly proper concern about middle-income status countries. The reality is that the Global Fund deploys half its resources in middle-income countries and specifically has programmes to deal with neglected, vulnerable populations in high middle-income countries. We have given £9 million to the Robert Carr fund specifically to address some of those issues.

I put it to hon. Members that as countries develop and become wealthier—I accept entirely that, as the hon. Member for Glasgow North (Patrick Grady) pointed out, there is a question of what defines a middle-income country, and there is a wide spread—there has to be an expectation and a challenge to them to start deploying more of their resources to deal with the problems of healthcare and AIDS in particular. It is very much part of the Addis agenda that countries deploy their own resources, and part of the challenge to us and to the Global Fund is to hold them to account for doing so.

My hon. Friend the Member for Finchley and Golders Green was right to challenge me on the issue of research and development. I do have concerns, but we are the leading investor in product development partnerships, which delink the market incentives for research and development and replace them with the prioritisation of public health objectives. Some 11 new products are now on the market in low-income countries as a consequence of the partnerships that we have developed. In addition, we have invested. We are the fifth largest funder of UNITAID and have put €60 million into its programme for developing diagnostics and treatments. Indeed, there is also its groundbreaking development in the treatment of paediatrics, with some 750,000 treatment regimes for children.

[Ms Abbott]

I agree with the Minister that as countries get wealthier, in principle they should take responsibility for their own HIV/AIDS programmes. However, when there are allegedly middle-income countries that are members of the Commonwealth but which, to all intents and purposes, are going backwards on LGBT rights, does Her Majesty’s Government not have a responsibility to intervene with the type of projects that would make it easier to access marginalised communities?

[Mr Swayne]

I accept entirely that there is a challenge to all the developed world and all right-thinking countries to hold those regimes to account for their treatment of human rights and respect for human rights. Nobody should be left behind—that is the principle that we have to abide by—and we must find programmes and measures to deal with that. I accept that the hon. Lady is right on this issue.

On the issue of research and development, we are alive to this problem, but let us consider it a work in progress. I accept entirely that there are still problems, but I am glad that the World Health Organisation is now implementing what it calls an observatory on research and development, and that a working group will be set up to drive the matter forward.

The issue of condoms was raised by the hon. Lady and by the hon. Member for Strangford (Jim Shannon). I am very much in favour of the distribution of high-quality male and female condoms. What is more, I want to see much wider distribution of the benefits of microbicides, which were raised by the hon. Member for Glasgow North with respect to the rings and gels that are being used and in which we have invested some £20 million. I believe that that is essential.

The hon. Member for Strangford raised a key point—I think his words were that AIDS is being used as “a weapon of war.” He is right about that, and I want to see reproductive and sexual health as a key part of our response to any humanitarian emergency.

Of course, I want to see a successful replenishment of the Global Fund. That is essential—[Interruption.] The hon. Member for Glasgow North is signalling that he wants a commitment to be made now, but I am going to have to disappoint hon. Members over a figure and commitment now. That has to be left to the Secretary of State and it can only be done once the bilateral aid review and the multilateral aid review have been published. However, I am impressed by the way in which the Global Fund has attempted to address our preoccupation with women and girls and to make its response to women and girls central to its strategy. We now want to see how that changes things on the ground, because women’s needs are highly complex and our response has to be correspondingly comprehensive.

My hon. Friend the Member for Finchley and Golders Green asked me on a number of occasions how we were going to address the needs of women and girls, and it is a response that goes well beyond what we can do specifically to address the issue of AIDS. It is a question of changing culture and of changing law. It is a question of changing the perception of human rights. It is a question of changing economic development and of giving women the power to protect themselves. It is about empowering women and giving them information and access to family planning services. It is about giving them an education and a livelihood. All these things will empower women to ensure that they are enabled to negotiate the terms under which sexual intercourse takes place. However, I tell my hon. Friend this: a world free of AIDS—one in which absolutely no one is left behind—is one in which the rights of a girl are promoted and protected from the minute she is born.