HIV: Women and Girls

Lisa Cameron Excerpts

Tuesday 12th April 2016 Westminster Hall

[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.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Gentleman for securing this extremely important debate. Does he agree that the issue is not only access to treatments but access to technology? During the Easter recess I was interested to read about portable methods for monitoring and assessing HIV. It is clear not only that joined-up thinking is needed across Departments—including Health and DFID—but that we should look at STEM subjects and our contribution to technological advances to ensure that people in rural communities have access to treatment through advances in technology.

[Mike Freer]

The hon. Lady makes an important point. I visited South Africa and saw some of the work being done by Médecins sans Frontières in the townships there. What was interesting was that, despite the poverty, virtually everyone had a mobile phone. Many of the treatments, including the prompts to adhere to ARVs and other information, could be provided by harnessing technology. There is a huge gap that can be tackled, particularly in remote communities. Through the use of mobiles and other forms of remote technology, we have an opportunity to get information to people in remote areas and ensure that they have access to education and, if necessary, some form of treatment. Access to technology is a major challenge that colleagues in the Department for International Development can perhaps look at through the Global Fund.

We need to look the cost of new drugs. I hope that DFID can take a lead in looking at how the current research and development model prohibits access and innovation. Let me give an example about paediatric treatment. In South Africa and elsewhere, there is an absence of paediatric antiretrovirals. In the clinics in many of the townships of South Africa, doctors and nurses have to crumble the tablets and, almost through guesstimates, come up with a dosage suitable for the child or baby because paediatric antiretrovirals are not financially viable for the drug companies. The existing models work against providing universal access to ARVs and containing and defeating the epidemic. I believe that DFID can take the lead in looking at a way of de-linking the cost of research and development from the demands of profitability.

A proposal is under discussion to create a global R and D fund that would operate through a combination of grants, milestone prizes and end-goal prizes. If it were based on an open innovation-type approach, it could reward all those who have taken part, entered the process and contributed to developing the new treatment. That idea is not pie in the sky; it has not been developed by those who seek to undermine the pharmaceutical industry. That kind of development is championed by none other than the Prime Minister. In fact, the Conservative party manifesto contained a pledge—my right hon. Friend the Minister looks puzzled—that this country will

“lead a major new global programme to accelerate the development of vaccines and drugs to eliminate the world’s deadliest infectious diseases”.

I challenge colleagues in DFID to take the lead in looking at different ways of funding R and D to reduce the cost of second and third-line antiretrovirals. The Government have been generous in maintaining the 0.7% funding and in the money allocated for the global fight against malaria and the Ross fund.

Tackling HIV and AIDS in women and girls is a task we cannot shirk. It cannot and must not be subsumed into the main work of the Department and mainstreamed. We need explicit targets and action that we can hold the Government and Ministers to account on. I thank colleagues for attending today, and I look forward to hearing my right hon. Friend the Minister’s response and other colleagues’ contributions.

--- Later in debate ---

[Dr Lisa Cameron]

In addition to a medical model, does my hon. Friend agree that it is extremely important that couples counselling is also offered to help in coming to terms with HIV diagnosis, reducing stigma and the risk of violence and desertion by a partner, and ensuring that adaptive coping strategies are applied?

[Patrick Grady]

That is a useful point. My hon. Friend brings considerable experience of those issues to the debate, so it is useful to have her contribution.

That brings us to funding and prioritisation. I generally echo all the questions directed at the Minister so far. On the prioritisation that DFID is prepared to give to the sustainable development goals, every credit is due to the Government for the role they played in the negotiation and establishment of those goals, which are a hugely comprehensive framework for global development. We now have a road map that can take us to the kind of world that we know is possible, which will allow us to reach other targets such as the 90-90-90 target, which has been referred to. However, I do not think I am alone, even in the Chamber, in being slightly disappointed by the lack of emphasis given to the sustainable development goals in the Command Paper, for example, or the lack so far of a joined-up Government approach or even of information about that. Indeed, my hon. Friend the Member for Lanark and Hamilton East raised questions about monitoring.

Other mechanisms also need to be considered. The Global Fund is due for replenishment, so it would be interesting to hear a timetable from the Minister for the Government’s commitment. They have said repeatedly that they are prepared to give up to £1 billion, so my question has repeatedly been: if they are prepared to give up to £1 billion, why not just give £1 billion? The Global Fund knows how much money it needs and the UK has an opportunity to show global leadership by committing as much as it can to that replenishment.

Finally, the point about middle-income countries is crucial. I spoke about Zambia earlier on, and the definition of a middle-income country stretches from a GDP per head of something like—I do not have the figure in front of me—$1,500 to $13,000. In that vast range, a country can suddenly become a middle-income country and find itself less able to access the resources and support that helped it to attain that status. It would be interesting to know how the Government intend to support countries as they transition to middle-income status to reduce the risk of back-sliding in so many areas, not least HIV/AIDS transmission.

HIV is a preventable and treatable disease and we have the knowledge and ability to reduce transmission and improve access to treatment, especially with regard to women and girls. If we do that, we boost development, help to build stable societies and grow economies. Everyone benefits, but we must have the political leadership and willingness to invest effectively.