World AIDS Day

Lord Goldsmith of Richmond Park Excerpts

Thursday 1st December 2022 Lords Chamber

[Lord Fowler (CB)]

My Lords, is it not a tragedy that, although we now have all the means to eliminate AIDS, unlike at the time when I was a Minister, the annual figures still show 650,000 annual deaths worldwide, including, very significantly, over 200,000 deaths of women and, worst of all, 100,000 deaths of children? In the light of this continuing emergency, how can it be justified that the Government have cut back the resources they are devoting to fighting this disease, and will they now reconsider that policy?

[The Minister of State, Foreign, Commonwealth and Development Office (Lord Goldsmith of Richmond Park) (Con)]

My Lords, the UK is committed to working in partnership to deliver on the global AIDS strategy and end the epidemic of AIDS by the end of this decade. This is evidenced by our recent pledge of £1 billion to the Global Fund, which will help to provide antiretroviral therapy for 1.8 million people. The UK also provides substantial funding to the World Health Organization and UNAIDS and supports countries to strengthen their health systems. Together we are working towards ensuring that all can access the prevention and treatment services needed to make progress on HIV and AIDS.

[Lord Cashman (Lab)]

My Lords, I echo the words of the noble Lord, Lord Fowler. Some 38.4 million people globally were living with HIV in 2021 and, as we have seen with other pandemics, an infection in one country ultimately affects us all, so it is in our national interest that we increase funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Globally and nationally, we have seen incredible advances in tackling HIV. Central to those benefits is empowering individuals to test and take control and therefore live a healthy life with HIV positive status.

So I ask the Minister whether the Government will commit to widening the prescribing of PrEP beyond sexual health clinics to pharmacies, general practitioners, and community and maternity services? PrEP is part of the armoury that prevents transmission. We have the tools, but they are useless if they are not widely accessible.

[Lord Goldsmith of Richmond Park (Con)]

My Lords, the UK met the UNAIDS 95-95-95 targets for the first time two years ago in 2020, meaning that 95% of HIV positive individuals were diagnosed, 99% of those people who were diagnosed were receiving treatment and 97% of those receiving treatment were being virally suppressed. I very much note the suggestion by the noble Lord about increasing the availability of PrEP, and I shall convey that message to the health service.

[Lord Allan of Hallam (LD)]

My Lords, there are concerns that a fall in HIV testing levels during the pandemic may hamper the Government’s efforts to eliminate HIV transmission in England by 2030. Does the Minister share those concerns, and will the Government take extra measures to increase testing levels again?

[Lord Goldsmith of Richmond Park (Con)]

My Lords, I do not have specific figures in relation to the rate of testing during the pandemic. If they exist, I shall certainly make sure that they are made available. However, I can absolutely say that the UK remains completely committed to the global goal of achieving zero new HIV transmissions by 2030. As a nation, we have made big progress domestically, as I relayed in my previous answer, and internationally we remain one of the main funders and supporters of action to tackle HIV/AIDS.

[Baroness Falkner of Margravine (CB)]

My Lords, will the Minister take up the powerful point made by the noble Lord, Lord Cashman, that, in the domestic UK context, women are losing out on getting treatments, including PrEP? There is a very low take-up. Will he speak to his colleagues in the Department of Health about that?

[Lord Goldsmith of Richmond Park (Con)]

It is certainly the case globally that women with HIV have some of the highest maternal death rates, which is why our ending preventable deaths approach, which is a major focus of UK ODA, has a strong rights and equality focus and will remain a priority for the UK. In the domestic and UK context, I shall certainly convey that suggestion to the Department of Health.

[Lord Herbert of South Downs (Con)]

My Lords, I welcome the Government’s recent commitment of £1 billion to the Global Fund which, in the circumstances fiscally here in the UK, is a remarkable and generous donation and makes us one of the best contributors still in the world to that important fund. Of the 650,000 deaths from AIDS every year globally, to which my noble friend Lord Fowler referred, some one-third are from tuberculosis, which is the biggest single cause of death of people who have HIV. The co-infection of the two diseases remains a serious problem. Does my noble friend recognise the importance of tackling both major epidemics—tuberculosis and HIV—together? That commitment will continue to be important if we are to have some chance of beating these diseases—although there is no chance of beating TB by 2030—at least within the lifetime of a generation.

[Lord Goldsmith of Richmond Park (Con)]

I first thank the noble Lord for his comments about his contribution to the Global Fund. I agree with him—in the face of the budgetary pressures that we are facing, I was very relieved and pleased that we were able to make that commitment to the Global Fund, which is doing extraordinarily important work.

The noble Lord also makes an important point about TB. It is the case that until just a few years ago, the trajectory of TB was very much downwards. It was one of those historic illnesses that we had almost got to grips with, or certainly believed that we were getting to grips with. One problem is that we are seeing the weakening of the effectiveness of antibiotics. Currently, there is a limited supply of antibiotics and, if we continue to abuse them, as we are doing globally—well over half the world’s antibiotics are used just to keep animals alive in factory farm conditions in which they would not otherwise survive—that will be the height of irresponsibility. We will be wasting globally this treasure—because antibiotics are a miracle cure that our ancestors would have dreamed of—just to get our animals a bit fatter a bit quicker and to keep them alive in conditions in which we should not be keeping them in any case. So this is a priority—the UK is leading on this issue, and is doing extraordinarily important work on it—but I do not think that we can solve the problem that the noble Lord raised unless we get to grips with our abuse of antibiotics.

[Baroness Thornton (Lab)]

I think the Minister is allowing his other passions to slip into his answers—and well done to him for doing that. I commend the noble Lord, Lord Fowler, for his absolute consistency in championing this issue.

The role of UNAIDS is crucial for making progress in the global fight against HIV and AIDS, but it is now facing a severe shortfall in its operating budget. What steps will the Government take to support UNAIDS in building its capacity? Secondly, on the domestic front, the law really needs to keep up with the science, as has been referred to already. In recognition of this today, the Labour Party supports people with HIV having equal access to fertility treatments. Does the Minister agree that this is important? How can he help to take it forward?

[Lord Goldsmith of Richmond Park (Con)]

I echo the noble Baroness’s remarks in relation to the noble Lord, Lord Fowler, who has a long and distinguished record of championing this issue and is widely respected for having done so.

The noble Baroness asked about UNAIDS. Of course, the UK is completely committed to UNAIDS. We will continue to work to ensure that UNAIDS leads the implementation of the ambitious new global AIDS strategy for 2021 to 2026 at the UN high-level meeting on HIV in June last year. The UK was at the forefront of working to secure the highest level of commitment from our global partners so that the world has the best chance of meeting those 2030 goals to end AIDS.

On the domestic question, I am afraid that I am not qualified to answer it, but I instinctively agree with its premise and I shall make sure that the Department of Health has a look at that.

[The Lord Bishop of Gloucester]

My Lords, in sub-Saharan Africa, adolescent girls and young women are three times more likely to acquire HIV than adolescent boys and men. Can the Minister say what is being done to fund programmes which help to keep girls in education, which we know reduces their vulnerability to HIV by up to 50%?

[Lord Goldsmith of Richmond Park (Con)]

The right reverend Prelate is right. We continue to support stronger health systems around the world more broadly, because that in turn helps to end AIDS-related deaths and prevent new HIV infections. As was said earlier, women with HIV have the highest maternal death rates, which is why our ending preventable deaths approach remains a priority for the UK.

Education—particularly the education of women and girls—has for some years been a top priority, as enshrined in the integrated review and the international development strategy. It remains a priority and will remain one.

[Lord Patel (CB)]

My Lords, a key challenge for the UK in meeting the target of eliminating HIV transmission by 2030 is the elimination of undiagnosed cases which, of the total of 107,000 cases, are currently probably around 5,000. How do the Government intend to tackle that?

[Lord Goldsmith of Richmond Park (Con)]

My Lords, much of the work that we support is through the multilateral system—we were talking earlier about the Global Fund. Increasing diagnosis rates remains a key priority for not just the Global Fund but other multilateral organs. Through our support for those institutions, we are in turn supporting increased and escalated efforts to boost diagnosis rates.

[Baroness Masham of Ilton (CB)]

My Lords, will the Government give some new publicity to the importance of the prevention of HIV/AIDS? Some people think that it has gone away; we have heard clearly and loudly today that it has not gone away.

[Lord Goldsmith of Richmond Park (Con)]

It is certainly right that, here in the UK, we have seen remarkable progress, and people in the UK can take comfort from the figures that I cited right at the beginning of this exchange. But the same is not true internationally—as we heard from the noble Lord, Lord Fowler—where the numbers are really shocking, with 650,000 annual deaths. So prevention has to be, as it is with all preventable diseases, a key priority. I hope that my answer just two questions ago in relation to prevention of early deaths, particularly among women and girls, will have provided some reassurance to the noble Baroness.

[Baroness Brinton (LD)]

My Lords, I refer to the Minister’s response to the question from the noble Lord, Lord Cashman, about the availability of PrEP beyond sexual health clinics. It is really important that it is more universally available. My question is: are we helping other countries to access PrEP, particularly for the women and children in Africa whom the right reverend Prelate referred to earlier on?

[Lord Goldsmith of Richmond Park (Con)]

The wider availability of PrEP is an issue that I know the Government are working on. I do not belong to the relevant department, so I cannot provide authoritative figures, but the case is bullet-proof and I know that that view is shared by colleagues across government. But I will have to provide, via them, a more updated response to that, I am afraid.

In terms of the international rollout and availability of PrEP, I believe that that is something the Global Fund is also doing. The Global Fund is the main vehicle that we use and is therefore the main vehicle that we support. That is why our commitment to the £1 billion is so welcome. All that work is through those multilateral institutions.

[Lord Bruce of Bennachie (LD)]

My Lords, will the Minister remind the current Chancellor of the Exchequer that, as a newly elected MP and member of the International Development Committee, he led a campaign to ensure that the UK set annual targets, monitored them and delivered retrovirals across the developing world? Will he remind the Chancellor of the Exchequer of that commitment and suggest that he repeats it now?

[Lord Goldsmith of Richmond Park (Con)]

My right honourable friend the Chancellor has long been a champion of UK Aid. I very much hope that, as a consequence, in his current capacity he will be able to do more than that. I hope that he will be able to return us as quickly as possible, as soon as the fiscal situation allows, to 0.7%. With 0.5%, we are still one of the most generous countries in the world, but it also inhibits some of the areas where we showed real leadership in the years up to that decrease. I have every confidence that the Chancellor will wish to do everything he can in his current post to bolster our position of global leadership through our deployment of aid, and part of that of course is having rigorous targets and ensuring that we have value for money.

[Lord Paddick (LD)]

My Lords, is not one of the major issues around HIV the stigma attached to people who are HIV positive? It is not widely understood but, with effective treatment, viral load can be undetectable, and those people cannot transmit the virus to other people. What are the Government doing both in the UK and globally to reduce the stigma associated with HIV?

[Lord Goldsmith of Richmond Park (Con)]

The noble Lord makes an important point, and he too has been a vocal champion both in the domestic context and beyond. The UK itself as a country is a champion of human rights around the world, and we are committed to the principle of non-discrimination on any grounds, including on the basis of sexual orientation or gender identity—the issues that are often conflated with the issue that we are discussing today. The noble Lord is absolutely right to point to the stigma associated with HIV/AIDS and his point around the facts of the issue will have been recorded for posterity—the facts of the efficacy of current treatment and the removal of danger that that results in.