HIV (Developing Countries)

Tony Cunningham Excerpts

Wednesday 19th December 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on bringing this important issue before the House. Some people know about it and others have acquired knowledge of it, as I have through my office and the organisations that I deal with.

The topic is worthy. Many of us cannot fail to be touched by the scenes on television from Africa and other parts of the world, and we often think, “If only the children had more food.” However, looking more deeply at the issues, they need not only more food, but more medication and, in many cases, HIV medication. The hon. Lady referred to the statistics. Some 1.7 million people died of AIDS in the past year, and there have been 2.5 million new infections this year, so there has been an increase to about 38 million people with HIV infections across the whole world. Those figures put the issue into perspective, and bring into focus where we are on this.

Every year, one of the girls in my office takes a two-week summer holiday in a small country called Swaziland. I will speak specifically about that country, because I have some knowledge of the area. She does it through the Elim Church’s international missions; the headquarters are in Newtownards in my constituency. The missions do marvellous work in Swaziland, in schools, education, and health, and in trying to build lives and give people more quality of life and opportunity. Two years ago, we had the youth choir over from Swaziland. What put the issue into perspective for me, perhaps for the first time, was meeting some of those young people, who were in their teens or early 20s. I did not know this until they had returned home, but the girl in my office said, “Jim, many of those people you met have AIDS—not by choice, but from birth.” That puts the issue into perspective; it certainly did for me.

In Swaziland, the people are very similar to those in Northern Ireland—they have the same friendliness that we have, and that the Scots also have, and which we are renowned for—and it is also about the same size as Northern Ireland, but there is one big difference: 40% of Swaziland’s population has HIV/AIDS. The perspective is that nearly half the population has it, and the difficulty is that no one talks about it. I agree with what the hon. Lady said about educating people better to address the key issues that affect them.

When someone goes into an overcrowded hospital in Swaziland, they find two people on each bed and another lying beneath each bed. That is the nature of their hospitalisation. They are probably there for tuberculosis, cancer or some other problem, but they will never admit that the underlying issue is HIV/AIDS, and we must address that. Those lovely young people from Swaziland whom I met had what I would call heavenly voices, but that belied the undercurrent of their health issues.

In Swaziland, to use that country as an example, people do not protect themselves against HIV. They do not use the condoms that are given out for free, because that would be an acknowledgment that they were already ill or could become ill. We have to get past the barrier that seems to exist. In Swaziland, as in many other African countries, male circumcision is also available as a method of trying to reduce the number of people with HIV/AIDS. Will the Minister give us details, if she has them—if not, I am happy for her to reply in writing—on how much the use of condoms and male circumcision has reduced HIV/AIDS in Swaziland, in which I am particularly interested, and across the world? For every one starting treatment, two become infected, which gives us an idea of the massive mountain that we have to climb.

My office sponsors a child in Africa. It is not big money; every week £1 goes into a box to sponsor a young orphan in Swaziland. Through the Elim missions, that money gives orphans clothing, school fees, school books, food and, most importantly, the HIV medication that they need to allow them to live a full, normal life—small moneys, but big dividends and big returns. The kids live on a farm and are sponsored by people from all over the world who understand their illness and how to treat it. The orphanage has a hospice, with a nurse who picks up the first signs of infection. They have hope and a future, but unfortunately the same cannot be said of most people with AIDS in Swaziland, not because of ignorance, but because they just do not want to face the key issues.

An entire generation is missing due to this disease. Grandmothers look after toddlers because the parents have died of AIDS. The grandparents who concentrate on the children perhaps do not want to talk about it. They do not talk about it to their grandchildren, because they do not want them to know that their mums and dads died from it. Again, we can see the dangers for that third generation. A middle generation is missing because of the epidemic, and the older generation is keeping that from their grandchildren, so another generation is being raised not to talk about this unspoken illness.

The scenario is replicated across Africa and the whole world; we have statistics and information relating to places such as Indonesia. Will the Minister respond about the educational drive that we need? It has to be an educational drive that people will respond to, not one that sounds good on a piece of paper that can be sent off without our knowing how the drive works or whether it will be successful. We need to know that it will ensure that we can put an end to losing entire generations. I have looked through the statistics on India. It has had an AIDS campaign since 2001, and it has reduced new infections by 50% in 10 years. The statistics illustrate that; there were 270,000 infections in 2001, and 120,000 in 2012. However, there are still 2.1 million people in India with AIDS, which gives us an idea of the magnitude of the problem.

There have been many pharmaceutical developments, and some of the costs are fantastically different. In America, one dose of medication would cost $12,000, but the same medication can be produced in India, where there are pharmaceutical companies, for $300. Again, we must focus on that. With the wonders of modern medicine, HIV/AIDS no longer has to be a death sentence; medication and care can allow people to have a long life. That life will not be as long as ours in this Chamber, because the disease reduces people’s length of life and their time on this earth, but it will be longer than if they were under the threat of the disease without any medication.

Medication is not always readily available, and given the cost implications, it is clear to many that change must come from stopping the spread by educating people and changing their mindset. If that needs the help and support of those of us in the western world, I believe that we should give it.

[Sir Tony Cunningham (Workington) (Lab)]

Does the hon. Gentleman agree that, in many African countries, for education to be successful, it needs political leadership behind it? Without that, we will struggle.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I absolutely agree that we need leadership at the very top in all countries, and that we need to make the necessary commitment.

The pupils who came over here as part of the choir from Swaziland were young, and although they were AIDS carriers, they were clearly focused on what they had to do for the future. If we can keep young girls at school, or give them an improved livelihood, so that their focus is on the good things of life, we can reduce the number who can be infected by AIDS. I support the efforts of the hon. Member for Mid Derbyshire to highlight this issue in the hope of securing attention and help for people who are so much in need, in Swaziland and many other countries across the world.

--- Later in debate ---

[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.