HIV Treatment: Low and Middle- income Countries

Debate between Pamela Nash and Desmond Swayne

Wednesday 11th March 2015 Westminster Hall

[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.