HIV: Women and Girls

Helen Grant Excerpts

Tuesday 12th April 2016 Westminster Hall

[Mike Freer (Finchley and Golders Green) (Con)]

I beg to move,

That this House has considered tackling HIV in women and girls.

It is a pleasure to serve under your chairmanship, Ms Buck. I start by thanking my right hon. Friend the Prime Minister, the Secretary of State for International Development, my right hon. Friend the Member for Putney (Justine Greening), and her ministerial colleagues for their ongoing commitment to international development and the 0.7% spending target, despite the best efforts of the august Daily Mail and other media. It is good to see that our ministerial colleagues remain firm in their commitment to international development.

As chair of the all-party group on HIV and AIDS, I called for this debate to provide an opportunity to reflect on the progress made and the challenges ahead in the response to HIV and AIDS and, in particular, in ending the AIDS epidemic as part of the sustainable development goals. I want to use the debate as an opportunity to press my right hon. Friend the Minister on the Government’s commitment to the SDGs, which were adopted in September 2015 by UN member states to galvanise efforts to meet the needs of the world’s poorest by 2030.

The final framework outlined in the agreed text contains 17 goals and 169 targets—it is not a brief document. One of those targets is:

“By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”.

If the aim of ending AIDS as a public health threat by 2030 is to be achieved and if we are to bend the curve of the epidemic to manageable levels, the bulk of the progress must take place in the next five years. Without that, the epidemic could spiral out of control, and we can expect a spike in treatment resistance. Investment not made at this stage will lead to greater treatment costs at a later date. The joint United Nations programme on HIV—UNAIDS—agrees and has released fast-track targets. The 90-90-90 targets aim to ensure that by 2020, 90% of people living with HIV know their status, 90% of them are accessing treatment and 90% of those accessing treatment are virally suppressed. If we achieve that, the number of onward transmissions of HIV will be significantly reduced.

Meeting the targets is a stepping stone that will ultimately make it possible to end AIDS as a public health threat by 2030 and avoid an estimated 28 million HIV infections. The latest figures released by UNAIDS show that nearly 16 million people are now accessing antiretroviral therapy, or ARVs. That compares with the figure of 1 million 10 years ago. That is good progress. In 2014, there were 2 million new HIV infections, compared with 3.4 million in 2001. Those figures show that progress is being made, but they underline the need to do more.

[Mrs Helen Grant (Maidstone and The Weald) (Con)]

I congratulate my hon. Friend on securing this important debate. Does he agree that unfortunately, as a result of stigma, prejudice and discrimination, many people with HIV and AIDS are driven underground and therefore do not seek treatment? We must do all we can to deal with that injustice and prejudice.

[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.

--- Later in debate ---

[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.

[Mrs Helen Grant]

DFID has put a lot of money into the global fund—I am sure that my right hon. Friend the Minister will confirm the amount, but it is something like £1 billion—which has done some great work in tackling AIDS and HIV. Government support for that sort of multilateral aid is very important. Does my hon. Friend share my hope that, following the multilateral aid review, investment in funds such as the global fund will continue to be significant?

[Mike Freer]

My hon. Friend makes an important point. Our commitment to the global fund is outstanding—I believe we are its second-largest donor. My concern is that, because we are the second-largest donor, the global fund listens to the mood music from the UK Government. One issue that I have raised on many occasions is how our withdrawal of aid from middle-income countries, stopping much bilateral aid and moving through to multilateral aid, leaves many marginalised groups bereft. No transitional funding is put in place. We have started to see that kind of emphasis being reflected in the priorities of the global fund because it takes its lead from its major donors, which is understandable.

If the mood music coming from DFID is to deprioritise and, unintentionally, to leave marginal groups bereft, so the global fund will, perhaps by accident, also leave those marginal groups bereft, as it follows the UK lead in targeting non-MICs. I understand the strategy for MICs, but there is a significant risk that those groups that are most at risk in MICs are, through either cultural differences, stigma or criminalisation, left to fend for themselves. That cannot be a good outcome for the HIV/AIDS epidemic. I hope that my right hon. Friend the Minister will be able to address that.

It would be a catastrophic mistake to lose the focus on HIV/AIDS because we are on the brink of finally being able to control the epidemic as a public health threat. Will my right hon. Friend tell us how his Department is planning to meet the SDG target to end the AIDS epidemic by 2030, particularly for women and girls? What assessment has been made of the Department’s capacity to implement the target? The challenge of achieving universal access to ARV therapy remains ahead of us. As I mentioned earlier, something in the region of 20 million people living with HIV are not accessing treatment.

Last year the all-party group on HIV and AIDS conducted an inquiry into access to medicines that revealed some of the challenges that many low and middle-income countries face in accessing medicines. Treatment prices remain prohibitive in many countries. The price of treatments is primarily driven by licensing costs and decisions about what the market will sustain. Intellectual property rights grant exclusive rights to manufacturers that can make drugs without competition, which leads to high prices.

Affordable first-line treatments are now available in low-income countries in the form of generic drugs. That has been a major step forward in increasing access to treatments. However, the cost of second and third-line treatments remains prohibitively expensive, as such products are largely protected by patents, which keep the price high. Many middle-income countries are excluded from licensing deals that allow generic production, forcing them to purchase drugs at inflated prices. That restricts access to treatment. If a large proportion of people with HIV are women and girls, they will be excluded, because the health system will simply not be available or the treatments are too unaffordable to be universal.

International donors, including the UK, have been scaling back bilateral overseas development for MICs, thereby expecting national Governments to increase domestic funding. As I have mentioned several times, that leaves marginalised groups bereft of access to treatments, and some treatments will simply stop being provided.

--- 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.