HIV (Developing Countries)

Pamela Nash Excerpts

Wednesday 19th December 2012 Westminster Hall

[Pamela Nash (Airdrie and Shotts) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing this debate and on making a thoughtful opening speech that covered a number of topics that I, too, want to explore. I should also like to congratulate UK organisations, and the agencies that they support overseas, on their fight to combat the HIV/AIDS epidemic. They include the International HIV/AIDS Alliance, Save the Children, Oxfam, Christian Aid, and Voluntary Service Overseas; I could go on with the list for the rest of the afternoon. I shall concentrate first on VSO, as I was lucky enough to do volunteer work with it in Kenya during the last recess. It became clear to me that civil society plays a key role in Kenya when it comes to the response to HIV/AIDS.

I want to focus on three main points. The first is the issue of the rights of men who have sex with men. I very much appreciate the fact that the Minister, in her short time in office, has made it clear that she is committed to tackling this issue, and that appreciation goes right across the board. I am sure that she shares the grave concern felt by the hon. Member for Mid Derbyshire and me about the Anti-Homosexuality Bill that has appeared on the Order Paper in Uganda. The Bill had been promised as a Christmas present to the people of Uganda. Although its Parliament is now closed for the holidays, I am pretty sure that the Bill will be firmly back on the agenda in 2013.

One of the most shocking sections of the Bill states that any member of the Ugandan public can be obliged to tell the authorities about homosexual people that they know. Failure to do so could lead to prosecution. The Parliament, therefore, is not only outlawing practising homosexuality, but criminalising those who do not inform on homosexual friends, family members and colleagues. Criminalising a section of the population that is most at risk from HIV and denying them access to basic services not only undermines their human rights but poses a devastating threat to public health in a country where over 7% of the population lives with HIV.

Even those who are inherently against the practice of homosexuality must see that the legislation would pose a health risk, not just to the community, but to the entire population. This is a matter of human rights, and must be of interest to people across the world and to leaders in Africa. Will the Minister confirm whether she or other Government Ministers have raised this matter with African leaders, in the hope that they might raise it with both the Speaker of Uganda and President Museveni?

Following the recent announcement by the UK Government that they are withdrawing direct budget support from the Ugandan Government, I was concerned that the Department for International Development did not appear to offer a route back for the funding to be reinstated. None the less, I do support the reasons for the funding being withdrawn at this time. I worry, though, that there is little incentive for the Ugandan Government to address the corruption issues that led to that withdrawal of funds, and to engage with us and other countries on human rights abuses, such as those we are about to see if the Anti-Homosexuality Bill is passed.

Part of the reason why the Bill is back in the headlines is to distract people from the problems caused by corruption, and to keep out of the headlines the fact that the UK Government have withdrawn direct budget support from the Ugandan Government. Will the Minister confirm whether there is a possibility of Uganda again receiving direct budget support, and what obligations it will have to fulfil to achieve that?

Moreover, what support is our Government providing to organisations that are fighting for lesbian, gay, bisexual, transgender and intersex people in Uganda, such as Sexual Minorities Uganda, for which many of my colleagues on the all-party parliamentary group on HIV and AIDS have shown support? Finally, what provisions have been put in place to support the health needs of all people in Uganda following the suspension of direct budget support to the country?

My second point relates to access to HIV medicines. In my role as chair of the all-party parliamentary group, I have been honoured to meet many inspirational people who are living with and affected by the virus. One of them is Angelina Namiba, who I believe the Minister met in her constituency last week. Angelina has been brave enough to share her story in the national press this week, and I congratulate her on her courage in doing so. She has also participated in many events here in Parliament and has shared her story, allowing us further to understand what it is like to be a young woman living with HIV in the UK today.

Women such as Angelina live healthy, happy and productive lives because they are lucky enough to receive the treatment that they need. Sadly, 7 million people around the world are not receiving that treatment. The Minister may be aware that the majority of antiretroviral drugs are produced in India, which has been able to take advantage of the flexibilities in laws on the trade-related aspects of intellectual property rights set by the World Trade Organisation. Some 80% of the drugs used in Africa and purchased by multilateral organisations, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, come from India.

The United Nations Development Programme’s Global Commission on HIV and the Law recently highlighted the fact that many of those flexibilities are currently under threat from a series of trade agreements. Clauses relating to data exclusivity, which would require generic companies to redo clinical trials and would therefore significantly delay generic versions of medicines, have hopefully been dropped from the EU-India free trade agreement, but there are other treaties, including the EU-Thailand free trade agreement, that may contain equally harmful provisions. Has the Minister had any conversations with colleagues in the Department for Business, Innovation and Skills about the impact of such trade agreements on the availability and affordability of HIV medicines? Although price is not the only barrier to accessing HIV medicines, it is an important one.

When I was in Kenya with VSO in September, I witnessed the difficulty that people have in rural areas—they were very rural areas, as I know from my 10-hour trip there in the back of a car. People have to travel for many hours every week on poor roads to access clinics and the medication that they so desperately need. Poor health systems and infrastructure hinder people’s ability to access HIV treatment. Next year, the all-party parliamentary group will be looking in more detail at the barriers to accessing medication, and I look forward to working with colleagues and, hopefully, the Minister on that matter.

My final point is about the importance of the UK as a global leader in fighting HIV and AIDS. I am delighted that other Members have already raised that point today. The Department for International Development is the second largest bilateral donor on HIV, and has given tremendous political and financial support to the Global Fund to Fight AIDS, Tuberculosis and Malaria. I was delighted to hear, from the Secretary of State at the all-party parliamentary group’s world AIDS day event, that DFID is “absolutely committed” to getting to zero: zero infections, zero discrimination and zero deaths. A new strategy for HIV that maps out how to achieve that goal would illustrate DFID’s clear commitment to tackling HIV.

Last year, the Government focused on family planning, and I was pleased that a side event at this summit highlighted the links between HIV and sexual and reproductive health rights. We cannot tackle any major development issue, be it food security, hunger or violence against women, without also addressing HIV. Moreover, as we go into discussions about the post-2015 development agenda, we must not lose sight of the incredible challenges that lie ahead. As campaigners from the Stop AIDS Campaign asked parliamentarians just three weeks ago, why stop now? We cannot afford to ignore this disease, which still takes almost 2 million lives each year. An AIDS-free generation is within our grasp, but AIDS is certainly not over. We have the tools, the science and the knowledge to turn the tide on this epidemic. We just need to sustain the political will.

[Sir Tony Cunningham (Workington) (Lab)]

Thank you, Mr Bayley, for calling me to speak. It is a pleasure to take part in a debate under your chairmanship. I begin by thanking the hon. Member for Mid Derbyshire (Pauline Latham) for securing this vital debate, and I pay tribute to the work that she does on the issue.

As I was reminded when I met campaigners from Why Stop Now? on world AIDS day recently, impressive progress has been made in the fight against HIV/AIDS, but as other speakers have already said, there is still much more work to be done. Millennium development goal 6, which is to combat HIV/AIDS, malaria and other diseases, galvanised international attention to the fight against HIV, and created political momentum that has played a substantial role in the success of the HIV response.

Since 2005, 25 countries have seen a 50% drop in new HIV infections. In 2011, a record 8 million people living with HIV had access to antiretroviral therapy, which is more than half of those in need of such treatment. Globally, there were more than 500,000 fewer AIDS-related deaths in 2011 than there were in 2005. As a result of the mobilisation effects of the MDGs, people living with HIV are living longer, healthier and more productive lives. A tipping point—where more people living with HIV are initiated into treatment than there are people newly acquiring HIV—is now within reach.

However, global action and shared responsibility is necessary to sustain investment in AIDS programmes. Consequently, although we have all welcomed the progress made to date, we must also acknowledge the challenges that lie ahead and make a concerted effort to maintain political momentum. I was particularly disappointed—I put it no more strongly than that—that the UK failed to send a Government Minister to the international AIDS conference in Washington in July.

[Pamela Nash]

I just want to highlight that an ex-Government Minister attended that conference on behalf of Parliament: Lord Fowler. There was also representation at the conference from the all-party group on HIV and AIDS, and from the all-party group on global tuberculosis. We were able to meet parliamentarians from across the world and discuss a lot of the important issues that we have discussed today.

[Sir Tony Cunningham]

And vital work it is. That gives me the opportunity to pay tribute to my hon. Friend for her personal commitment in this area, and to the all-party group on HIV and AIDS, which does incredibly valuable work. We must ensure that the UK and the EU maintain their commitment to financing efforts to combat this epidemic, and make strategic plans to capitalise on the opportunity that we have all said is within reach.

Let me move on to some of the challenges that we face. First, progress on HIV has been uneven across countries and certain populations. Although many countries have seen impressive declines in the rates of new HIV infections, since 2001 the number of people newly infected in the middle east and north Africa has increased by more than 35%. HIV prevalence is also consistently higher among sex workers, intravenous drug users and men who have sex with men. In sub-Saharan Africa, as has already been said, women have a 60% higher risk of HIV infection than men. These groups often face legal and social barriers, including discrimination and criminalisation, which impede their access to services.

Secondly, as the majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding, there is a need for greater integration of sexual and reproductive health responses, and HIV responses. I think that the Liberal Democrat Member, the hon. Member for St Ives (Andrew George), mentioned how important that is.

In 2011, one in five maternal deaths was directly related to HIV, but when women living with HIV receive antiretroviral treatment during pregnancy, the risk of transmission is reduced to less than 5%. This progress on mother-to-child transmission has been hailed as a hugely significant factor, and it provides a real opportunity to take control of the problem.

Finally, we need to acknowledge the importance of middle-income countries, which are often forgotten. Three of the top five countries with the highest HIV burden but the lowest coverage of antiretroviral treatment are middle-income countries. We need to focus on tackling this inequality within and between countries, and ensure that human rights are integral to the global response to the HIV epidemic. Will the Minister tell us what steps her Department is taking to tackle discrimination and to ensure that there is access to HIV treatment for the poorest, most vulnerable communities? There is also a need for urgent action to ensure that we can continue to reduce transmission and expand access to treatment to those who need it.

As a number of speakers, particularly the hon. Member for Mid Derbyshire, mentioned, the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was created in 2001 to increase funding to tackle three of the world’s most devastating diseases, has approved $22.9 billion for more than 1,000 programmes in 151 countries and provided AIDS treatment for 4.2 million people. That is incredible. The fund channels half of all antiretroviral drugs to those living with HIV/AIDS. The UK has been the fund’s third biggest donor since its creation, and the second largest bilateral HIV donor, which reflects our impressive leadership on this issue. I was pleased that the hon. Member for Mid Derbyshire talked about a period of 30 years; this work is not party political, but will go on across decades and across political parties.

However, in May 2012, the International Development Committee’s inquiry into DFID’s contribution to the global health fund urged the Government to honour their promise to increase their contribution to the fund significantly, over and above the current pledge of £384 million for 2012 to 2015. The Government have cited a desire to see reforms to the fund as the reason for the delay, so will the Minister tell us more about the fund’s new funding model and strategy? The IDC specifically stated that

“DFID is a key partner whose increased contribution to the Global Fund could unlock funds from other donors. It should do all possible to commit additional funds earlier than 2013 by prioritising its assessment of the Global Fund ahead of, and separately from, the broader update of the Multilateral Aid Review.”

Given that next year will be a replenishment year for the fund, will the Minister use her G8 discussions to leverage additional funding from other countries and announce further UK funding for the fund? Does she agree that announcing funding for the fund would help to increase certainty and encourage other donors to make a commitment of additional resources?

The UK Government should be doing everything they can to ensure that the global health fund is able to operate at the height of its ability, tackling these horrific diseases and saving lives, so I ask the Minister: can she say when we can expect to see the “increased contribution” to the fund from the UK that was announced by the previous Secretary of State for International Development, the right hon. Member for Sutton Coldfield (Mr Mitchell), earlier this year? Also, what steps are the UK Government taking to galvanise support from other donors for the global health fund? Although the fund is not the only institution involved in the fight against AIDS, TB and malaria, it is by far the single biggest actor in the fight against these diseases. It was a British Government who spearheaded the drive to establish the global health fund, and it is the current British Government who should pick up the mantle at this important moment, showing the leadership to get the fund back into full operation.

In conclusion, it is clear that progress is being made on HIV. The number of new infections is declining, and the number of treatments is increasing, but we must not lose sight of those who are still in desperate need. Rather than focusing on single programmes or issues such as family planning or drug availability, the overall approach must be one of cohesion. Health systems and the integration of HIV/AIDS responses with wider programmes of reproductive health must be considered. Commitments to address the global AIDS pandemic must not take a back seat as other issues take the political stage in the UK. As significant advances are made and global leaders in the United States and elsewhere begin to state openly that an AIDS-free generation is within reach, the UK must continue its leadership on this issue.

The significance of what we face must not be forgotten, and as 50% of people eligible for HIV treatment do not receive it, it is essential to support those most at risk, to help them to access the help that they desperately need without fear of discriminatory laws or prejudices. The UK’s impressive record on this issue must be maintained and, as such, we need continued and renewed leadership. Will the Minister tell us what steps the Government are taking to increase access to medicines for the 7 million people who are still waiting for HIV treatment? Will the Government commit to a blueprint that will lay out the UK’s contribution to the attempt to gain control of the HIV pandemic internationally? Much has been done; much is still to be done. However, as the hon. Member for Mid Derbyshire said so eloquently, success is within our reach.

[The Parliamentary Under-Secretary of State for International Development (Lynne Featherstone)]

Thank you, Mr Bayley, for calling me to speak. It is a pleasure to serve under your chairmanship this afternoon.

First, I thank the hon. Member for Mid Derbyshire (Pauline Latham) for calling a debate on such an important topic so soon after world AIDS day. I also thank hon. Members from all parties for their thoughtful and important contributions to this debate on what I still regard as one of the priorities for all of us in this day and age. I sometimes feel that, with the advent of drugs that mean people can live with AIDS rather than it being a death sentence, a complacency has begun that somehow the situation is not as bad as it was. With the tantalising prospect of zero infections and zero transmissions just out of reach, we know that success can be achieved, but if any of us let up on our commitment to tackling the disease it will not happen. We must translate our commitment in Westminster Hall today to those around the world who have the power to take the fight forward, and we must keep going in that regard.

As many Members have said, there is much to celebrate. The latest UNAIDS report shows an unprecedented pace of progress in the global AIDS response, with 700,000 fewer new HIV infections each year across the world than a decade ago, especially among newborn children. The work to eliminate HIV transmission from mother to child is clearly delivering results. More than 8 million people now have access to treatment and, for the first time, countries are investing more money in HIV than is received from global giving, which shows that we are moving forward to a sustainable response. That is really good news.

Many people, including me just now, have raised the possibility of seeing an end to transmission—zero infections—but so much is still to be done, and there are risks that could seriously jeopardise the incredible progress we have made. Too many people are still getting infected, with 2.5 million new infections last year. Women remain disproportionately affected, accounting for 58% of people living with HIV in Africa, and I will come on to specific points raised about that in a moment. Some 7 million people still do not receive the treatment they need, and in low and middle-income countries work to address HIV in key populations—sex workers, men who have sex with men, injecting drug users and prisoners—is still almost entirely funded by international sources, which is an inadequate human rights response and is not sustainable. I will come on to some of the issues relating to human rights and homosexuality.

The context in which we work is changing; the dynamics of the HIV epidemic are changing and the patterns of resources are shifting. We must continue to adapt our ways of working to overcome those challenges, and we need a global HIV response that is fit for purpose. DFID supports, therefore, the strategic investment approach, which allows countries to make decisions about how to allocate resources most effectively and efficiently on the basis of national evidence. I am pleased that through the approach DFID and other members of the HIV community are embedding the principles of effectiveness, efficiency and equity. The focus will help to drive more and better results and improve value for money.

The decisions taken at the recent board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria demonstrate that efforts are being made to find new and more efficient approaches. The new funding model should better align with country processes, reduce transaction costs, and make a greater impact with investments. DFID is closely following its implementation to ensure that it achieves those aims.

Many Members have mentioned the issue of the global fund. We have committed £1 billion between 2008 and 2015, and that time scale has not been delayed but rather brought forward by one year. Regarding increasing our funding, we have stated that future funding increases are contingent on the global fund’s progress with reforms. I hear the exasperated, “But hasn’t it done enough?” We have committed to reviewing our position paper, and we will have the multilateral aid review update, which is due in the first half of next year. That will provide us with the evidence, but the intention is to make the increase. The global fund has moved a long way from the days when there were issues in round 11 and we had to suspend payments to the fund. With the fund’s replenishment planned for September 2013, the UK is committed to working with others to ensure that reforms succeed and, as has been mentioned, to using our influence with other donors to draw in more overall financing to raise the final total.

One of the deepest ironies of the HIV epidemic is that the people most in need of prevention and services are from communities that are most neglected and discriminated against. A human rights approach is, therefore, essential, and through our bilateral aid review process DFID’s country offices have been updating their HIV programmes, based on the latest evidence and on national responses. In Zimbabwe and other parts of southern Africa, where there is evidence of growing epidemics in key populations, we are exploring how we can pilot innovative approaches to prevention with sex workers, adolescents and prisoners. We have also given new funding for the Robert Carr Civil Society Networks Fund to support global and regional networks to improve HIV responses for key populations.

We also recognise that addressing gender inequality and ensuring women’s rights is also essential to achieve universal access. The Prime Minister appointed me as international champion for tackling violence against women and girls across the world, and that issue is a key part of my agenda. Violence against women and girls is one of the most systematic and widespread human rights violations in the world, and it materially and significantly increases the risks of maternal death and vulnerability to HIV and AIDS.

The issue of sex education has been raised. I recently returned from Zambia, and I was shocked to find that no one talks about sex there. Not only is sex education not taught in school, sex is simply not spoken about. One of DFID’s programmes there is about girls’ empowerment, and I went to visit the girls and asked them which of their life lessons—that is almost what they are—they liked the most. They had had only three lessons so they did not have many to choose from, but it was heartbreaking that they said that what they most liked was finding out about their own bodies. They had absolutely no idea about the changes that were happening to them.

[Pamela Nash]

I want to reassure the Minister that I witnessed a similar DFID-funded programme in Rwanda that was much further forward than the three lessons. I witnessed young girls being fantastically confident in talking about their own health issues. They had much stronger and brighter futures as a result of the programme.

[Lynne Featherstone]

That is the key point: education is vital. The girls were saying that the boys were already very jealous because they were not allowed to go to the girls’ meetings. The initiative was empowering them to feel confidence in their bodies and about their rights over their bodies, and the boys were beginning to be a bit more wary of them. It is a long process, and negotiating such relationships, even in this country, is not always easy.

Having said that about boys, there is also a lot of work to do with boys and men. I went to a gender-based violence clinic—a one-stop shop—where remarkable work was being done with bringing the men along. Where there had been violence, the men had to come in for counselling. They were invited in, and if they did not come they were invited again, by the police. If they still did not come the police went and got them—quite extraordinary. Of the 10 survivor women I talked to, five said that they were still with their husbands, who had changed. One of the men had joined a men’s network. Men who have multiple partners are a real threat, where the spread of HIV is concerned.

Many Members raised issues about Uganda and the homosexuality Bill. I went to Uganda before I moved to DFID, in my violence against women role. Where women are oppressed, there are often hideous homosexuality laws. I raised the issue with the Speaker of the House in Uganda. I would not say that what I said was taken in the best way, but I raised the issue politely, but firmly. It is important to be able to discuss matters, even when people disagree. The discussion was private and appropriate. The issue is a really serious one, and it is not uncommon in many countries across Africa and Asia. I am looking closely at what is possible and at how we move forward on the agenda. One thing we do is to support civil society and Ugandan groups. I met with groups when I was in the country, and there is a lot of fear of a backlash, so how we move forward is a delicate matter.