HIV Treatment: Low and Middle- income Countries

Pamela Nash Excerpts

Wednesday 11th March 2015 Westminster Hall

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

It is a pleasure to serve under your chairpersonship, Mrs Main. I and the other members of the all-party group on HIV and AIDS are extremely grateful to be granted this debate to discuss access to HIV treatment in low and middle-income countries. The debate is based on the findings of our “Access Denied” report, which our group has been working on for a long time, so we appreciate the chance to bring it to Westminster Hall today.

I am grateful to the members of the group who have come to join us today. They have shown great dedication to this issue, which has not been riding high in the public agenda in recent years. Nevertheless, it is still extremely important and I am grateful for their support. It is notable that the group has extremely active members from all political parties represented in the House of Commons, and we have many active members of considerable experience from the other place, too. The cross-party consensus has been consistent for the four years that I have been chair of the group, as I understand it was before my chairpersonship, and I hope that that will long continue.

The debate is about access to HIV treatment in low and middle-income countries, but many issues that we will cover today, and which were covered in the report, are relevant to various diseases of poverty. I hope that we are able to discuss some of those later in the debate.

Our report outlines the findings of almost one year of research conducted by the all-party group, which included visits to South Africa and India, and also many written and oral evidence sessions here in Parliament.

Despite the incredible progress that has been made in the battle against HIV, there remain many barriers to accessing medicines and treatment in low and middle-income countries. The latest estimates from UNAIDS—the joint UN programme on HIV/AIDS—show that there are around 35 million people infected and living with HIV globally. There are encouraging figures, too. New infections have reduced from a peak of 3.4 million in 2001 to 2.1 million in 2013, the most recent year that we have complete figures for. However, 2.1 million is still a staggering number of people, so we must continue to do everything we can until we reach the ultimate goal of zero infections.

AIDS-related deaths have fallen from a peak of 2.3 million in 2005 to 1.5 million in 2013. In the past three years alone, deaths have fallen by a huge 19%. The statistics show that incredible progress is being made, but those huge numbers also show that more must be done. Behind the statistics are real people trying to live fulfilling lives. Mothers and fathers are trying to provide for their families, and young people are facing the prospect of a lifetime living with a currently incurable, although treatable, disease. If they are to have any chance of a high quality of life, they must be able to access treatment.

We now have almost 14 million people across the world accessing ARV—antiretroviral therapy—compared with fewer than 1 million 10 years ago. That is a tremendous, unprecedented achievement, which is the result of the global community coming together and a campaigning movement unlike anything the world has seen before. Many of the people who access treatment are able to do so thanks to the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria. I commend the Government for their significant commitment of £1 billion to the fund, and also for the utilisation of the UK’s influence on convincing other donor countries to contribute.

So, 14 million people on treatment is clearly a significant number, but that leaves us around 21 million people in the world still unable to access treatment. That is equivalent to three out of every five people living with HIV unable to access ARVs. If 60% sounds high, the figure is even higher and even worse when we consider paediatric care. Of those children and adolescents living with HIV, 80% are unable to access treatment; we covered that in depth in the report. We have reached a crossroads in the AIDS response. Progress has been made, but international aid and public interest in HIV and AIDS is no doubt diminishing.

According to figures from UNAIDS, international donor funding for the HIV response is stagnating, with funds remaining largely the same since 2008, despite the fact that we now have an increased scientific understanding of HIV. We now know, for example, that starting treatment earlier saves lives, and, thanks to groundbreaking research, we have proof that treatment is highly effective at preventing transmission of the virus in the first place. That new tool, combined with improved targeting of a range of effective prevention interventions, means that we could significantly reduce the number of new cases of HIV by scaling up our response.

To sum up my introduction, we have the tools at our disposal to end AIDS in a generation, so this is not the time for us to walk away from that important issue. This is the time when we have to scale up the response. The Government have been at the forefront of that so far, and I want that to continue.

[Simon Kirby (Brighton, Kemptown) (Con)]

The hon. Lady is absolutely right. We need renewed political commitment to keep the momentum going so that we do not lose it and undo much of the good work that we have achieved to date.

[Pamela Nash]

I thank the hon. Gentleman for that intervention. He is an active member of the all-party group, and I appreciate his support in the work that we do.

I want to move on to the barriers to accessing treatment, which we have drawn attention to in our report. Various barriers were obvious to us at the beginning of our inquiry, but the impact of many came as a surprise. Barriers include the continued high cost of second and third-line treatments. The cost of first-line treatments has come down considerably, particularly due to the fantastic impact of the medicines patent pool. Indeed, the full impact that that will have is yet to come to fruition. However, second and third-line treatments remain very expensive for the poorest people living with HIV.

In our inquiry, we also found that there is completely inadequate access to the most effective testing and diagnostic tools, especially viral load testing. We found that continued weak and unsupported health systems in low and middle-income countries were having a direct impact on people living with HIV. Poor supply chain management is having an impact, although it is avoidable with technical support. Lack of investment in research and development is still having an impact. We found that particularly in lower priority areas and in less profitable treatment areas such as paediatric medicines.

In many countries there is still no political prioritisation of key populations most at risk, unlike here in the UK with our development work. We still see men who have sex with men, sex workers, injecting drug users and transgender people not getting the prioritisation that they need. They are being left behind, even in countries that are otherwise doing well in creating access to medicine. We also continue to see severe stigma and discrimination with respect to all people who live with HIV. That stops people accessing not only treatment, but advice on prevention and testing. That is causing people to contract HIV; it is not just affecting their treatment.

Sharp reductions in support—financial, technical and otherwise—to countries becoming classified as middle income are having a direct impact on the treatment of people living with HIV. To be clear, that is a much bigger debate in international development, but it is a clear example of the impact that is happening.

I will discuss some of those barriers in more depth, but I will start with the cost of treatment. Treatment prices remain one of the biggest barriers to accessing ARV treatment. From my experience in the all-party group and otherwise, the justification that we have often heard for high prices of medications has been the extremely high cost of research and development. Although that is a considerable cost and investment for many pharmaceutical companies, it was enlightening to hear, in one oral evidence session for the report, a pharmaceutical company representative admit that it is not the case that that determines the price. He was clear in saying that the price of treatments is primarily driven by licensing costs and decisions by pharmaceutical companies about what the market will bear.

Intellectual property rights grant exclusive rights to manufacture drugs without competition, and that lack of competition leads to high prices. That said, there is a globally accepted principle that IP rights and patents do not interfere with public health. That was not always the case, however, and in my experience threats to that principle have been overcome only by huge public campaigns.

Governments can bypass IP rights if there is a public health need by imposing compulsory licences. Alternatively, innovator drug companies can agree voluntary licences. Both those ways allow generic pharmaceutical companies to produce quality-assured generic treatments. We saw that first hand during our inquiry, when we visited India and South Africa. We visited generic companies and saw the work that they were doing, and we went to clinics to see the people who were being treated with those drugs, who otherwise would not be receiving any medication. We now have affordable first-line treatments that are available as a result of the voluntary licences, and that has been instrumental in increasing access to treatment.

We now have a price for first-line treatments of around $100 per person per year, whereas 10 years ago it was $10,000 per person per year, so there has been a huge drop in price. Unfortunately, however, if a patient’s first-line treatment is failing and second and third-line treatments are required, the cost of those treatments still remains high.

[Jim Sheridan (Paisley and Renfrewshire North) (Lab)]

I genuinely congratulate my hon. Friend on securing this extremely important debate. Will she expand on the role of the pharmaceutical industry? On page 21, the report mentions that

“a leaked document outlining a lobbying plan for the Innovative Pharmaceutical Association South Africa (IPASA)—the representative body for pharmaceutical companies in South Africa—highlighted the industry’s plans to delay reforms.”

What does that mean?

[Pamela Nash]

We met the South African Government and lobby groups in South Africa on that issue. There was a war between the pharmaceutical companies and Médecins sans Frontières and other smaller groups about this, and it was part of a wider campaign from some pharmaceutical companies to prevent any legislation that might reduce their power to have higher prices. That included such things as “evergreening”, which we have seen in other countries, when patents are granted for a drug because there is a slight change in its chemical composition. Drugs are designed to have a new patent and therefore get round some of the existing patent legislation.

There has been a lot of experience of those companies trying to dodge that, but there are good examples of companies such as Gilead, which have been willing to be at the forefront of being part of voluntary licences and of the medicines patent pool. I do not want to stand here and paint the pharmaceutical companies as the bad guys, because without them we would not have those drugs, but we want to encourage responsible behaviour from them and ensure that they realise what a fantastic contribution they can make to the public health of the world and of people living with HIV.

As I said before the intervention from my hon. Friend the Member for Paisley and Renfrewshire North (Jim Sheridan), there is still a clear problem with second and third-line medication being much more expensive than first-line treatment. In relation to the points that my hon. Friend made, issues have been raised about free trade agreements, in the inquiry and since with the all-party group.

The Transatlantic Trade and Investment Partnership will certainly not be a stranger to the inboxes of most Members in Westminster Hall today. TTIP and the Asia-Pacific Trans-Pacific Partnership—free trade agreements that are under negotiation—seem to pose the risk of introducing additional property rights restrictions or extending patent exclusivity. Although TTIP and TPP do not have a direct impact on the low and middle-income countries that we are discussing, an impact will be felt by them. There is a reasonable fear that the precedent set by those trade agreements will have an impact and shape future agreements.

Any introduction of more onerous patent rules would hinder the ability of generic manufacturers to operate and reduce competition and drive prices back up. That would be disastrous for access to treatment, and our Government must do all they can to protect global public health within these and future agreements. I would be grateful if the Minister clarified today whether the Department for International Development shares any of those concerns and if he put on record his Department’s formal input into free trade agreements. I appreciate that some of that is private, but I am asking how the Department does that and whether he feels that has an impact on the Government’s view as they go into these negotiations.

I shall move on to middle-income countries. During the inquiry, I was particularly struck, more than ever before in my involvement in international development, by the squeeze on middle-income countries and particularly by the impact on the poorest people living in those countries. As I said, this is part of a much bigger debate in international development—it is not confined to HIV—but access to medicine is a clear example of where we might be going wrong.

In providing HIV treatment, middle-income countries in particular are facing a crisis of increased prices combined with reduced financial support. Many of those countries are excluded from the licensing deals that I just mentioned for first-line treatments that allow generic production and supply, forcing them to purchase from innovator pharmaceutical companies at market prices. Those prices are prohibitive and inconsistent. For example, prices for second-line drugs in Argentina are $2,570 per person per year, and the price in Mexico is similar. That is over 12 times the price that South Africa pays at $204 per person per year, which is double the price that I mentioned earlier of $100, which is available for first-line drugs in many low-income countries.

At the same time as they face increased prices, many middle-income countries are having their official development assistance withdrawn from bilateral and multilateral donors. As far as I can see, that has been this Government’s policy, not only in bilateral support, but in using the UK’s influence on the expenditure of multilateral donors to which we contribute, such as the global fund. In addition, we are, in my view, using outdated country classifications and pushing more and more countries prematurely into middle-income status.

When those factors combine, national Governments in middle-income countries are unable to provide services, leading to a treatment crisis. Classification of countries must move away from the current gross national income to a more nuanced analysis. Further support needs to be given to countries, as they graduate through classifications. Decisions about the provision of aid need to be based on need, not just country classifications, although it is completely correct that resources should be prioritised to those who need them most.

Of course, we should expect countries to take on an ever-increasing responsibility for their own development as they become wealthier, but we should not assume that a country with a label of middle-income status has the resources or the technical capacity to cope with aid being withdrawn. The inequality within middle-income countries must be kept in mind. Increasing GNI does not instantly equate to improved living standards or fantastic new health systems, particularly for the poorest and hardest to reach. In relation to access to treatment, funding decisions should be based solely on evidence.

As bilateral donors such as us are withdrawing funding from middle-income countries, so the burden falls on multilateral donors to plug the gaps until countries in transition can fund their services from domestic resources. However, we have seen multilateral organisations following the lead of bilateral donors and reducing support for middle-income countries.

I repeat to the Minister that we should not underestimate the influence that the UK has globally. I say that not with a conceited British ego, but from the experience of speaking to multilateral donors and the people who run those organisations and to people from donor countries and from countries that benefit. When we speak to them, they beg us to bring to DFID the view that this is a huge problem. If a solution to it is to be found, it will require political leadership from the British Government and DFID and a concerted effort to make this issue a priority to ensure that it receives the necessary political attention. Will the Minister tell us whether that is recognised by the Government and whether there is any change in the Government’s thinking on how we look at middle-income countries and their support, particularly on this issue but also more generally?

As I said, the current models of research and development are not delivering all the treatments necessary to meet public health needs. R and D is not prioritised based on need; it is prioritised according to the most profitable products. In our report, we found that there is a gap in relation to treatment for many HIV co-infections, paediatric treatment and diagnostics for small children. Existing models for R and D rely on pharmaceutical companies securing patents that grant exclusive rights to sell the drugs that they develop. If a potential market does not exist, there is currently no incentive to develop products. The need for market advantage reduces collaboration between researchers and increases delays in research into potential vaccines and cures and more effective treatment regimes.

At this point, I want to highlight the fact that in the report we note the disappointment in the UK Government for withdrawing 80% of the funding for the International AIDS Vaccine Initiative and research into an HIV vaccine. Will the Government reconsider that? If not, can the Minister explain why not?

On treatment, a key recommendation in the report is for DFID to play a role in developing new R and D models that are delinked from profits, based on open data sharing and reward people for the development of new clinical technologies, rather than exclusive sales rights being granted. We have recent examples of where what I have described could be a continued problem and where the solution that we have proposed could work. The Ebola crisis is a good example of the failings of the current global model, whereby a vaccine is developed only after a crisis has developed because there was no market incentive to develop one before. Médecins sans Frontières estimates that a vaccine for Ebola will emerge not from a private laboratory, but from publicly funded research.

Models for encouraging innovation in relation to HIV and neglected diseases can broadly be divided into push and pull mechanisms. Push mechanisms reduce the risks and costs of investment in R and D. They include direct funding of research and tax credits, both of which have already been used by the UK Government. The main drawback to push mechanisms, such as direct funding, is that they require funders to make a judgment about which research bodies are most likely to achieve the needed results. Clearly, more research is needed into who would be the best people to make that judgment.

Pull mechanisms, in contrast, create an extra incentive to achieve the result, such as a new medicine, with the benefit delivered only on achievement. Examples of such mechanisms include prizes for the first researchers to come up with a specified innovation, advance market commitments or tax credits on the sale of a certain product that has yet to be developed. There are examples of that already.

We have seen success in delinking R and D costs in relation to the meningitis A vaccine initiative. That developed an adapted meningitis A vaccine through collaborative research, which included the National Institutes of Health and the Serum Institute of India, a private vaccines company. The cost of the vaccine is approximately 50 cents a dose. Furthermore, delinked models of R and D are under consideration for the development of new antibiotics, particularly because there are no incentives for industry to develop products that are meant to be both affordable and conserved or tightly managed.

Our research findings show that the Government could be doing much more to explore the benefits of alternative research models, and I urge them to commission a paper analysing the costs and benefits of alternative R and D models. I ask the Minister whether the Department is considering that. It was a key recommendation of the “Access Denied” report and was previously communicated to the Department.

I want to touch on another finding of the report—the lack of access to viral load testing. We need effective diagnostic tools if we are to provide quality care, but we are seeing very limited investment in that area of research and provision. Viral load testing is the gold standard of diagnostic testing, with increases in viral load indicating treatment failure. If any of us in this Chamber were living with HIV in the UK, we would be undergoing regular viral load testing to ensure the effectiveness of our treatment. The idea is that if the treatment is not effective, people are moved on to second-line or third-line treatment as soon as possible.

In low and middle-income countries, however, viral load testing is limited, which leads to lower standards of care and delays in identifying treatment failure. There have been recent moves to reduce prices, but the tests are carried out only in specialist centres with limited capacity. When I was in India, we went to a clinic and saw the situation at first hand. There was very limited capacity to provide viral load testing. When someone was suspected of having a treatment failure, they had to go in front of a board. There were layers and layers of bureaucracy for such a person. The only justification that I can give is that people there just did not have the capacity and were trying to limit the number of individuals going for viral load testing because they could not afford to send any more. When we met representatives of organisations that were lobbying the Government and, indeed, us on this issue, they told us horrific stories of people who had died waiting to get a test to know whether their treatment was failing. That is something that we do not need to live with in this country, and we have the technology to stop it happening. I feel that we have a responsibility to try to increase the capacity for viral load testing across the world as soon as possible.

Even as the tests are becoming more affordable, there remains a challenge to ensure that these systems are in place. There is a need to develop affordable, accurate point-of-care testing to increase available testing and to reduce delays. That would avoid the need for patients to travel hundreds of miles to testing centres far from their homes and would significantly improve the quality of care received by patients.

Diagnostics are just one area where we see a disparity in treatment between rich and poor countries. We also see that across the spectrum of clinical settings. Distribution networks and health systems in low and middle-income countries are far behind where they need to be. Supply chains are vulnerable to a number of issues, resulting in poor access to treatments. Those challenges include significant delays in registering new drugs, poor demand forecasting and ordering, inadequate storage facilities, stock-outs, corruption and poor patient record management. I would be grateful if the Minister outlined what his Department is doing to address those issues and to support health system strengthening to improve access to treatment, particularly in terms of what we can do to encourage investment in making viral load testing cheaper and more accessible to low and middle-income countries.

The final issue that I will consider is that key populations are being left behind. That has been much debated in the main Chamber and in this room by the all-party group on HIV and AIDS and by our friends among other all-party groups. In addition to the practical, scientific and economic barriers that have been outlined, there are definite social barriers to treatment. The UNAIDS report on the global AIDS epidemic demonstrates that key populations are being left behind when it comes to access to treatment across the globe. The problem is not confined to low, middle or upper-middle-income countries, but it is particularly acute in some upper-middle-income countries—such as former Soviet Union states and countries in central Asia—because HIV epidemics are growing rapidly among key populations.

As MSF pointed out in its submission to our inquiry, the problem of pricing in such countries is compounded by the fact that the epidemics are not generalised but concentrated in marginalised populations. For the avoidance of doubt, I am talking about injecting drug users, sex workers, men who have sex with men, and the transgender population. As I outlined earlier, many global funders actively restrict funding to such countries. That inevitably creates barriers to access for the most vulnerable groups, because there is no political will in those countries to help the key populations that are most affected.

The UNAIDS report highlighted the barriers to treatment created by punitive and discriminatory legislation in many countries:

“As of 2013, 63 countries have in at least one jurisdiction, specific provisions that allow for the persecution of HIV nondisclosure, exposure and/or transmission. Criminalisation of key populations also remains widespread, and 60% of countries report having laws, regulations or policies which present obstacles to effective HIV prevention, treatment, care and support for key populations and vulnerable groups.”

Stigma and discrimination must be challenged wherever they are encountered, whether at a community or a state-wide level. If we do not remove social barriers to accessing testing and treatment, scientific advances will be ineffective. The thing I find most painful about this section of the report is that the position of key populations is not improving but getting worse. There have been many debates in this Chamber about the situation in Uganda and the change in its laws, and there has been much interest in what has happened in Russia. There is cross-party support in the House for fighting discrimination, and I am proud of our country’s record of working to do so. I hope that that will continue.

In conclusion, I am grateful to have had the opportunity to debate this important subject. Hon. Members may think that I have gone on a bit, but I could speak for hours about the detail of the report. It was born out of the huge impact of the report on access to medicines that our predecessor group published in 2009, which I have seen on shelves across the world in countries that I have had the privilege of visiting as chair of the all-party group. A huge amount of progress has been made in the past five years, and a great deal has changed, so I felt that it was time to look at these issues again. As I said at the start of my remarks, despite that progress, so much more can be done. We need to ensure that that happens by working together to tackle the barriers that are outlined in the report.

--- Later in debate ---

[The Minister of State, Department for International Development (Mr Desmond Swayne)]

It is always an enormous pleasure to follow the hon. Member for Glasgow Central (Anas Sarwar), particularly when he makes such a helpful and thoughtful contribution. I congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) not only on securing this debate and on introducing it so well but on the enormous impact that her all-party group has achieved with its two publications. It is extraordinary for an all-party group to be able to inform the public and the legislature in that way. I commend the other Members who have contributed: the hon. Members for Paisley and Renfrewshire North (Jim Sheridan) and for Dumfries and Galloway (Mr Brown) and my hon. Friend the Member for Brighton, Kemptown (Simon Kirby). I owe my hon. Friend a particular debt because he drew my attention to this subject and engaged and interested me in it. He has worked very hard on HIV and AIDS in his constituency, where he rightly says that they have been a significant issue. I pay tribute to him.

I have been asked a large number of questions, so I will race through putting the Government’s position on the record, and then I will deal with the questions as expeditiously as I can. The hon. Member for Airdrie and Shotts said that there are 35 million HIV-positive sufferers, but I think that one of the most worrying statistics is that 19 million of them do not know that they have the disease. We have to draw attention to that. Only 34% of those who are eligible for treatment under the World Health Organisation’s 2013 treatment guidelines have access to antiretroviral treatment.

We remain the second biggest donor in the world. We set out our approach in the document “Towards zero infections” in 2011, and we updated it in “Towards zero infections: two years on” at the end of 2013. In those documents, we clearly laid out a pathway for withdrawing from bilateral funding and transferring to a multilateral approach to this problem. Principally, we are going to work through the Global Fund, which represents about one fifth of the entire world’s contribution.

We have changed the way we operate, but we have not reduced it at all. I looked at the figures extensively this morning. From 2006-07 to 2009-10, we spent £849 million on HIV/AIDS, and from 2010-11 to 2013-14 we spent £1,070 million. The highest years for expenditure were last year and one a couple of years before that. Therefore, quite properly, we are maintaining the pressure on this important issue. We are not slacking or suffering from donor fatigue. The measure of that—the hon. Members for Glasgow Central and for Airdrie and Shotts referred to this—is our commitment of £1 billion to the Global Fund from 2014 to 2016, subject to a 10% burden share.

We see ourselves as the voice of the affected populations. I will return to that point, because a number of hon. Members have expressed concern about it. We are driving forward improvement and integrating HIV treatment with health systems in the countries where people are affected. The hon. Member for Glasgow Central drew attention to that important agenda. We are driving forward the centrality of women and girls. He was entirely right when he said that, every hour, 50 young women between the ages of 15 and 24 are affected. That is twice the infection rate of young men, and it represents 22% of new infections. In sub-Saharan Africa, 57% of sufferers are women.

We want to use market shaping to ensure that drugs are available at affordable prices, so we have committed £35 million between 2012 and 2015 to the Clinton Health Access Initiative. That money has been used effectively to shape the market and to bring about £1 billion of savings to the purchasing countries, which translates to 2.5 million more people being treated and getting drugs, so it is an important part of the agenda.

The hon. Members for Dumfries and Galloway and for Airdrie and Shotts spoke about children. I recognise that there is a gap in the market for paediatric care. The United Kingdom and France are the major funders of UNITAID, to which we made a 20-year commitment. As part of that agreement, we have committed an average of €60 million per year. UNITAID provided 400,000 children with fixed-dose combinations last year, and was instrumental in reducing the price of those doses from $252 per child in 2006 to $130 in 2011. Those actions contributed to the 52% reduction in child infections since 2001. That reduction has been accelerating in recent years.

UNITAID also funds the medicines patent pool, which has been performing well. I know that the hon. Member for Airdrie and Shotts has an interest in it because she raised it with my noble Friend Baroness Northover. That model was designed specifically for AIDS, but it is reasonable to ask whether it can be expanded and used to deal with other diseases. It is an effective way of operating and it has been a success, so I hope it is going to be part of the agenda in future.

[Pamela Nash]

I am extremely grateful to the Minister for making that point, which will be good news not only for the all-party group but for the organisations that support us. I want to make one small point, which I have raised informally with the Department. The minutes of the UNITAID board meeting in December state that there was a reduced contribution from the UK Government. Can the Minister clarify that or seek advice from his colleagues?

[Mr Swayne]

The commitment of an average of €60 million per year for 20 years has been and will be met, but it is an average. There was a reduction, and my understanding is that it was made good with a €40 million contribution. The contributions are being met and we are fulfilling the requirements.

HIV treatment is linked to broader issues of health development, the strengthening of health systems, gender equality, and stigma and discrimination. All those things have to be addressed. We have to have a rights-based prevention and treatment regime. That remains a key policy objective in tracking how our contributions and investments deal with those issues. We need to be much better informed, and we must understand how to tackle stigma. Only when that happens will more people be able to access preventive programmes, get tested, and initiate and adhere to treatments.

The product development partnerships model has been very successful in bringing forward new drugs to the market. It has brought forward 43 new drugs in the past 10 years, and there are 350 under development. The Department for International Development is a strong supporter of PDPs; indeed, we were the first Government donor to them. I congratulate the Labour party on its initiative in 2008 and on driving forward that innovative agenda. It was an important contribution. We remain a globally significant player in that field, having committed £154.2 million between 2013 and 2018.

I was asked any number of questions. Let me start with those about vaccines and the International AIDS Vaccine Initiative. There has been no cut. We fulfilled the contract that we had with IAVI. All the money that we had committed was paid. We have a new contract now for £5 million, for which it competed, for a slightly different programme.

Let us be clear about what has happened. It is quite right that we have withdrawn from something that we were previously involved in, just as any organisation continually reviews its operations and does what it does best. I understand that some six vaccines went for field trials and we were funding that process. The results were disappointing, so it was back to the laboratory. We do not consider laboratory work as part of our comparative advantage. There are organisations in the world that are much better at dealing with that sort of scientific funding and do that work. Frankly, I believe that our funds are better expended elsewhere, where we have a comparative advantage.

Remember that we have not made a saving; we are spending more than we were spending before. We are spending it differently and I believe that we are spending it effectively, although we are not funding IAVI to the extent that we were in the past. That is a perfectly reasonable position to have taken, given the change in the situation.

Sustainable Development Goals

Pamela Nash Excerpts

Wednesday 28th January 2015 Commons Chamber

[Fiona O'Donnell (East Lothian) (Lab)]

It is a pleasure to follow the Chair of the International Development Committee, of which I am a member, although I think he made the cheapest political jibe of the day. However, I will not pursue that any further; I will speak to him about it another time. I would rather pay tribute to the work he has done in this place. He will be a huge loss —we will lose his experience, his commitment and his generosity in working with new members of the Committee —but I am sure he will continue to make a contribution in some other way, because it will be too much of a loss otherwise.

I am surprised at the sensitivity about looking at the hard politics that exist—and they do—in aid and development. That does not mean that there are not times when we can work together and agree. People may have problems with tone—I am pleased to say that the present Secretary of State has a very different tone from her predecessor—but we should not be put off talking about the substance and the different choices that we make. In the case of the right hon. Member for Eddisbury (Mr O'Brien), although it is not a declarable interest, I would like to say that we are both patrons of Malaria No More. I am pleased and honoured to work with him in this area, but that does not mean that we cannot raise questions. Why do we think it is okay to have the Independent Commission for Aid Impact give the Department green, amber or red ratings, but not for us to talk about its performance in this Chamber and have the same open debate? I really do not understand that, so I deeply disagree with the right hon. Member for Banbury (Sir Tony Baldry), who is not in place at the moment. I think the public become more sceptical if we do not debate this issue enough and we do not have the open debate we need. There is nothing to fear from that; otherwise, it looks like we are being terribly precious about this issue, and that we think the public could not cope with knowing that there are risks with international development. My goodness, the gains are so much greater; it is worth taking those risks. It is often a dangerous and difficult environment for a Department to work in.

It is right that the Secretary of State has provided great leadership on the issue of women and girls. I pay tribute to her for that, but I would like to see different choices and other areas in which the Department could take a lead. I hope that the next Government—hopefully a Labour Government—will be able to make those decisions. I hope that dealing with malaria will have priority, because for every minute that each speaker is on their feet in this debate, a child dies of malaria. It is an entirely preventable disease that has killed more people in the history of our planet than any other.

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

Will my hon. Friend give way?

[Fiona O'Donnell]

I am not taking any interventions; I do not want to take time away from other contributors—I am practically a saint, Madam Deputy Speaker.

I would like to see both Front-Bench teams—I am treating them fairly and equally sceptically—making a commitment to at least maintain the investment for dealing with malaria. We know that the minute we take our foot off the gas, as the Americans say, we see a resurgence of the disease. We have seen with Ebola the knock-on effects of people not seeking treatment. That would be desperately sad. As Bill Gates said, when we had the honour of him coming to speak in the Palace of Westminster recently, we are now at the point of developing a toolkit that would allow us to eradicate malaria. That is the language I would like us to start using when we talk about malaria. I would like the UK to take the lead and say that the world’s ambition should be to eradicate malaria. We need to look at the progress made as a great story, with both UK Governments taking a lead in investment and contributing to halving the number of children who die of malaria.

That is the leadership I want to see on malaria because, as Bill Gates said, we have eradicated smallpox and are close to eradicating polio. We need to raise our ambition on malaria. This is not just about health; it is about the well-being of children and access to education. The World Health Organisation recently showed that 198 million people are currently missing out on either education or employment because of malaria. We need to think about the futures of these children. Departments should be pursuing economic growth for all these agendas. That is my plea to both Front-Bench teams today. I am grateful for the House’s attention.

[Nick Herbert (Arundel and South Downs) (Con)]

I am proud to serve as co-chairman of the all-party parliamentary group on global tuberculosis, which was established as a cross-party committee in 2005, after a group of Members went to see the problems of dealing with tuberculosis in Kenya and were immensely struck both by the then failure to get on top of a disease that had resurged globally and by the inadequate attention paid to this disease in our national discourse. Since then, our parliamentary group has worked to increase the profile of this terrible disease, which still kills 1.5 million people a year worldwide—entirely unnecessarily when this disease is, in the main, easily treatable and curable.

It is striking to reflect that TB was declared a global emergency two decades ago and that since then 25 million lives have been lost. However important our efforts to tackle Ebola—I fully support them and welcome DFID’s work in that respect and the sacrifice that many are making in doing so—we should note that TB kills as many people every two days as Ebola has so far killed in total. We have to make sure that we have a focus on this disease, while maintaining focus on the need to beat old diseases that pose a new threat today.

Yes, there have been successes. New cases have fallen sufficiently to meet the millennium development goal target, and deaths have nearly halved since 1990, but there are still 9 million new cases of TB globally every year. The number of new cases in central Asia, Africa and eastern Europe is not declining, and that is of particular concern. Moreover, we should note that the decline in new cases globally is only 1.5% a year. At the current rate, it will take us two centuries to beat the disease.

When the west got on top of TB, the annual decline was 10 percentage points a year. That tells us that unless we accelerate efforts to tackle the disease, we shall face a huge loss of life over the next 200 years, and we shall also face the growing costs of dealing with the disease. One of the reasons for that rise in costs is drug resistance. Drug-resistant TB is caused by the fact that we have drugs that are 60 years old. We have old-fashioned antibiotics. Nor do we have a proper vaccine for TB, although many believe that we do. As a consequence, we are seeing the emergence of a lethal form of TB that is 450 times as expensive to treat. It is worrying that less than a quarter of drug-resistant cases of TB are detected, and only half are successfully treated. The Prime Minister’s anti-microbial resistance commission, which was established last July, has warned that a failure to tackle drug resistance could mean 10 million deaths from all diseases by 2050, and that, crucially, that would reduce world GDP by two to three and a half percentage points by 2050. All those facts make the case for more action now.

[Pamela Nash]

The right hon. Gentleman is making a powerful speech, and I agree with what he is saying, but is he as disappointed as I am that the Government have not committed themselves to the widely supported target of ending AIDS, TB and malaria by 2030?

[Nick Herbert]

No. I was about to say that the Government’s response has been superb. They have just committed £1 billion to replenish the global fund, which is one of the biggest commitments that have been made. Eighty per cent. of all the world’s funding to fight TB is channelled through the fund, and as a result 12.3 million TB sufferers have been tested and treated so far. However, it should be recognised, in the context of the overall programme for tackling TB and the World Health Organisation’s target of ending TB by 2035, that there is a £2 billion annual shortfall. That is not the responsibility of the United Kingdom. There is a global shortfall amounting to a quarter of the resources that we need to beat this disease.

Let me urge two courses of action. First, we need to focus in the sustainable development goals on diseases that we can beat—TB, HIV and malaria—and on an explicit target to beat them. Secondly, we should step up our research and development effort to combat TB. We are at a tipping point: there is an opportunity, and there is a threat. The opportunity is the availability of new technology, which could enable us to beat TB within a generation. The threat is drug resistance, along with inadequate funding and insufficient efforts to combat the disease. That could mean an awful lot of cost and human suffering in future. DFID is the world’s best funder of research and development, and, given its fantastic leadership position, it could convene an international effort to step up research and development to beat TB.

I am proud to have led the formation of a global TB caucus last year, when 170 Members of Parliament from five continents came together to urge stronger action to tackle this disease. The success of our Committee and the caucus has been due to their cross-party nature, and the fact that they have operated on the basis of consensus. That tone was sadly lacking in the ill-judged speech of the hon. Member for Wakefield (Mary Creagh).

International Development (Official Development Assistance Target) Bill

Pamela Nash Excerpts

Friday 12th September 2014 Commons Chamber

[Philip Davies]

I confirm that I certainly meant no discourtesy, Madam Deputy Speaker, but I stand by everything I said. I think I agreed with about 0.7% of what the right hon. Member for Kirkcaldy and Cowdenbeath said in his speech.

At some point, when you allow, Madam Deputy Speaker, Members on the Government Benches will no doubt be invited to support the closure of this debate. I want them to know exactly what they will be doing. Ultimately, they will be answerable to voters in their constituencies in the not-too-distant future. By allowing this Bill to go into Committee and to make progress, Members are basically signalling the death knell of the EU (Referendum) Bill promoted by my hon. Friend the Member for Bromley and Chislehurst (Robert Neill). At some point, all my hon. Friends will have to explain to their electorate, and to other candidates in that election, why they feel that this Bill is more important than that Bill. I do not believe it is, particularly given that the spending on aid is being achieved at the moment anyway. They will have to explain that, and I hope they feel relaxed about doing so. Many of my hon. Friends present—virtually all of them—are in safe seats, which seems to me probably no coincidence. However, I hope they will explain their actions to colleagues in less favourable circumstances, and I hope they know that that is what they will be doing when they go into the Lobby later today.

I am not surprised that the Liberal Democrats or the Labour party support the Bill. They are perfectly entitled to do so as it matches their philosophy. In a socialist philosophy, which Labour and the Liberal Democrats share, what is important is not outputs, but inputs.

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

Will the hon. Gentleman give way?

[Philip Davies]

I will not give way. We have heard so much drivel from people with a different opinion from me. I am trying to get some balance into the debate.

When Labour Members argue that we should be judged only on how much money we spend, it does not come as a great surprise, because that is what Labour and Liberal Democrat politicians have always argued for. I remember in the last Parliament asking why truancy under the then Labour Government was so terrible, and the Minister’s answer was: “We’ve spent £1 billion extra tackling truancy”, as if that was fine. Truancy had got worse, but that did not matter because they had spent £1 billion extra on tackling it. It struck me then as even more criminal than ever. They had spent £1 billion and truancy had still got worse. If they had said, “We’ve saved a bit of money and it’s got a bit worse”, that might have been some justification, but for it to get worse and to proudly boast, “That’s all right because we spent £1 billion extra”, is complete nonsense. So of course Labour and the Liberal Democrats believe in the Bill.

What I cannot understand in my heart is how any self-respecting person who wants to call themselves a Conservative can possibly subscribe to the view that we should be judged simply on a piece of legislation that sets out only how much we are to spend, and that it is irrelevant what we do with the money or whether we can afford it. Those should be the things a Conservative thinks about, but many of my colleagues seem to want to abandon their Conservative principles. I should perhaps be reassured that had the Government taken my view, most of my hon. Friends would be arguing the opposite of what they have been arguing today. They might be supporting this policy not through sincere belief but because of their desire for advancement. I do not know whether they believe in the Bill. In many respects, I hope they support it because they think it will help their advancement, because if they genuinely believe in it, I do not see how they can call themselves Conservatives in any shape or form.

There seems to be a view—a politically correct attack to close down debate—that runs simply: either a person is for international aid and therefore in favour of the Bill, or they are against international aid and therefore oppose the Bill. It is an all-or-nothing argument. If someone criticises Britain’s huge, often mismanaged aid budget, they are accused of not wanting to help the neediest in the world. It is designed to cover up mistakes in the overseas aid budget and ignore shortfalls. This politically correct campaign has allowed international aid to linger as such an inefficient part of Government spending, without sufficient checks or proper rigour.

I believe that humanitarian aid is very important. It provides relief for people who suffer from acute distress following conflict, famine, natural disasters and other emergencies. That work is vital. This country has always stepped up to its responsibilities, and I have no doubt it will always do so, when it sees images around the world of tragedies taking place. However, I am sceptical about the aid that dominates more than nine tenths of official aid spending—development aid. It is the predominance of this aid spending that we are mainly focusing on here. This aid offers continuous support to recipient countries in the areas of education, health, water and sanitation, government and civil society, economic infrastructure, economic production, debt relief and other things across many different Departments.

We have to consider the country’s financial position. Thanks to considerable overspends over many years by the Labour party, we have a huge debt mountain, and scandalously our debt payments are still as big as the budget of one of the biggest Departments. I hope that the right hon. Member for Coatbridge, Chryston and Bellshill will allow me to say that, because of the disastrous way in which the former Chancellor and previous Prime Minister, the right hon. Member for Kirkcaldy and Cowdenbeath, ran this country, it seems that he was determined to make us a recipient of international aid rather than a contributor to it.

At a time of national austerity, it seems to me sensible that we would want to reduce the aid spending given to other countries. It would not have been a bad thing even to have frozen aid spending to other countries, but to increase it massively, as we have done, at the same time as we are making the case that we have no money and have to cut spending everywhere and cut our cloth accordingly, is completely and utterly ridiculous.

[Philip Davies]

My hon. Friend is absolutely right. I personally think that if my constituents were asked for what area it was more important to guarantee a certain level of expenditure—the NHS or overseas aid; the defence budget or overseas aid; the police budget or overseas aid; the education budget or overseas aid?—the overseas aid budget would come off second best in any head-to-head contest. Lord only knows why on earth people in this place think that the public believe uniquely that this particular Government Department should have its funding increased massively and then protected at that level. To be perfectly honest, I think they all need to get out more.

[Pamela Nash]

Will the hon. Gentleman give way?

[Philip Davies]

I am not giving way to the hon. Lady.

We are not even spending taxpayers’ money. We keep on talking about how important it is to spend taxpayers’ money wisely, but we are not spending that money. We do not have any money. When will people understand that even now we are borrowing? Even after the Chancellor’s welcome measures, we are still borrowing £100 billion a year. We are not in a position to spend 0.7% of our GNI on overseas aid, because it is actually much more than that. What we are doing is borrowing money from other countries, paying interest on it to then hand it over to other countries. At the start of this Parliament, we were in the ludicrous situation of borrowing huge sums of money from China in order to give China overseas aid to help that country to get along. It could hardly be made up. No wonder most of my constituents think that the people here are round the bend.

[Philip Davies]

My hon. Friend is absolutely right.

Are we going to take into account the debt interest that we will have to incur on the money we are spending on overseas aid? Is that going to be taken into account as part of the 0.7%, or is that on top of the 0.7% that we are actually handing over? As I made clear in my intervention on my right hon. Friend the Member for Meriden (Mrs Spelman), the idea that we even know what we are spending is a complete nonsense as well, because the goalposts are always moving. It was first supposed to be 0.7% of GDP; now we are told it is 0.7% of GNI; and in the autumn of this year, apparently, how GNI is calculated is going to be changed, which will mean an upward revision to GNI, making our aid as a proportion of GNI lower so that we will have to spend even more on overseas aid to hit our 0.7% target.

[Pamela Nash]

Will the hon. Gentleman give way?

[Philip Davies]

No, I will not.

My right hon. Friend the Member for Meriden provided some of the history. I recommend the 6th report of the Lords Select Committee on Economic Affairs for the Session 2010 to 2012, which was a marvellous report on the effectiveness of overseas aid. This all dates back to the UN General Assembly of 1970. The idea that this target is somehow well thought through and relevant to today’s needs and environment is complete and utter nonsense. The target was first plucked out of the air 44 years ago. The idea that it is likely to be the right one to use now is for the birds. It is completely nonsensical to think that the right target in 1970 automatically must be the right target in 2014, when the world is so different.

--- Later in debate ---

[Philip Davies]

No, I am not giving way again. The last intervention was so poor that I do not think it justifies another one.

My right hon. Friend the Member for Meriden mentioned opinion polls and public support for these things. A YouGov-Cambridge poll in 2011 made clear the public’s opinion. The following question was asked:

“Along with spending on the NHS, the international aid budget is the only area of government spending that is not facing cuts. The government has promised to increase this budget by one third to 0.7% of Gross National Income (GNI) in line with international agreements signed previously. Generally speaking, how favourable or unfavourable are you towards this policy?”

Some 56% of those asked were unfavourable, and only 9% considered themselves to be very favourable to it.

When asked if they would support or oppose a freeze on spending on international development—at the level as it was then in 2011—69% of people said they supported a freeze. Also, 69% of respondents said international aid fails to reach ordinary people in the developing world and is wasted by corrupt Governments; 49% believed international aid enhances the power of bad Governments in developing countries; and 55% thought it discourages Governments in developing countries from spending money on their own people.

Those statistics mirror the feedback that I get from my constituents when we talk about spending on overseas aid. They understand the fact that this country has no money, that we are borrowing and spending way beyond our means and that we have to tighten our belts. They therefore find it extraordinary that we are spending about £4 billion a year more on overseas aid than we were in 2010. That is completely nonsensical and unjustifiable.

The Bill proves that overseas aid does not work. I remember going to see my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) to discuss these issues a few years ago. I told him that I would have more sympathy for overseas aid if he adopted a policy in which we considered the situation in every country individually and decided how we could help it to better itself by establishing a programme that would last for a certain number of years, after which we would expect it to have sorted out its governance and corruption. After that point, our assistance would eventually tail off and the country would stand on its own two feet and head off into the future.

If that were the Government’s policy on overseas aid, I would have some sympathy for it. I would want to scrutinise it, of course, but it seems pretty reasonable. However, the Bill does not propose that we do that; it proposes the exact opposite. It says that we are going to spend the same amount of money every single year in perpetuity. That is basically an acceptance that our assistance will fail, that it will not turn around a country’s fortunes or deal with the causes of poverty, and that it will just be a hand-out to make a few middle-class, Guardian-reading, sandal-wearing, lentil-eating do-gooders with a misguided guilt complex feel better about themselves. It will do nothing to alleviate the real causes of poverty in those countries.

We know that the current system does not work. We have been pouring tens of billions of pounds a year into Africa, year in, year out. How much further forward is Africa today, compared with when we started pouring in those tens of billions of pounds? It is barely any further forward at all—

[Pamela Nash]

Rubbish!

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The hon. Lady will not shout across the Chamber, no matter how much noise the hon. Member for Shipley (Philip Davies) is making.

Oral Answers to Questions

Pamela Nash Excerpts

Wednesday 5th March 2014 Commons Chamber

[The Prime Minister]

I agree with my hon. Friend that the big companies in Britain—BAE Systems, BT, British Airways—are taking on apprentices in larger and larger numbers, which is hugely welcome. The challenge is now to encourage small and medium-sized enterprises in Britain to take on apprentices too. We need to make it simpler—we have done that—and we need to make sure that it pays, and we have done that. We need to advertise to promote to these companies what a great job apprenticeships can do for them and for the country.

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

To coincide with today’s launch of the new all-party group on youth unemployment, figures have been published by the House of Commons Library that show that, despite the figures that the Prime Minister has just cited, the dole queue for under-25s still reaches from London to Edinburgh. Will the Prime Minister tell us whether he thinks that that reflects the success of his policies, and will he commit to meet the all-party group to discuss long-term solutions to this complex problem?

[The Prime Minister]

Of course there are still too many people unemployed in our country, but there are 1.6 million new private sector jobs, 1.3 million more people in work, big cuts in unemployment, big reductions in the claimant count, and almost half a million fewer people relying on out-of-work benefits. That is what we want to do, and we have not forgotten the record of the Labour party. Unemployment rose by nearly half a million, female unemployment rose by 24%, and youth unemployment went up by 45%. Instead of giving lectures, the Opposition should make an apology.

HIV and AIDS

Pamela Nash Excerpts

Tuesday 10th December 2013 Westminster Hall

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

It is a pleasure to open this debate and to see you in the Chair, Mr Dobbin. I thank Mr Speaker for granting us the debate and my colleagues for attending this morning. Many of them have shown great support to the all-party group on HIV and AIDS, which I have chaired for two and a half years.

I am happy to see my hon. Friend the Member for Wirral South (Alison McGovern), in her newish role as shadow International Development Minister. I am also happy to see the Minister in attendance this morning; she has a strong personal commitment to the HIV response and has demonstrated that throughout her time at DFID. She has championed both the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNAIDS, overseeing a significant increase in funding to both, which the all-party group has been delighted to see.

Today’s debate is timely, not just because we recently commemorated world AIDS day, but because today is international human rights day. As we mourn Nelson Mandela, we remember him as one of the great advocates of the AIDS response. He summed up the challenges very aptly when he said:

“AIDS is no longer just a disease; it is a human rights issue.”

The universal declaration of human rights states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself…including…medical care”.

The virus has so far infected 58 million people, become the sixth biggest killer in the world and left 1.6 million people dead in the past year alone. However, it is not just the scale of the epidemic that makes it a human rights issue. It is a human rights issue because its effect on a country is dependent on that country’s wealth, and an individual’s social status still determines their risk of being infected and their ability to access treatment if they are.

HIV is the sixth biggest cause of death in the world, but it is the second biggest in low-income countries and does not even feature in the top 10 causes of death in high-income countries. The 1.6 million people did not die of AIDS last year because treatment does not exist; they died because the medicines were too expensive for them to buy, or because the stigma was too much for them to seek help in time. AIDS and poverty are now mutually reinforcing negative forces in many developing countries. We are 30 years into the epidemic, and AIDS is sadly still a major health and human rights issue, despite the leaps and bounds in progress we have made on prevention, testing and treatment.

One of the main barriers to fighting the epidemic, which stubbornly remains, is stigma. Last year, I took part in a Voluntary Service Overseas placement in Kenya to help parliamentarians and civil society there to strengthen their own all-party group on HIV and AIDS in the Kenyan Parliament. As part of that, I was lucky to work closely with Llina Kilimo MP, a much respected politician and campaigner on HIV and women’s rights. I remember her telling me that no one dies of AIDS. I was confused for a few seconds, but then realised that she meant that no one talks about dying of AIDS. When someone dies of AIDS in Kenya, the family will usually announce the cause of death as the secondary illness that was brought on by AIDS. Owing to the stigma attached, they keep their status quiet.

The best known example of that comes from Nelson Mandela’s own family. When his daughter-in-law passed away at the age of just 46, it was announced that she had died of pneumonia. It was not until her husband, Mandela’s son, died just a couple of years later that Mandela took the brave decision to announce to the world that his son had died of AIDS. In the midst of huge personal tragedy, burying his own son, he decided to use the occasion to show leadership on an issue that he feared would destabilise his country and damage the progress he had made in South Africa. He said at the time:

“That is why I have announced that my son has died of AIDS…Let us give publicity to HIV/AIDS and not hide it, because the only way to make it appear like a normal illness like TB, like cancer, is always to come out and say somebody has died because of HIV/AIDS, and people will stop regarding it as something extraordinary for which people go to hell and not to heaven.”

Mandela had already established his well known campaign 46664—named after his prisoner number on Robben island—a couple of years before he knew of his son’s HIV status. The campaign aimed to raise not just money but awareness, to get people talking about HIV and AIDS and to attempt to alleviate the stigma that too often stops people from seeking the treatment they need. Although there has been progress since Mandela’s landmark press conference in his garden following his son’s death in 2005, I fear that the stigma attached to HIV still prevails in Africa and across the world.

Mandela’s great work is not over. People are still dying from a preventable disease, and there are still 16 million people living with HIV without access to the treatment they require. We know that women, children and socially excluded groups are the people most affected by HIV, but one of the reasons for that is that they are least likely to have a political voice and are therefore not paid enough attention.

That might seem an odd statement, given the attention paid to the issue on world AIDS day recently, and the fact that many non-governmental organisations and some of the biggest ever global campaigns and organisations now provide treatment. However, we are fighting a losing battle for the political will to end AIDS in some of the countries most at risk, because of the stigma attached—not to being HIV-positive, but to talking about the matter at all.

The project in Kenya that I have mentioned was a follow-up to one carried out by my predecessor as chair of the all-party group, David Cairns, in Kenya two years previously. He helped the National Empowerment Network of People living with HIV/AIDS in Kenya— an umbrella organisation for HIV support groups—to set up an all-party group on HIV with Kenyan parliamentarians. However, that all-party group had not quite taken off.

When I was asked to go, I was concerned about the impact I could make; if David could not make a difference and set that group up, I did not see how I could. Surely, in a country as badly affected by HIV as Kenya, MPs would be falling over themselves to join a group that campaigned on it; it must be one of the biggest issues for their constituents. However, I found that HIV was not far up the political agenda—even just before the general election, when I was there.

What I am saying is not a criticism of the Kenyan Government, who have in many ways been at the forefront of the AIDS response, but politicians were not discussing HIV as a major issue for Kenya or talking about the next steps of their response to it as part of the general election campaign. With a few notable and brave exceptions, candidates and politicians told me privately that they did not feel they could speak about HIV. They were worried that the sensitive issues of HIV prevention would put voters off. A couple said that they were worried that voters would think that they were HIV-positive, and that that would damage their chances of being elected.

[Sir Peter Bottomley (Worthing West) (Con)]

In South Africa, when senior judge Edwin Cameron said he was living with HIV/AIDS, it became possible for a number of people in representative positions to be rather more open. There are also HIV choirs in townships around Cape Town. Those developments show that a way is beginning to be found of getting what everyone knows into the open. If things are brought out from behind the curtain, it is easier for people to take the action that will reduce the spread of HIV/AIDS, and there can be greater acceptance of people with the condition.

[Pamela Nash]

I completely agree. The problem is not unique to Kenya. In fact, I spoke at last year’s international AIDS conference in Washington, where I shared a platform with Ryuhei Kawada, who is a member of the Japanese House of Councillors. I believe that he is the first politician elected while openly being HIV-positive; I know that some have revealed their status later, but he was elected having already revealed his status. At last year’s event, he spoke passionately about his hope that he would be the first of many and that others would follow in his footsteps to try to relieve the stigma around HIV. It is clear that we need more public figures to reveal their status, but it is a big ask.

Let me be clear that the news is not all bad. I did not come here to spread doom and gloom. Truly excellent progress has been made in the global fight against HIV. I do not want to bore or bamboozle Westminster Hall with stats, but four recent figures from UNAIDS highlight the success so far. There has been a 33% decrease in new HIV infections since 2001, a 29% decrease in AIDs-related deaths since 2005, a 52% decrease in new HIV infections among children since 2001 and a fortyfold increase in access to antiretroviral therapy between 2002 and 2012. That last figure, in particular, is astonishing and shows just how far we have come. Such achievements should be applauded.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I congratulate the hon. Lady on securing this debate and on all her work. It is so important to keep ensuring that HIV is a priority in the world. Does she agree that, when countries have a high incidence of co-infection, it is important to have joint programmes to control TB and HIV/AIDS?

[Pamela Nash]

I completely agree. I believe that colleagues will touch on that subject today, so I will not go into much depth, but it is something that my all-party group has worked on along with the all-party group on global tuberculosis. I hope that the hon. Lady will join in with such campaigns in future.

We cannot get carried away with progress, however. Many good news stories exist, but we have not yet reached our goal of ending the epidemic, the very nature of which means that we must continually work to eradicate HIV; if we do not, all our efforts will be overturned as it spreads further and further.

I am delighted that the Government have increased funding to the key multilateral organisations that fight AIDS. I congratulate the Minister on her role in achieving that, but I must highlight a few areas where the Government could and should be doing more. Strategies to combat the HIV epidemic are intrinsically linked to each country’s human rights environment.

Young people aged between 15 and 24 account for 45% of all new infections, according to the United Nations Commission on Human Rights. Two recent studies of women in Uganda and South Africa found that those who had experienced intimate partner violence were 50% more likely to have acquired HIV than those who had not experienced such violence. A study conducted in Malawi by the Salamander Trust, which works closely with the all-party group, revealed that women living with HIV were terrified that they would face violence if they told their partner or family about their status. Men who have sex with men are also particularly vulnerable, partly because of punitive laws in many countries.

Likewise, failure to provide access to education and information about HIV and AIDS treatment and care and support services further fuels the epidemic. I know that the Minister agrees that those elements are essential components of an effective response, but what does the Department for International Development plan to do specifically to ensure that human rights are at the heart of the HIV response?

One way is to invest in grass-roots community groups. One organisation that is particularly in my and others’ hearts is Sexual Minorities Uganda—SMUG. Members will remember the tragic murder of its leader, David Kato, in 2011. David Cairns met David Kato during a visit to Uganda, and I remember him being deeply pained at his death.

To honour both the memory of David Cairns and the heroic bravery of David Kato in his fight against prejudice, the David Cairns Foundation donated a staggering £10,000 to SMUG to help to establish Uganda’s first health care clinic specifically for the LGBT community in Kampala. It is projects such as that that will sustain the AIDS response in a country where homosexuality is criminalised. The most vulnerable populations need a place to get tested and treated without fear of imprisonment or death.

I was pleased to see that DFID will be giving £4 million to the Robert Carr Fund for Civil Society Networks, a vital organisation that reaches global and regional civil society networks. Although such funding is, of course, positive and given that civil society activism will be the backbone of the sustainable response to HIV/AIDS, will DFID be doing more for grass-roots organisations?

I am cutting my speech short as I was not expecting such an attendance this morning and a few hon. Members want to speak, but I want briefly to discuss carers. HIV affects the human rights of not only those living with it, but also those who care for the ill and the orphaned. That effect impacts disproportionately on the poorest and most vulnerable in society. In 2005, Nelson Mandela said:

“Women don’t only bear the burden of HIV infection, they also bear the burden of HIV care. Grandmothers are looking after their children. Women are caring for their dying husbands. Children are looking after dying parents and surviving siblings.”

In sub-Saharan Africa, an estimated 90% of care for people living with HIV is done in the home by family or community-based carers. Voluntary Service Overseas highlights that inequality between women and men continues to fuel the pandemic. What is DFID doing to encourage the Governments with whom it works in partnership to adopt policies that recognise the contribution of home-based carers affected by HIV/AIDS?

I want to touch on harm reduction. I do not have the time to go into it in much depth, but I want to mention the upcoming United Nations General Assembly special session on drugs in 2016. Concerns have been raised with me that harm reduction practices for injecting drug users could be affected by the special session. The UK has historically shown great leadership in harm reduction over the years and in reducing the impact of HIV on injecting drug users. Would DFID therefore consider calling for a cross-Whitehall working group in the lead up to the 2016 special session, to ensure that the UK maintains its strong leadership on harm reduction policies across the world and that nothing happens to jeopardise it?

Before I conclude, I want to touch on a future challenge for the global response to HIV—access to medicines. I was pleased that DFID carried out a review of its position paper on HIV and AIDS. The review is more than twice the size of the original paper and is testament to the Minister’s and the Department’s commitment to the issue. I remain concerned, however, that it is missing some key elements.

I am particularly concerned about access to antiretroviral treatment. Those who have been here longer than me will know that that was a focus of the all-party group long before I became an MP, with the group conducting an inquiry in 2009 resulting in a report titled “The Treatment Timebomb”. The report effectively laid out the case that people living with HIV are now living longer—thankfully—but that the cost of treatment will therefore continue to rise to levels unaffordable for many unless something is done to ensure that intellectual property rights and patents do not infringe on a person’s right to health.

I appreciate that that presents a complex challenge to Governments throughout the world. DFID’s review mentions the challenge, but the little attention given does not reflect the magnitude of the issue. Without affordable medicines, the AIDS response could not have existed and most certainly would not be sustainable in future. Will the Minister tell us what steps DFID will be taking to tackle this fundamental human rights issue of access to medicines for HIV patients? Has she had discussions with other Departments that might have influence?

Rhetoric on HIV in recent years has spoken much of the end of AIDS being within our grasp—we have the means to do it. However, although it is true that we can now prevent people from being infected and that we can treat people living with HIV so that in practice they live a full life span, we are a long way off achieving the end of AIDS.

Recently, I spoke at the annual general meeting of Stop AIDS, which is a fantastic organisation working to secure the global response to HIV and AIDS. At the AGM, the non-governmental organisation ONE reported that we are getting close to a tipping point in the epidemic, which it defined as the total number of people newly infected by HIV being equal to, and eventually lower than, the number of HIV-positive people newly put on ARVs. That is truly excellent news, which demonstrates that we are on the right track to end AIDS, although we cannot be complacent.

We are still off track on some key millennium development goals for treatment and prevention. Funding is insufficient to control and ultimately defeat the disease. Much work remains to be done and, as we approach a new global architecture in the post-MDG framework, it is vital that that is recognised by the UK and other countries that lead the way in development.

To conclude, I reiterate that HIV is not only a medical issue, but a social and a human rights one. It is one of our key human rights concerns today. I look forward to hearing the contributions of my colleagues and the Minister’s response.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Dobbin. I congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) on securing this important debate so soon after world AIDS day and just after the Global Fund to Fight AIDS, Tuberculosis and Malaria replenishment last week. I congratulate her on the important work that she does as chair of the all-party parliamentary group on HIV and AIDS, and on her powerful contribution to today’s debate, which was truly excellent. All who have contributed are part of the cohort who go out and fight the fight against HIV/AIDS because, as hon. Members have emphasised, it is such an important and ongoing cause.

When I came into post, I made HIV/AIDS one of my top priorities. When I was shadow International Development Minister—the post now occupied by the hon. Member for Wirral South (Alison McGovern)—I went to South Africa with Business Action for Africa, along with a Labour and a Conservative Member of Parliament, to look at AIDS projects. During that visit, we went into the townships around Johannesburg and saw the conditions there. The trip had a profound effect on me. Many hon. Members have raised the phenomenal work done by Nelson Mandela. I was in South Africa at a time when the treatment for HIV/AIDS recommended by the country’s leadership was to take a shower. We can see the effect of Nelson Mandela’s work from the way in which things have changed and the amount of Government-funded work that now takes place.

When I visited South Africa, only the big corporations such as SABMiller and Anglo American provided facilities for their own employees, and they did so to stop them dying, not from pure altruism. Many hon. Members have spoken of the stigma associated with HIV/AIDS. I went into a hospital built by Anglo American where people came forward and declared their HIV-positive status in front of other members of staff. That gave those members of staff, who were afraid of the associated stigma, the courage to declare themselves and ask for testing. That was one of the most moving experiences of my life. I say to all who take MPs on trips to enlarge, inform and develop them that that trip, eight years ago, may have been a reason why I made HIV/AIDS one of my priorities when I came into office. In addition, I grew up in an era when HIV/AIDS first became an issue. Being terrified by the AIDS prevention adverts and having many friends who died of HIV/AIDS long before there was any treatment for it, left its mark on me.

I will address the points that have been raised as I go along, after which I will try to address any that are not in my speech. There is much to celebrate. The latest UNAIDS figures show an unprecedented pace of progress in the global AIDS response. There are 1 million fewer new HIV infections each year across the world than there were a decade ago, especially among newborn children. We do a lot of work on preventing mother-to-child transmission, which is an obvious stop point, and that work is delivering results. Nearly 10 million people now have access to treatment. Although international assistance remained flat, low and middle-income countries increased funding for HIV, accounting for 53% of all HIV-related spending in 2012. That shows that we are moving towards a lasting response.

That is all excellent news, but, as we debated in Washington last week, we need to put renewed efforts into going the extra mile and achieving an AIDS-free generation. We cannot take our foot off the pedal. Risks remain that might seriously jeopardise the incredible progress we have made. Too many people are still getting infected; 2.3 million were infected last year. As many hon. Members have said, girls and women remain disproportionately affected by the virus. Infection rates in young women are twice as high as in young men. Although tremendous progress has been made on treatment scale-up with the change in the World Health Organisation treatment guidelines in 2013, at least 16 million people who are in need of treatment are not currently receiving it. Stigma and discrimination continue to drive key affected populations underground, which inhibits prevention efforts and increases the vulnerability of those populations to HIV. In 60% of countries there are laws, regulations or policies that block effective HIV services for key populations and vulnerable groups. I will return to that point.

The UK Government were delighted and proud to pledge £1 billion of UK funds at the fourth Global Fund to Fight AIDS, Tuberculosis and Malaria replenishment in Washington last week. The UK pledge alone will save a life every three minutes for the next three years, and it will deliver life-saving antiretroviral therapy for 750,000 people living with HIV. The hon. Member for Strangford (Jim Shannon), who is not in his place and has sent his apologies for having to leave, raised the issue of leverage. The UK contribution helped to leverage, and contributed towards, an unprecedented $12 billion replenishment total. That is 30% more than was pledged at the equivalent event in 2010, and 50% of those funds will go towards dealing with HIV and AIDS.

The UK now calls on all outstanding donors to step up to the plate over the period from 2014 to 2016 to ensure that the target figure of $15 billion is reached and there is maximum impact in terms of lives saved. The Secretary of State and I are telephoning other countries to lobby them. The contribution from one country—I believe it was Switzerland, but I will correct the record if I am wrong—tripled after my telephone call. That is the point of the lobbying effort across the world, which will not end with the pledging in Washington. We must continue that effort to ensure that we reach our targets. We are also working with recipient countries to help them realise increased domestic contributions in the fight against the three diseases. We were delighted by the political commitment of recipient countries at Washington and by the financial commitment of Nigeria, which pledged $1 billion to the national fight against the three diseases. The fight is becoming truly global, with equal partnership and purpose.

This year, we conducted an internal review of our 2011 HIV position paper, which we published last month. I thank STOPAIDS for its help; I see Ben Simms wherever I go in the world. Two years on, DFID is making good progress against its expected results. Treatment-related commitments have already been achieved, and the remaining targets set out in the HIV position paper are on track to be met by 2015.

Several hon. Members mentioned the shift in funding from bilateral to multilateral. Over the past two years, we have been sharpening our focus and working more to our comparative advantage in our bilateral programmes. As the 2011 position paper predicted, the balance between multilateral and bilateral funding has shifted and our bilateral efforts are focused on fewer countries where the need is greatest. The hon. Member for Newcastle upon Tyne North (Catherine McKinnell) asked what we were doing in the programmes where we are shifting the balance of our funding. We now have some exciting new programmes in southern Africa, which is the region hardest hit by the epidemic. Given the urgent need to reduce new infections, we have prioritised critical prevention gaps and we are moving towards complementary work to deal with those gaps. As hon. Members have said, civil society has been, and remains, an essential partner for DFID in addressing those gaps. We are proud to support other multilateral organisations, such as UNAIDS, to ramp up their efforts in the global HIV response. That will reach many more countries, at a much greater scale, than the UK alone could help.

As I have announced, we will increase our annual core contribution to UNAIDS by 50% to £15 million in 2013-14 and 2014-15. That will give the organisation an extra £5 million a year to support its critical role in co-ordinating the world response to HIV and AIDS. In total, our combined bilateral and multilateral contributions secure the UK’s place as a leader in the global HIV response and demonstrate our commitment, in providing a considerable share of total global resources, to universal access to HIV prevention, treatment care and support.

The review paper highlighted three areas of particular focus for the UK: being a voice for key affected populations; renewing efforts on reaching women and girls affected by HIV; and integrating the HIV response with wider health system strengthening, which hon. Members raised, and other development priorities. That includes tackling the structural issues driving the epidemic.

I shall refer to human rights, which many hon. Members raised. In countries with generalised epidemics, HIV prevalence is consistently higher among key affected populations: men who have sex with men; sex workers; transgender people; prisoners; and people who inject drugs. Over the years, DFID has spearheaded support to HIV programmes for key populations. They have been and they will remain a key policy priority for us. We will use DFID’s influence with multilaterals to be a voice for key populations and to push for leadership and investment. We will focus on evidence-based combination prevention services, such as condoms, HIV testing and counselling, and comprehensive harm reduction programmes.

Of particular importance are the programmes and initiatives we are supporting to reduce stigma and discrimination. Our ultimate vision for key populations is for their human rights and health to be recognised, respected and responded to by their Governments. The UK is proud to be a founding supporter of the Robert Carr civil society Networks Fund, through which we support those particularly vulnerable groups. Valuable lessons have been learnt from the fund’s first year and this world AIDS day, the fund announced a second round of grants.

[Pamela Nash]

Before the Minister moves on from the Robert Carr fund and key populations, will she clarify whether any DFID money will go to grass-roots organisations? As I said earlier, the Robert Carr fund operates regionally and I know that a lot of money goes through multilaterals. It would be good to have some clarification on how we are getting money through to smaller groups.

[Lynne Featherstone]

I will come back to that issue shortly.

Human rights was one of the key issues raised by hon. Members. The UK Government are at the forefront of work to promote human rights around the world. We regularly criticise Governments who violate those rights, including those that discriminate against individuals on the basis of sexuality. I have personally raised those issues with Ministers, Prime Ministers and Presidents in Africa. We take some of our lead in DFID bilateral countries from activist groups in the LGBT community, so that may take place behind closed doors due to the difficult, sensitive and dangerous nature of some of the work they do in countries where the law is such that they may face prosecution and for which they could face a backlash. I am committed to raising such issues with Governments across the world, as is the Foreign Secretary and many others across Government. Human rights is at the forefront of our work.

Women and girls are at the centre of our HIV response. Globally, the rate of new HIV infections among women and girls has declined, but the pace of decline is not as rapid as we would like and it is a critical area for renewed UK and global efforts. Gender equality and women and girls’ empowerment lies at the heart of DFID’s development agenda. Since 2011, each of our bilateral programmes has seen a greater focus on HIV prevention addressing the needs of women and girls. We are supporting research to improve outcomes for women and girls, including the development of female-initiated HIV-prevention technologies, and we are looking into how gender inequality drives epidemics, with a particular focus on improving what works for adolescent girls in southern Africa.

We know that in a crisis, girls and women are more vulnerable to rape and transactional sex. The highest maternal mortality and worst reproductive health is in countries experiencing crisis. Contraception, prevention and treatment of HIV and other sexually transmitted infections, and safe abortion are life-saving services, yet they are often ignored in humanitarian responses. That is why DFID is currently developing a new programme on sexual and reproductive health in emergency response and recovery, including services to reduce the transmission of HIV. We welcome the fact that the global health fund will also prioritise women and girls more in 2014 and we look forward to working closely with it on that.

In terms of integration with the wider health system, we know that for a response to be lasting, we must integrate HIV within other sectors and find concrete solutions to sustainable financing. We recognise that a strong health system is an important way to improve the reach, efficiency and resilience of services. The co-infection connection and the integration of HIV services with TB services, sexual and reproductive health services and the wider health system were raised. People living with and affected by HIV, including children and people with disabilities, need to be treated holistically and not just as a series of health problems.

We are also working with countries to ensure that they are in the lead role and increasingly financing their own national responses. In the end, that is the only way to sustainability. We are also working with the global health fund and others to look at market shaping. The hon. Member for Newcastle upon Tyne North mentioned tiered pricing—we term it market shaping—as a way of further reducing commodity prices not only for low-income countries, but for middle-income countries graduating from donor support, which many hon. Members mentioned.

I have tried to cover most of the points raised, but I have left a few things out. Integrated responses to tackling TB-HIV co-infection were highlighted in the HIV position paper review as a key area of current and ongoing effort. It will contribute to the global results to help halve TB-related deaths among people living with HIV by 2015. A cross-Whitehall group on harm reduction was called for. The UK Government remain committed to supporting harm reduction efforts to ensure that that goal gets back on track. DFID is currently liaising with other Whitehall Departments on the drafting of the Commission on Narcotic Drugs ministerial statement, and will remain engaged on that crucial issue in the lead-up to the UN special session on drug control in 2016.

Hon. Members mentioned access to medicines, which is vital. The access to medicines index, last published in November 2012 and supported by DFID, shows that companies have their own strategies for managing their intellectual property and supporting access to medicines. The medicines patent pool currently has agreements with the US National Institutes of Health, Gilead Sciences, ViiV Healthcare and Roche. The UK will continue to support actively that collaborative initiative to enhance access to more affordable treatment and to promote the development of appropriate treatment for children. The UK strongly encourages other companies that have patents for the new first-line treatment for HIV to consider beginning formal negotiations to enter the pool. The medicines patent pool idea was endorsed by the G8 and the UN General Assembly session on HIV and AIDS, to support the availability and development of new first-line treatments for HIV and AIDS.

In addition to funding for antiretroviral drugs through the global health fund, UNITAID and other agencies, DFID also works to make markets for antiretrovirals work better to reduce prices, increase the number of quality suppliers and enhance access. Our partnership with the Clinton Health Access Initiative has already contributed to secure price reductions of almost 50% on both first and second-line therapies for HIV, saving African Governments more than £500 million. That is sufficient to put an extra 500,000 people on AIDS treatment for three years. As has been said, that fall in price from $100,000 per treatment to $100 is the most incredible result. We need to keep pushing down those prices for as long as we can. In terms of civil society, we continue to provide funding for work at the grass roots through our civil society programme partnership arrangements and other DFID civil society grant awarding schemes.

I have only one minute, so I will reply to hon. Members by letter if I have missed any points. The UK and others made huge contributions last week in Washington. There is a great sense of excitement and common purpose in the world, leading towards the vision we all hope for—an AIDS-free generation—an historic moment. A sad truth of the HIV epidemic is that it is often women and girls who are most at risk of human rights abuses in developing countries and least able to get access to the services they need. Addressing gender inequality, stigma, discrimination and legal barriers remains our priority.

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.

UK Aid (Uganda and Rwanda)

Pamela Nash Excerpts

Monday 19th November 2012 Commons Chamber

[Justine Greening]

I appreciate the work the right hon. Gentleman’s Committee has done to help inform these important decisions. He is right that we discuss with other donors, both at official and ministerial level as appropriate, all views that are held about what is happening on the ground, and, critically, the implications for aid. As he rightly pointed out, we must always bear in mind that the point of development programmes is to help people on the ground. Surely, we have to bear that in mind before we simply turn off the tap. That is precisely what I intend to do.

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

Over the past 10 years, I have worked in Uganda and have seen the impact of DFID’s direct budget support, particularly on health care. Will the Secretary of State tell us what impact assessment DFID has carried out in Uganda on the possible reduction of vital services to the Ugandan people as a result of the suspension of direct budget support?

[Justine Greening]

To provide the hon. Lady with some reassurance, let me say that the vast majority of our aid goes not through the Government of Uganda, but through other non-governmental organisations on the ground. We are looking at what we can do to ensure that we continue to achieve the same results in relation to the programmes that we had planned to have undergoing at the moment in Uganda. Again, I have to steer a balance in ensuring that taxpayers’ money is spent appropriately and is not withdrawn from the system by corruption and fraud, while, as she pointed out, making sure that we bear in mind that the programme was there to make a difference and that we still want that difference to be made.

Oral Answers to Questions

Pamela Nash Excerpts

Wednesday 8th June 2011 Commons Chamber

[The Parliamentary Under-Secretary of State for International Development (Mr Stephen O'Brien)]

I am pleased to confirm that the commitment of the UK Government, who are the second largest contributor globally to the effort against HIV and AIDS, is set to continue. The matter will be central to the discussions that I have in New York tomorrow at the United Nations meeting.

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

As the Minister has just alluded to, the UN General Assembly’s high-level meeting on HIV/AIDS is taking place this week. Can he assure the House that the UK will raise the issue of homosexuals being prevented from accessing information and health care in relation to HIV/AIDS in countries where homophobia is still prevalent?

[Mr O'Brien]

The hon. Lady is quite right that if we are to make prevention equal to treatment, it is vital that we tackle what leads to the problem, whether it is men having sex with men or injecting drug users. Both those matters often lead to some difficult discussions and policy take-up in countries that do not wish either to discuss or to accept them—