HIV: Women and Girls

Gareth Thomas Excerpts

Tuesday 12th April 2016 Westminster Hall

[Mike Freer]

My hon. Friend makes good points. We often think of stigma and prejudice as affecting poorer parts of the world and, unfortunately, many parts of the Commonwealth, but stigma remains an issue even in the UK. Even in the UK, people seeking treatment for HIV will often go to a sexual health clinic outside their local area because they are afraid of the stigma that can be attached to being seen as being HIV-positive. We have made significant progress, but a lot remains to be done in the UK and in particular the developing world. My hon. Friend makes an important point.

There are still around 20 million people living with HIV who are not accessing ARVs. Just half of those living with HIV are simply not aware of their status. I want to talk about some of the key issues facing the AIDS challenge and the HIV challenge. Since 2000, adolescent deaths have tripled. AIDS is the leading cause of death for adolescents in Africa and the second greatest cause of adolescent deaths globally. Some 60% of new HIV infections are among young women. Globally, HIV/AIDS remains the biggest killer for women of reproductive age. More than 5,000 young women and girls acquire HIV every week. In southern Africa, adolescent girls and young women acquire HIV seven years earlier than their male peers, which has a devastating impact on their life chances. HIV/AIDS is a major barrier to the ability of women and girls to participate in education and to become and remain economically active. If we want to achieve gender equality across education, health and economic participation, we have to tackle HIV/AIDS in women and girls.

We know what needs to be done to achieve the target to end the epidemic by 2030. We know that we need to challenge and end the stigma and discrimination faced by those living with HIV/AIDS. That stigma acts as a barrier to people being tested and accessing the services they need. We need to improve access to treatment for those who are diagnosed as having contracted the virus. With just 25% of girls having a full understanding of how HIV is transmitted and prevented, we need to improve education. We also need to tackle violence against women and girls. Adolescent girls and young women who have experienced sexual violence are 50% more likely to have acquired HIV.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I commend the hon. Gentleman on securing this debate and on his chairing of the all-party group. Given that the highest incidences of HIV and AIDS among women and girls tend to be in countries with strong historical links to Britain, does he accept that we have a particular responsibility to show international leadership on the issue? Would this not be a good time for the Minister to announce that the Secretary of State will, as a result, be attending the 2016 UN General Assembly high-level meeting on ending AIDS in June this year?

[Mike Freer]

The hon. Gentleman makes a strong point. It is still a shame on the Commonwealth that so many of our Commonwealth partners continue to discriminate against people with HIV and against lesbian, gay, bisexual and transgender people. Later, I will go on to mention some of the challenges with our withdrawal from many of the middle-income countries. It leaves many marginalised groups and many criminalised groups bereft of support, whether that is treatment or even just accessing healthcare in general.

On the Durban conference later this year, the hon. Gentleman will not have seen the answer to my written question that was published about 10 minutes ago, but the Department of Health will be sending ministerial colleagues to represent the UK and the Department for International Development is sending officials. The UK will be represented at the Durban conference—that is hot off the press.

Let me turn colleagues’ attention to some of the other issues. This is not just about the wide range of complexities, whether it is access to treatment, violence, education or economic participation; it is about how we approach research and development, both in dealing with HIV/AIDS and, in the developed world, in accessing the medical tools most needed to meet public health needs. The UK has an important role to play in meeting those ambitious objectives.

Historically, DFID has been a leader in the global response to HIV and AIDS and was viewed as one of the most forward thinking and effective agencies. When he responds, I am sure that my right hon. Friend the Minister will confirm how DFID’s research and development is progressing, so that we can ensure that our standing as a world leader in that field will remain. At one time, the Department had a large dedicated policy team engaged in the AIDS response. It showed financial leadership through increased funding of the Global Fund to Fight AIDS, Tuberculosis and Malaria, but I am concerned that its AIDS and reproductive health and rights team has gradually reduced in capacity and was renamed the sexual and reproductive health and rights team, with HIV being theoretically mainstreamed across DFID’s work.

There is increasingly a perception that DFID does not have the focus on HIV and AIDS that it once did. To be fair, every Minister I have spoken to in the DFID team, including the Secretary of State, has confirmed that HIV/AIDS remains a Government priority and an integral part of the Department’s work; yet the newly published UK aid strategy makes no reference to HIV or AIDS and gives no indication of how the UK intends to contribute to meeting the SDG target to end the AIDS epidemic by 2030. I checked the DFID website, and as far as I can see it appears to be silent on eradicating HIV as a departmental goal. It used to be a specific target and there used to be specific mention of what the Department was doing to eradicate HIV, but the website currently appears to be silent on that issue. Will my right hon. Friend the Minister explain why HIV has not been explicitly included and commit to putting that right?

[Mr Gareth Thomas]

When the hon. Gentleman researched the DFID website, was he able to find any speech by the Secretary of State or one of her ministerial colleagues on Britain’s contribution to HIV/AIDS that had not been provoked by a debate like this one, or by other House of Commons debates or questions?

[Mike Freer]

To be fair, I did not search through all the speeches given by colleagues in the Department. I did see that the most recent targets and policy statements ended in 2015, when the SDGs were agreed, and that some of the other policy documents dated back as far as 2013. To be fair to colleagues in the Department, I am sure that they have made speeches, but I did not search the database. I was searching the targets and policy pages. I am sure that my right hon. Friend the Minister will be able to direct me to what I have missed, but it appears that the website is currently silent on specific targets and policies.

Can my right hon. Friend the Minister reassure me that he will ensure that the HIV response is given a clearer and explicit inclusion in the strategies to meet the needs of women and girls in order to support gender equality, as well as all the other related issues? Addressing HIV is a key component of the women and girls agenda, and I hope he will confirm that it will be made a specific target and policy of the Department and will be clearly and explicitly mentioned on its website. The lack of a clearly articulated HIV strategy sends out a signal that HIV is being deprioritised and absorbed into other areas.

--- Later in debate ---

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship for the first time, Ms Buck, and to follow the hon. Member for Finchley and Golders Green (Mike Freer), who gave a measured and constructive speech. I will try to continue that tone.

This debate is a timely opportunity to ask whether the Secretary of State and her ministerial colleagues have, perhaps inadvertently, downgraded the Department’s work on HIV and AIDS. Ministers rarely mention HIV and AIDS unless pushed. There is—granted, my exploration of DFID’s website was only cursory—no record of a serious ministerial speech on this issue unprompted by Parliament for a very long time. There is no sign of a push to signal Britain’s continued interest in the major international efforts to tackle the factors that still drive the spread of HIV and AIDS. Given the urgency of the investment that is needed if we are to achieve the 90-90-90 targets, which the hon. Gentleman spoke about, it is disappointing that the Secretary of State does not appear—unless the Minister has news for us—to have a major plan to do the advocacy work that is needed at an international level.

The 10 countries that had the most people living with HIV in 2014—the last year for which figures are available—are South Africa, Nigeria, Zimbabwe, Mozambique, Uganda, Tanzania, Kenya, Zambia, Malawi and Ethiopia. They are all countries in which DFID has a significant bilateral programme or with which our Government have a long history and good connections. Britain’s continued influence with the countries that have the most people living with HIV is unlike that of any other country in the G7 or globally. It is therefore all the more important that Britain continues to show leadership on this issue.

Similarly, the slightly different list of the countries with the highest incidence of HIV among adults, as opposed to the general population, comprises countries with which Britain has a close relationship at Government level or, with one exception, where DFID has significant programmes. Again, that highlights the importance of Britain’s role in galvanising further investment in antiretroviral programmes and in championing the legal and cultural changes that are necessary to improve the response to HIV and AIDS.

The Department’s work focusing on girls and women is important and very welcome, and it is strongly supported on both sides of the House and among the non-governmental organisation community. I commend the Secretary of State for that work. However, I continue to be surprised by the apparent lack of interest in the impact on women and girls of being HIV positive. HIV and AIDS continue to be the biggest single killer of women of reproductive age globally. Despite that fact, the impact of HIV on women as a priority group is not frequently discussed or reflected in ministerial policy.

[Mrs Helen Grant]

The hon. Gentleman is making very important points about women and girls, but does he agree that they should be included as decision makers, not simply as victims and recipients of aid?

[Mr Thomas]

Absolutely. Britain’s international leadership on this issue is important because one of the things that we, as a country, should be championing is the cultural change that is needed in countries so that, as the hon. Lady says, women and girls become more active decision makers. At the moment, in too many cases, they are not. I gently bring her back to the important point she made about the strong support given by Britain to the global fund. I welcome that investment, but it is not enough to outsource leadership on HIV and AIDS from ministerial offices to the global fund. Political change is needed in countries as much as investment in health services, with which the fund helps. I fear that that is the important missing link in Britain’s response at the moment.

On 16 March, at International Development questions, I asked the Secretary of State specifically whether her Department’s spending on HIV and AIDS would be rising or falling over the comprehensive spending review period. In her reply, she said that the Department was planning shortly to publish the results of its bilateral aid review. Will the Minister set out for us whether he expects bilateral HIV-specific programmes to be rising, when up to now they have been in decline?

I am told by some of the NGOs that follow the Department’s work on HIV and AIDS closely that no mention of any such work seems to be in the aid strategy published by the Department last November. It would be good to hear from the Minister why that omission has happened. Furthermore, the sexual and reproductive health team, which has responsibility for HIV and AIDS work—certainly on the basis of ministerial answers to written questions—appears to be prioritising a series of other issues. They are very important issues, granted, but they are issues other than HIV and AIDS. Again, it would be good if the Minister explained that choice to downgrade the work on HIV and AIDS by the sexual and reproductive health team in DFID.

I come back to the first intervention that I made on the hon. Member for Finchley and Golders Green. He mentioned the Durban meeting, but I gently suggest that the UN General Assembly’s high-level meeting on ending AIDS, which is to take place in New York in June, is equally important. That is surely the perfect opportunity for the Secretary of State to set out Britain’s continuing commitment to and willingness to play a significant leadership role in tackling AIDS.

In addition, Britain could ask the new Commonwealth secretary-general to prioritise a discussion of the work needed in Commonwealth countries to tackle the HIV and AIDS epidemic. Foreign Office ambassadors and senior staff could perfectly reasonably be tasked to talk to senior figures about what more might be done in countries with particular challenges in tackling AIDS.

[Mrs Helen Grant]

I thank the hon. Gentleman for his generosity in giving way. At those various international meetings, global ministerial commitments to tackle issues such as forced marriage and early marriage are also key factors in fighting HIV and AIDS.

[Mr Thomas]

The hon. Lady is absolutely right. A series of factors drive the spread of HIV and AIDS. A health response is needed—we have rightly talked about the need to invest more in antiretroviral AIDS therapy and to improve health services more generally. A series of cultural practices need challenging and gender empowerment issues need addressing.

The only way that such things can happen is if political leaders are willing to step up to the mark. The challenge needs to come from a country such as Britain that has shown great leadership on the issue in the past; we will work with and support them, but we want things to change. I hope that the Minister will reassure me that the Secretary of State is willing to show that kind of leadership in future.