HIV (Developing Countries)

Debate between Stephen Doughty and Pauline Latham

Wednesday 19th December 2012 Westminster Hall

[Pauline Latham]

I thank my hon. Friend for those comments. I will come on to those points in a moment, but they are very important because we do need an integrated approach. It cannot be a stand-alone approach; it has to work together with other things.

The global commission’s findings clearly demonstrate that the myriad laws, across multiple legal systems, have one thing in common: by punishing those who have HIV or the practices that may leave them vulnerable to infection, they serve simply to drive people further away from disclosure, testing and treatment—fostering, not fighting, the global epidemic.

To quote Dr Shereen El Feki, the representative from Egypt on the global commission,

“It is time to say, ‘No more.’ Just as we need new science to help fight the viral epidemic, we need new thinking to combat an epidemic of bad laws that is undermining the precious gains made in HIV awareness, prevention and treatment over the past thirty years.”

I absolutely support her position. She argues, and I agree, that deliberate and malicious transmission of HIV is best prosecuted through existing laws on assault, homicide or bodily harm, rather than the special HIV criminal statutes that have sprung up in recent years and that sweep up those—pregnant women among them—to whom they should never apply.

In relation to pharmaceuticals, existing intellectual property laws require a complete overhaul to ensure that the interests of public health are balanced against incentives for innovation, and that the best new HIV medicines are available to all. Laws that criminalise sex work, drug use, same-sex relations or transgender identity do little to change behaviour aside from discouraging the people most at risk of infection from taking measures to protect themselves and their communities from HIV. Laws against gender-based violence and towards the economic empowerment of women are badly needed, and need to be enforced, to reduce women’s vulnerability to HIV. To work towards making an HIV-free generation a human reality, the world needs to take a joined-up, 21st-century approach to, as I said, one of the greatest public health challenges of our time.

Let me now discuss what my hon. Friend the Member for St Ives (Andrew George) mentioned in his intervention. Since the Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002, it has saved an estimated 7 million lives, disbursed antiretroviral drugs to more than 3 million people, treated 8.6 million cases of TB and distributed 230 million insecticide-treated bed nets.

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

I thank the hon. Lady for securing this important debate. I must apologise to her and to you, Mr Bayley, because I must leave the debate early to attend the Energy Bill debate in the main Chamber, but I wanted to be here today to listen to the comments being made. The hon. Lady has made important points about children, access to medicines and the pharmaceutical industry. She will be aware that 72% of children living with HIV still lack access to the ARVs that they need. Does she agree that we need to see a greater commitment to treatment, care and support for those children and simpler drug formulations that are more suitable for younger people suffering from HIV? Does she recognise, like me, that without treatment 30% of children living with HIV will die before their first birthday and 50% before they reach the age of two?

[Pauline Latham]

I thank the hon. Gentleman for that intervention. We need drugs to be regularly available at an affordable price, but many countries where the problem is rife are chaotic and often in conflict, so the drugs would not necessarily get to where they are needed.

We have a role to play with DFID, because we provide a lot of health strengthening in different countries, but we must ensure that the health strengthening in the Governments is true. Often a Government will take money out of the health system, because we have put it in. We must ensure that the systems we put money into to fight this huge epidemic are absolutely transparent. It is also important that drugs are age-related; a drug for a young child will not be the same as a drug for somebody in their 50s. The hon. Gentleman makes an important point.

The global fund is the largest international financier of the fight against the three diseases. It channels two-thirds of the international financing provided to fight TB and malaria and half of all antiretroviral drugs to people living with HIV and AIDS. It also funds the strengthening of health systems. Inadequate health systems are one of the main obstacles to scaling up interventions to secure better health outcomes for HIV, TB and malaria. In contrast to other multilateral institutions, the global fund has been ranked by DFID as performing very highly on transparency and accountability. However, 2011 was a difficult year for the global fund, as the cancellation of the round 11 funding caused great concern among non-governmental organisations delivering services through the fund in developing countries.

In 2012, the Select Committee on International Development, of which I have been a member since the 2010 general election, held a short inquiry into the global fund. It concluded that the UK Government should release the additional funding promised to the fund without delay. In the Government’s response to the inquiry, DFID unfortunately states that they will wait until after the second multilateral aid review, which is due to be published in spring 2013.

The global fund has gone through a huge transformational process, developing a new strategy and recently appointing a new executive director, Mark Dybul. It now has a new funding model. Due to financial constraints, however, the fund has withdrawn its programme from some middle-income countries, such as Ukraine, where the figures on the HIV epidemic are rising. Will the Minister look urgently at that?

On drugs, it is worth noting that approximately 80% of the 8 million people currently taking ARVs are prescribed generic versions. Competition in generic drugs has enabled the cost to be reduced at least tenfold to around $100 a year for first-line treatment. That was only possible due to India’s pre-2005 patent laws and protracted discussions with the pharmaceutical industry in the late 1990s and early 2000s. Since India’s patent laws have become compliant with the agreement on trade-related aspects of intellectual property rights—TRIPS—it is not possible for Indian companies to make generic versions of newer medicines within the 20-year patent period. We are, therefore, reliant on the good will of pharmaceutical companies to reduce prices for poorer countries.

During 2012, it is estimated that about half a million people will need second and third-line treatment, which is patented and at least three times the price of first-line treatment. Third-line treatment is as much as 20 times the price. One initiative to deal with the cost of drugs is the medicines patent pool, which would enable free generic competition on newer patented medicines. Unfortunately, only one company—Gilead Sciences Inc—has signed up and more companies need to join for the system to be viable. Will the Minister comment on what she plans to do to help that happen?

As we move towards 2015, a lot of work is being undertaken to put together a post-millennium development goals framework. One risk we face as the MDGs come to an end is that the global community will turn its back on the gains made in the past decade. It is important to consider the linkages between HIV/AIDS and other diseases. A post-MDG framework must continue to work towards the unmet MDGs. There is an urgent need for continued action on HIV: each day more than 7,000 people are newly infected with HIV; and 7 million people are still in need of HIV treatment—a number set to increase dramatically as all 34 million people living with HIV will ultimately require it.

TB is the leading cause of death among people infected with HIV/AIDS in developing countries, and 1.1 million people were living with HIV-acquired TB in 2010. Because HIV infections attack and weaken the immune system, an HIV-positive person with latent TB is 20 to 40 times more likely to develop active TB than someone who is not infected with HIV. Promoting and implementing the linkages between HIV and other relevant areas—including gender, sexual and reproductive health, maternal and child health, TB, education, and hunger and nutrition—brings wider benefits for development. A post-2015 framework must therefore ensure that goals and targets support synergies between areas. In particular, it must ensure that addressing HIV is part and parcel of a coherent and holistic approach to strengthening overall health, social protection and legal systems. Will the Minister tell us what progress she hopes will be made at the G8 next year?