World AIDS Day 2017

Stephen Doughty Excerpts

Tuesday 5th December 2017 Westminster Hall

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

I beg to move,

That this House has considered World AIDS Day 2017.

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to see by Members from across the House in attendance. I am thankful for the fact that this important debate has been granted because, as we all know, on Friday—1 December—it was World AIDS Day. This World AIDS Day was particularly important to me because it was my first as chair of the all-party parliamentary group on HIV and AIDS. I personally thank, on behalf of the all-party group officers, the hon. Member for Finchley and Golders Green (Mike Freer), who unfortunately cannot be with us today, for all his hard work while he was chair of the group. I also thank those officers who have been able to join us today, and I draw attention to our relevant declarations in the APPG register.

This World AIDS Day was one of many anniversaries. It was the anniversary of Positively UK and the 30th anniversary of the National AIDS Trust. It also marked 30 years since the first UK Government public health campaign on HIV—“Don’t Die of Ignorance”—the famous tombstones adverts for which we must pay credit to the Lords Speaker. He has made an enormous contribution to the HIV cause, both then and over the years since. It was a delight to join him and the Commons Speaker in Westminster Hall last week at the exhibition of the iconic AIDS memorial quilts, which have been placed out for the 30th anniversary. The AIDS Memorial Quilt Conservation Partnership organised the exhibition, and I am sure that many Members have seen it. It was moving to see such a visual display of a deep and personal part of our social history and to meet family and friends who lost loved ones to AIDS in the 1980s and 1990s. It was also a reminder of how far we have come in tackling the HIV epidemic, in the UK and abroad, but, perhaps more importantly, it highlighted that there is still so much further to go. Given that it is a Department for International Development Minister who is responding to the debate, I will focus the majority of my remarks on the international aspect, but I will also touch on a number of issues to do with the UK domestic situation.

Last week, as well as joining with the Terrence Higgins Trust, Positively UK and the memorial quilts organisation, I met some absolutely incredible young people—Davi, Horcelie and Masedi—at the incredibly powerful and personal World AIDS Day event that Youth Stop AIDS held in Parliament. The young people spoke about their experiences in Indonesia, the Congo and southern Africa, and the challenges so many people around the world still face. Hearing their personal stories of how HIV and AIDS have affected their lives and those of their families was very moving and, I am sure Members will agree, it is important for us as parliamentarians to understand how our international policies can directly affect people’s lives. We are truly grateful for their courage to speak out about their status and their experiences.

Before we begin to look at the areas in which more work must be done, I want to highlight some of the excellent progress that has been made to date. Here in the UK, as Public Health England data have shown, this year marks the first time since the epidemic began that new HIV diagnoses have decreased among men who have sex with men—by 18%. That is a real achievement and is testimony to the hard work of Governments of many different types over the years, the HIV sector—including non-governmental organisations and all those who work in our health service—and many other stakeholders who have dedicated their expertise to improving HIV prevention and treatment. Clearly, something is working.

Internationally, huge strides have been made since the beginning of the epidemic, with a 48% decline in deaths from AIDS-related causes, from a peak of 1.9 million in 2005 to 1 million in 2016, thanks largely to the global scale-up of antiretroviral therapy. Having worked with a number of NGOs that work on the epidemic, including World Vision—which the Minister knows well—and Oxfam, and latterly in my time at the Department for International Development and then with Oxfam International, I have seen the epidemic and some of the efforts around it changing over the years, along with some very positive impacts. However, there are still 36.7 million people worldwide living with HIV, 14.5 million of whom do not know their HIV status.

Stigma is still a major barrier to accessing treatment. Even here in the UK, the Terrence Higgins Trust is working hard to get the message through that undetectable equals untransmittable—the U=U campaign—and that is also vital globally. Later in the debate we will talk a little about pre-exposure prophylaxis. PrEP is a game-changing drug that could reverse aspects of the epidemic, but access is a problem, particularly in low and middle-income countries—we have only just seen major trials and major availability in this country. Some 17 million people, or 46% of people living with HIV, are now on antiretroviral treatment and 38% of people are virally suppressed. That means that we are therefore still a long way from reaching the UNAIDS 90-90-90 targets, which are that, by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. UNAIDS has reported that progress on the decline in new infections has, unfortunately, slowed down and that we are now off track for achieving those internationally agreed targets. In 2016, there were 1.8 million new infections worldwide; the target is to reach just 500,000 by 2020.

Although overall new infections among adults have declined since 2010, progress has varied according to region. For example, in eastern and central Europe new infection rates have increased by an alarming 60%, and we have heard very worrying news from Russia this week, where there have been soaring infection and death rates from HIV/AIDS in recent years, as the epidemic has spread from intravenous drug users to the broader population. Russian and global health experts say that that is the result of the authorities’ long-running refusal first to acknowledge the problem and then to back internationally recognised policies to combat it, such as health education, drug substitution programmes and large-scale antiretroviral treatment programmes. That is alongside the suppression we see of the LGBT+ community in Russia and many parts of the former Soviet Union. Figures are merely statistics, however, and unless we look more closely at what they mean for people living in the poorest countries, and some middle-income countries, we do not see the real impact on lives and the devastating effect that HIV and AIDS can still have.

Although here in the UK AIDS-related deaths have been significantly reduced since the terrible days of the 1980s and early-1990s, worldwide, millions of people are still dying from AIDS-related causes. I would like to praise the leadership that DFID has shown on HIV over many years, under many Governments, particularly its recent contribution to the global fund. I was delighted to meet the fund’s interim executive director a few weeks ago here in Parliament, with members of relevant APPGs, and I congratulate Peter Sands on his recent appointment to that role.

HIV is treatable and should not result in death, but there are a number of reasons why it still does, and I will try to cover them. HIV is still the leading cause of death for women of reproductive age. According to UNAIDS data, young women aged between 15 and 24 are at particularly high risk of HIV infection, accounting for 20% of new HIV infections among adults globally in 2015. Although the UK Government are clearly committed to improving women’s rights and opportunities there is some concern that HIV is being overlooked in that area, given that there is, for example, no mention of HIV in the recent update of the strategic vision for girls and women. Will the Minister comment on that, and agree that, given the importance of HIV as the leading cause of death for women of reproductive age, he will consider adding in a specific reference to HIV when the strategy is next updated?

The all-party parliamentary group on HIV and AIDS is currently conducting an inquiry into the withdrawal of aid from middle-income countries and its impact on women and girls living with HIV, which we hope will shine some light on this crucial issue. Multilateral aid, such as that given through the global fund, is vital, but it is not the only answer. The UK has shown a very significant presence, both in its personnel and its ministerial involvement at international conferences and, crucially, at country level. A presence on the ground through bilateral aid is also crucial, and that is something we have recently discussed with the global fund and other organisations. Those bodies require partners on the ground with whom they can work, and we have a proud track record on that, which we do not want to see decline.

Young people are also particularly vulnerable, because they are often denied the information and freedom to make decisions about their sexual health and do not know how to protect themselves from HIV. Therefore, along with women we need to ensure that young people are at the heart of the UK Government’s HIV prevention and treatment strategies globally. Will the Minister tell us what steps he is taking to ensure that young people are at the heart of the agenda? Will he look at DFID’s youth agenda and include specific reference to young people living with HIV and AIDS?

I mentioned earlier that there has been an alarming increase in new HIV infections in eastern and central Europe. One of the key problems—aside from those issues I mentioned about stigma and the lack of commitment to education and treatment—is that some of the middle-income countries, particularly in eastern Europe and the former Soviet Union, are falling through funding gaps. As international aid is pulled out, their Governments are unable or unwilling to provide funding for HIV prevention and treatment services.

DFID’s support of the Robert Carr civil society Networks Fund is crucial in providing the necessary funding for civil society groups in those harder-to-reach places with harder-to-reach populations. We heard about the importance of the work funded by that network in the event with STOPAIDS last week. UNAIDS’s latest report, which was released on World AIDS Day, highlights that outside of eastern and southern Africa, HIV prevalence is highest among men, particularly within key populations, and that they are the least likely to seek treatment. UNAIDS warns that that is a blind spot within the current HIV response. DFID has given £5 million over the past three years to the RCNF. Will the Minister tell the House whether his Department plans to increase that amount to make further progress towards the 90-90-90 target?

While we have seen a significant increase for multilateral funding and the global fund, others are not doing their bit. What discussions has the Minister had with other donors about their responsibilities and their funding for the global fund and bilateral funding? STOPAIDS released an important report looking at UK bilateral funding, which had some worrying statistics. While I absolutely welcome the funding we have seen for the global fund, the RCNF and other things, we have worries in the sector that some of our bilateral funding is perhaps not what it should be. Will the Minister say a little about that and the steps we can take to increase the transparency of DFID’s funding in this area?

DFID is currently using a policy marker to estimate its HIV spend, which essentially means that a programme identified as having a significant HIV outcome is able to automatically attribute 50% of its budget to HIV tracking. The problem with that is that it risks overestimating our contribution in those areas. That might seem like a technical issue, but I am sure the Minister will agree that we need to know how our money is getting results and where it is being used. Currently, there is no way of accurately telling. Will he look at that issue and how we can improve our transparency on that spending?

Another crucial area is access to medicines. In our 2014 report, we highlighted some of the barriers to accessing HIV medicines. Sadly, three years later we are still grappling with some of the same concerns. While the cost of first-line treatment has come down from a high of £7,500 to £75 a person a year, thanks to generic competition and huge civil society pressure, third-line treatment remains prohibitively expensive for people living in low and middle-income countries, and there are still too few paediatric formulations available. Unfortunately, that is one of the downsides of the current system. We have close, frank and regular dialogue with those in the pharmaceutical industry, but we have to find ways of working with the sector to improve access issues.

While many great initiatives already exist—the International Partnership for Microbicides, the International AIDS Vaccine Initiative and various other public-private partnerships, the Medicines Patent Pool, multilaterals such as Unitaid and the Clinton Health Access Initiative and others—there is still more we could be doing to improve the situation. For example, we should ensure that where public funds are used, there are sufficient conditions in place to safeguard public return on research and development investment. Will the Minister say a little about the work his Department is doing to ensure that we have access to medicines for all those who need it? It is important that we continue to invest in vaccines. We need to invest in the prevention technologies that will ultimately be the way to secure a sustainable end to the epidemic.

Those are some of the challenges we face with HIV internationally, but before I conclude I want to reflect briefly on some of the domestic issues. The issues of stigma, discrimination and access to treatment for vulnerable groups apply across the board. I was astounded to read the other day that a YouGov survey found that one in five Britons would be uncomfortable wearing the red ribbon for World AIDS Day because people might think that they have HIV. There should be absolutely no stigma surrounding HIV status. We all need to do our part to ensure that we stamp out that stigma for once and all. I publicly had an HIV test at the Terrence Higgins Trust centre in Cardiff last week. I was proud to share that on social media and encourage others to take a test during national testing week. I thank all Members, including those here today, who have worn their ribbons in the past few weeks and who have been along to take tests.

I pay particular tribute to His Royal Highness Prince Harry and his new fiancée Meghan Markle for the part they have played by making one of their first public engagements going along to a THT centre. His Royal Highness took a test last year, and I understand that that increased testing rates significantly. As an all-party group, we were delighted to meet him recently and discuss his passion for and commitment to the cause. I am sure we all applaud that work.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

Before my hon. Friend finishes his excellent and timely speech, I commend him on securing the debate and apologise that I am not wearing my red ribbon, although I am wearing my sustainable development goal badge. “It ain’t over”—those are the words of the pledge we have all made to recommit our energies to ending AIDS/HIV by 2030, but we will not achieve that goal unless we are committed politically and financially to ensuring that it becomes a reality.

[Stephen Doughty]

I absolutely agree with my hon. Friend. “It ain’t over” was the central message from STOPAIDS when we met last week. We need to get that message out there loud and clear. The challenge has not gone away, although we have seen much progress.

On the domestic front, I want to mention two issues. I would be grateful if the Minister reflected on them and perhaps discussed them with his colleagues in the Department of Health. First, we have seen the fragmentation of services. The all-party group published a report last year called “The HIV Puzzle”. It looked at some of the fragmentation of services in England since the Health and Social Care Act 2012 and some of the resulting challenges for people in accessing treatment and prevention services locally. Some worrying statistics are coming out about treatment availability in some areas. Secondly, while we welcome the trial of pre-exposure prophylaxis in England and the announcement in Wales and Scotland, in England PrEP will be available to only 10,000 people over three years. What will happen when we reach 10,000? Will we suddenly stop making PrEP available? Surely that cannot be the case. The many organisations that campaign for PrEP want to see it available to all those who need it.

I conclude by thanking all the Members who have come here today to support the debate on World AIDS Day 2017. We will never forget the millions of lives lost to AIDS, and we will continue to fight in their name for HIV and AIDS to become a thing of the past.

[Mr Philip Hollobone (in the Chair)]

This is an hour-long debate that will finish at 5.30 pm. Six Members are seeking to speak. I am obliged to call the first of the Front-Bench spokesmen at seven minutes past 5. There are guideline limits of five minutes for the Scottish National party, five minutes for Her Majesty’s Opposition and 10 minutes for the Minister, with three minutes for Mr Doughty to sum up the debate at the end. [Interruption.] Mr Doughty is generously declining to have the full three minutes, but he will perhaps take a minute or so. I am afraid there will have to be a time limit of three minutes so that everyone has a chance to contribute. The next speaker will be Ross Thomson.

--- Later in debate ---

[Alistair Burt]

I do. The hon. Gentleman’s connections with Churches and Church movements not only in this country but worldwide are well known. Absolutely, that is an important point to put on the record because to some extent it sets the record straight about the commitment of the Church and Christian communities to this particular sort of work, which is important. In some parts of the world, only the Church network is there to provide social care across the board. We would all be the poorer without being able to support that.

Mention was made of the Robert Carr civil society Networks Fund, of which we are proud to be a founding member. I cannot give a further commitment at this stage—we are yet to announce it—but I recognise the issue and we will come back to say what the future funding position will be in due course. I have noted what colleagues have said.

There is also greater shared responsibility from low and middle-income countries. Domestic resources constituted 57% of the total resources for HIV in low and middle-income countries, which is a step in the right direction, but more needs to happen to build a sustained response. As good as that is, as all colleagues have said, there is much more to do, so let me deal with some of the questions I was asked.

In terms of the broad strategy, the UK’s ongoing HIV commitment is that we want to see AIDS ended as a public health threat by 2030. That is an important priority for us. We are proud to be the second-largest international funder of HIV prevention, treatment and care, as I have said, and as a leading donor we will use our influence to ensure that we collectively deliver on the global commitment—to end the AIDS epidemic as a public health threat by 2030—and that no one is left behind.

In relation to the gag, we will continue to show global health leadership by promoting and supporting comprehensive, evidence-based sexual and reproductive health and rights. We are the second largest donor for family planning assistance and we are the largest donor to UNFPA, the United Nations Population Fund, so we will skirt around issues raised by the gag.

On a new HIV strategy, the note I have states that the 2013 review of the UK position paper on zero infections identified the integration of HIV as the key strategic priority. We intend to continue that approach, rather than to develop a stand-alone strategy or conduct a further review. However, I have heard what the House has said, so let me reflect a little on that, as I will on the Youth Agenda point—whether HIV is included. It is not currently. Clearly, the Youth Agenda is a very important part of our strategy and we recognise, as all in the Chamber do, the significance of adolescent girls in particular and the related issues. Again, let me have a look at that to see whether we can say anything further about it. I will come back to colleagues in due course.

For women and girls generally, it was right to recognise the heightened risk. Empowerment of women and girls lies at the heart of our development agenda. DFID is supporting the generation of new evidence to improve outcomes for women and girls, including the development of female-initiated HIV prevention technologies, research into how gender inequality drives epidemics, and a particular focus on improving what works for adolescent girls in southern Africa.

The UK is also working with the global fund to increase its focus on girls and women, which I think is in accordance with the House’s wishes. Giving greater attention to women and girls is a shared priority for us and the global fund. With UK support, the global fund has embraced gender equality as being central to accomplishing its mission of ending the three diseases as epidemics, including it as one of its four strategic objectives in the 2017 to 2022 strategy. Between 55% and 60% of global fund spending directly benefits women and girls. That includes programmes to prevent gender-based violence and to provide post-violence services. The number of HIV-positive women since 2002 who have received services to prevent transmission of HIV to unborn children has reached 3.6 million, and we will continue to press on that.

[Stephen Doughty]

I welcome what the Minister has said about looking again at the issue of a strategy and, in particular, the situation with young people and women and girls. We have obviously got the Commonwealth Heads of Government meeting here next year. I suggest gently to the Minister that it would be very helpful to have a strong statement setting out the UK’s views on HIV and AIDS in those communities while we have the Commonwealth Heads in this country.

[Alistair Burt]

It is a competitive field to get things on the agenda for the Commonwealth Heads of Government summit. I know that health will play a leading part, but the details have not yet been sorted. As would be expected, concerns about HIV/AIDS are certainly well up there and an announcement will be made in due course.

The UK Government will, however, be represented at the international AIDS conference in Amsterdam in July. Precise attendance is still to be finalised, but that depends on my diary and whether we can fit it in. I would really like to go because I think that is what colleagues would wish.

Turning to finance—on which I will write further—there are two issues. On the STOPAIDS suggestion of a 22% cut, our response is that the report gives a snapshot of the figures in a given year and does not always reflect everything that is going on as programmes come to an end and others start. It also does not reflect our huge multi-year global fund contribution. The timing of disbursements partly accounts for the difference in spend between years, but committing £2.4 billion since 2010 to multilateral funds is substantial.

The other issue was integrating the funds and the tracking. DFID uses an HIV policy objective marker to track spending on HIV within broader programming. The system ensures that programmes address a range of developmental priorities, such as health-systems strengthening, governance, social protection and sexual, reproductive and health rights. I take the point that it is difficult to track, but it is important that we put the funds into integrated services, as well as spending them directly.

There are the technical challenges of tracking, so let me take that away as well—not necessarily to change it, but to see what might be done better to give more transparency. We will keep the process of integrating the funds going. It is right and proper to do so, along with the other commitments that we make. With that, let me sit down to allow the hon. Member for Cardiff South a couple of minutes to sum up.

[Stephen Doughty]

I thank all the Members who have taken part today, and in particular the Minister for his encouraging response on a series of issues. I am delighted to hear that he is thinking of attending the international AIDS conference in Amsterdam. The signal sent out by ministerial and official attendance at such forums is crucial, particularly given the very strong leadership role that the UK has played over many years. When people do not see us at those conferences and events, they wonder what is going on, so what the Minister said is really heartening.

I also welcome the Minister’s willingness to go away and look at some of the issues we have raised on strategy and on funding and its tracking. I know that those things are sometimes not easy, but given the nature of HIV and AIDS, and other issues such as TB, for example, it is important to understand what funding is going towards those epidemics and how it is being spent, so that we can all hold the Government to account. In some cases, it is also important for the Government to show how they are providing leadership to other countries and international organisations.

Clearly, there is much unity across the House on the importance of keeping this issue on the agenda and of us all continuing to play our part in ensuring that we tackle the HIV/AIDS epidemic in this country and globally. The message is very clear that this is not over. We need to keep the issue on the agenda, and we will all our play our part in doing so.

Question put and agreed to.

Resolved,

That this House has considered World AIDS Day 2017.