HIV and AIDS

Mark Durkan Excerpts

Tuesday 10th December 2013 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to serve under your chairmanship this morning, Mr Dobbin. Like others, I want to congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) for leading us in the debate and for the leadership she provides more generally in the House through the all-party group on HIV and AIDS. Like others, I want to pay particular tribute to her predecessor, David Cairns, for the positive and challenging work he undertook in the role.

The debate has thankfully given Members an opportunity to reflect on a number of points on international human rights day and to put AIDS in its important context—not only as a serious disease that confounded everybody when awareness of it emerged in the 1980s, but as an issue that challenges us at so many levels of policy and delivery. It challenges not only politicians, political systems, governmental processes and public services, but the private sector, and not least pharmaceutical companies and others. It is important, as we mark the progress made at a number of levels in understanding and getting to grips with the problem, that we acknowledge that a number of huge challenges are still present. Several Members have pointed out that we cannot let the significant progress that has confounded the worries and expectations of many years ago—there was almost a sense that it was impossible to counter the disease, and futile to try—lead to any sense of complacency. Progress will not move along on the wheels of inevitability. We should not assume that the momentum that is to be celebrated will be sufficient to take all else in its path; nor should we neglect the fact that some of the choices that can be made now and in the coming years could compromise some of that progress.

Rightly, the hon. Members for Stafford (Jeremy Lefroy) and for Airdrie and Shotts celebrated the signal importance of the global health fund. Sustaining that fund is hugely important. Yes, there are issues such as targeting to be ironed out, but the fund has had a signal impact. It has to be sustained, as does the commitment of all countries to it. We need to ensure, however, that the decisions about how it is managed and directed do not create perverse outcomes.

The hon. Member for Newcastle upon Tyne North (Catherine McKinnell) referred to the approach to, and emphasis placed on, the banding of countries by DFID and others. On one level, DFID’s categorisation of middle-income countries can be understood in terms of its rationale for prioritisation; but on another, it can condemn the many poor people in those countries to neglect, to their not getting the support they need. They are left facing higher prices than those faced by their counterparts in low-income countries, which is simply irrational. DFID has justified the rationale of prioritisation on the basis that the review would be all about buying results. We should not be in the business of buying a result that is bad for poor people in middle-income countries in the context of dealing with HIV/AIDS.

Many people have made the point that we should treat AIDS not just as a disease but as a human rights issue. That raises questions about not only health delivery and support, but other policies. The point was made that in many countries where there is a political difficulty in marshalling support for talking about HIV/AIDS, the criminal law on homosexuality is very regressive. As we talk to people in those countries—whether through the Commonwealth Parliamentary Association or the Inter-Parliamentary Union—we need address the AIDS question in the context of that debate, too.

I recall that when I visited Malawi a number of years ago, a politician—the then vice-president—was trying to talk about AIDS. He had broken a taboo, even by using the euphemism “the disease of the mattress”. He had to talk in very coded terms, but even that brought its own serious and adverse reaction. We have to support those who are trying to tackle the problem in those countries. We will not do that by saying, “Right, we have created enough momentum. That will look after itself.”

There has been progress on the patent pool, and I commend the leadership of companies such as Gilead and others. That poses a challenge to policy makers: how we make the most of those opportunities; how we encourage other companies to do more; how we encourage Gilead and others to make sure that more drugs go into the patent pool a lot earlier? As we deal with drugs that are needed for HIV/AIDS and other diseases such as TB and malaria, we also need to recognise that one of the major challenges is not only the supply of drugs but, in many of the developing countries, ensuring proper adherence. Systems are needed for that, but we also need to ensure that, as new and more specialised drugs capable of helping the young and the frail are targeted there, they are priced accordingly, so that there is no excuse for using anything else. However, we have made huge progress on this issue.

In 1985, I was on a staff exchange programme and worked for a number of months in Senator Teddy Kennedy’s office. The previous year, he had introduced and successfully passed in the Senate the first legislation that mentioned HIV/AIDS. However, even that had been a difficult and sensitive issue. It was time-limited legislation that provided research funding for one year. His challenge in 1985 was how to provide a second such piece of legislation. Even that was controversial. I remember sitting in meetings with him and his staff as they discussed how to frame a Bill that could also be subject to Senate hearings. The question was, how could they even conduct Senate hearings, because people did not want to talk about these issues? What would happen if there was discussion about prevention and condoms, for example? It was a highly sensitive issue. We have come a long way since that time.

Back then, Norman Fowler—now Lord Fowler—provided great leadership at Government level, and I was very pleased to see him presiding at events last week on world AIDS day, as he does so often. It is right that we recognise the quality of leadership that was shown here back then, but no less a quality of leadership is needed now as we face big issues and challenges. We need to address the questions that arise concerning the UN Special Assembly in 2016. There is the danger of complacency, and that mistakes might be made that will set back some of the work and progress that has been achieved. On world AIDS day, the Terrence Higgins Trust said that it is now providing advice and support to pensioners who are living with HIV/AIDS—something it never thought it would have to do. That is a mark of the progress that has been made. We need to celebrate that, but we also need to commit to ensuring that there will be no dropping back.