World AIDS Day 2017

Debate between Stephen Doughty and Catherine McKinnell

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.

Finance Bill

Debate between Stephen Doughty and Catherine McKinnell

Tuesday 2nd July 2013 Commons Chamber

[Catherine McKinnell]

Well, I am pleased that the Minister is engaging with the need to review his own Government’s spending plans so they can take stock of precisely how those plans are working to resolve the unemployment situation and the lack of economic growth in this country. If the Minister could provide some reassurance that his Government are focused on reducing the debt, that would be very helpful.

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

My hon. Friend was speaking about the spending review’s failure in respect of living standards, and that is crucial. Real wages are set to fall by 2.4% over this Parliament, meaning people will be worse off at the end of the Parliament than they were when this Government came to office. That is the real story: it is a spiral of lower wages, lower living standards and lower tax receipts, and then ultimately more debt, more borrowing and a higher benefits bill. Does my hon. Friend agree that that is the spiral we are in?

[Catherine McKinnell]

Yes. My hon. Friend makes a powerful point, and it highlights the complacency of this Government. They feel it is a case of “job done” as some jobs have been created in the private sector, but ultimately the reality families are facing is that they cannot afford to pay for heating and buy food and what they need for their children and their families because living standards are being so desperately squeezed.

--- Later in debate ---

[Catherine McKinnell]

That is another absolute failure in terms of the promises made by this Government that are simply not delivered. I hope that the Government will agree to undertake the review we are calling for today and that the House will, by voting with us, acknowledge that the economic plan the Government have so far pursued is failing and that they need to examine what last week’s spending review will deliver. I hope that there will be a recognition that they promised to rebuild, again as part of a “priority” programme, 261 schools and only one project has begun. It is devastating, not just for the children who need those new schools, but for the communities that need those jobs and the small businesses that need to supply the construction industry, which, as we know, has been brought to its knees by this Government’s failure to invest in infrastructure. Instead of investing in affordable homes, improving transport links and repairing Britain’s broken roads, which would give the country the short, medium and long-term returns that we are looking for, the Government are cutting capital spending in 2015. Announcing infrastructure projects for two years’ time will not create a single job today.

[Stephen Doughty]

My hon. Friend is making a crucial point about the impact on jobs. I had hoped that the spending review would consider jobs in the construction sector, where 84,000 jobs have been lost since the Tory Government came to power—that is, between the second quarter of 2010 and the first quarter of 2013. That is a shocking figure: 84,000 jobs have been lost when we should have seen 84,000 jobs created in the construction sector.

[Catherine McKinnell]

My hon. Friend makes his point very powerfully. It is a fact that a number of jobs have been lost in the construction industry that should have been created if the Government were taking not just our advice but that of the IMF and investing in infrastructure projects now. If they did so, tax receipts would improve this year and next year and we would not have to plan for failure in 2015, which is what the Chancellor came here to do last week.

Finance Bill

Debate between Stephen Doughty and Catherine McKinnell

Monday 1st July 2013 Commons Chamber

[Catherine McKinnell]

My hon. Friend makes a good point. The Government have trumpeted their commitment to 0.7% of GDP being spent on international aid, but they stand by and say that they can do little to assist in ensuring that that is not swallowed up by the three times more that is lost in tax avoidance every year. If they could assist, that would be a win-win situation for developing countries and the UK.

In new clause 12, we call for additional transparency in what the Exchequer Secretary admitted are four fairly reasonable requests. Those requests are well considered and are made in all sincerity. We want to be able to bring in additional tax receipts for the UK Treasury, but we also want to use our powers and information, and the additional intelligence that we would gain from transparency, not only to benefit the lives of UK citizens, for whom public resources could be funded through the tax receipts, but to support developing countries.

My hon. Friend makes the point that it is a win-win situation, and we very much agree. That is why we urge hon. Members to support our new clause. As I have said, it is completely reasonable and I cannot see why Government Members would oppose it, particularly Liberal Democrat Members—I am pleased that the hon. Member for Burnley (Gordon Birtwistle) is in the Chamber to hear this debate on an issue that I know the Liberal Democrats feel strongly about. Indeed, at their recent party conference they held a debate in support of some of the measures we are proposing. I therefore see no reason why Liberal Democrat Members will not vote with the Opposition in the Lobby this evening.

[Stephen Doughty]

My hon. Friend has been making strong points. Does she agree that in a way this debate exemplifies the difference between settling for charity and seeking justice on some of these issues? I would not say that the Government are not charitable. They continue to give aid; we continue to give aid—that is charity and people on both sides of the House do charitable work. However, when it comes to achieving justice on these issues, and getting a grip of the problems and understanding why they are there in the first place, we often find the Government wanting.

[Catherine McKinnell]

My hon. Friend makes the important point that we are talking about justice. We talk about justice and fairness in relation to developing countries when considering how a disclosure of a tax avoidance scheme, and the information we receive from it, might be used to support developing countries and international justice on that level. However, it is also about justice for UK taxpayers. We must ensure that companies that engage in the sort of tax avoidance activities that so rile members of the public, and should concern every Member of the House, do not have a competitive advantage over companies that do not engage in such activities, which may mean that their business ends up suffering.

That is what we are discussing and the amendments should not be just a step in the right direction. The announcements that came out of Lough Erne and the G8 agreement contained warm words and welcome sentiments, but there is an opportunity for the Government to start walking the walk, not just talking the talk. They must make not only warm statements but legislative changes that will move the issue forward and show the leadership that the UK should be showing. That would give us greater leverage when debating such matters on an international scale.

The Prime Minister rightly put tackling tax avoidance and evasion at the top of the G8 agenda, and Government Members now have the opportunity to demonstrate their commitment to delivering in that area. What came out of the G8 does not have to remain a statement of intent; it could become a reality for the UK today. We believe that our amendments would help the UK to take genuine action towards securing tax transparency and the fairness the world needs in the 21st century. I therefore urge all Members on both sides of the House to back our suggestions for how the Government can put their money where their mouth is on this issue.

Finance (No. 2) Bill

Debate between Stephen Doughty and Catherine McKinnell

Wednesday 17th April 2013 Commons Chamber

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

My hon. Friend has made very strong arguments. Will she join me in commending the work of organisations such as ActionAid, Global Witness and the Tax Justice Network, who have done excellent work in exposing a number of examples of corporate tax avoidance in countries such as Zambia, particularly resource-rich countries, and the devastating impacts those are having? If we did not have those stories out there, we would not be aware of the scale of the avoidance that is going on and the impact that it is having in those very poor countries.

[Catherine McKinnell]

I thank my hon. Friend for that intervention, which is powerful in itself, but very much reinforces the argument that we on the Front Bench are making today: we have the means within our grasp to make a difference to that situation. I hope that the Minister will provide some reassurance today, and that we shall get some Liberal Democrat support for our amendments, which seek to make a real difference on the ground. [Interruption.]

Returning once again to an amendment tabled by the Opposition last year—and I might say amendments tabled by Liberal Democrat representatives last year but which were withdrawn at the last minute—we believe that changes to the controlled foreign company rules introduced by the Finance Act 2012 should be properly monitored for their impact on developing countries. Many charities have been concerned that the CFC rule changes will make it easier for UK companies to avoid paying tax in developing countries in which they own subsidiaries. While the Government have estimated the potential loss to developing countries at £1 billion, which one would think would be enough, ActionAid believed it could be as high as £4 billion a year. So what we really need is for the Government to undertake a proper assessment of the impact of the changes on the overall tax take of developing countries since last year, and our amendment asks for that to take place.

In conclusion, we will support the Government’s legislation, brought forward today, to introduce a GAAR. However, we believe, along with my right hon. Friend the Member for Oldham West and Royton (Mr Meacher), who has tabled his amendments as a suggested alternative to the GAAR, that the Government’s GAAR has many potential flaws.

[Catherine McKinnell]

We support our amendments that we have tabled, and I have presented very clearly the reasons why we support them. I will go on to say why. We support the GAAR and we welcome its being put in place, but we want to see how effective it will be and we will continue to monitor it. We hope that the Government will accept our proposal to come back and report on progress within two years, so that we can continue to monitor its effectiveness and rectify, hopefully, some of the flaws that we see will hinder its effectiveness in tackling this problem. So we call on all—

[Stephen Doughty]

In terms of who will be supporting which amendments, was my hon. Friend not surprised a moment ago to hear comments from a sedentary position from one of the Liberal Democrat Ministers—in fact an International Development Minister—saying that she doubted their support? Having read previous Liberal Democrat policies on this area, I have to say that over the years they have been fairly progressive and very extensive. Was my hon. Friend not surprised to hear those comments?

[Catherine McKinnell]

I am very shocked to hear of those comments. I missed them at the time. If the Minister wants to explain her position or the Liberal Democrat Front-Bench position on these amendments, I will be glad to hear it.