AIDS, Tuberculosis and Malaria

Lord Cashman Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Cashman (Lab)]

My Lords, I thank the noble Lord, Lord Fowler, for initiating this extremely important debate and, indeed, for his long and distinguished record on these very important issues.

The Global Fund is a 21st century partnership. It works because it combines Governments, civil society, the private sector and people affected by these diseases. The genuine nature of this partnership ensures that there is unquestionable success. We should be proud that the UK contributed £1 billion to the fund in December 2013. This contribution will save a life every three minutes.

HIV/AIDS, TB and malaria disproportionately affect certain groups known as key populations. Despite progress within general populations accessing antiretroviral drugs for HIV treatment, key populations are being left behind in terms of access. TB disproportionately affects those working or living in overcrowded conditions, such as prisoners and labour migrants, particularly mining communities in South Africa. Also at risk are people living with HIV. They are over 20 times more likely to develop TB, and one in five AIDS deaths is from TB alone. HIV poses an increased risk to groups including young women, men who have sex with men, transgender people, who are often forgotten, injecting drug users, those in prison, migrant or mobile workers and sex workers.

Recently, the excellent report of the All-Party Parliamentary Group on HIV and AIDS, Access Denied, published last week, highlighted as a key issue the lack of political prioritisation of key populations. Problems happen, particularly in so-called upper middle income countries, when global funders withdraw support and this happens before domestic Governments are able to pay market prices for antiretroviral drugs. So, will the Government encourage the Global Fund to reassess its decision to withdraw funding from key population groups in middle-income countries unless there is clear evidence of how funding for services and treatment will be provided to key populations? Will the Government pledge to work with the pharmaceutical industry and multilateral organisations to make newer and more effective ARV drugs available and affordable to all, including marginalised populations and people living in middle-income countries?

The sad reality is that HIV/AIDS, malaria and TB do not discriminate. HIV/AIDS is the leading cause of death among young women of reproductive age in Africa, and the region’s young women are twice as likely to contract HIV as their male peers. This is partly due to their unequal status, which constrains women’s ability to negotiate condom use. It is therefore vital to develop a range of HIV prevention tools that can be used by diverse populations, such as female-initiated microbicides. Will the Government continue their support for product development partnerships and other approaches that are developing products targeted at such groups as women in low-income countries?

As I said earlier, sex workers are also at great risk from an increased number of sexual partners, greater exposure to sexual violence and the economic incentive to offer unprotected sex. Will the Government pledge their support for promoting health services and harm reduction globally as the most effective approach for addressing HIV and other diseases among sex workers and drug-using populations?

Much has been said in earlier debates about men who have sex with men, but the sad truth is that they are 13 times more likely to be living with HIV than the general population. The current slide towards criminalisation in certain countries of people accessing HIV services does no good whatever. These include countries within the Commonwealth, such as Uganda, where a Bill is pending. Therefore, I would be interested to know what the Government are doing to promote—we have to promote this; we cannot impose it—a change of direction as regards homosexuality within these countries. Will they follow the recommendation of the report of the All-Party Parliamentary Group on HIV and AIDS to significantly increase the funding of advocacy groups within these countries that need the resources, such as the Robert Carr network or the Stop TB Partnership?

Finally, and probably most importantly, will the Government desist from trying to prevent the Global Fund working in so-called middle-income countries, where the poorest and marginalised are those most in need and where the Global Fund must continue to work if we are to eradicate malaria, TB and HIV? Make no mistake, the weight and influence of the UK on the Global Fund board is significant. Many middle-income countries are facing a perfect storm of bilateral donors and the Global Fund pulling out of funding very rapidly before national Governments have the time, support or money to replace essential HIV funding and programmes. I thank noble Lords and look forward to the noble Baroness’s response to my questions.