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11 am

Mr. Andrew Robathan (Blaby): I am delighted to have the opportunity for this debate. It was prompted particularly by the third report of the Select Committee on International Development, entitled "HIV/AIDS: The Impact on Social and Economic Development". I commend that report to the House and to those outside the House. I had a part in it, and I congratulate the support staff involved and, in particular, the Clerk of the Committee, on writing it. It is an excellent report and deserves wider publicity than it has had so far.

What we are to discuss today is arguably the biggest disaster facing the human race. It is a crisis and a catastrophe and, to a large extent, it is not understood in the developed or the developing world. Last year the International Development Committee returned from South Africa and Mozambique having seen floods, among other things, and having witnessed the enormous AIDS problem confronting southern Africa. I asked my then research assistant, an extremely intelligent and well-informed person, what he knew about AIDS in Africa. He thought for a moment and said: "I think it is quite a problem, isn't it?"

I am afraid that that is typical of the reactions of people in this country, although that is changing to an extent, perhaps since the Durban conference last year. Yesterday I received an invitation from Christian Aid to a reception at the opening of Cold Heaven, an exhibition by Don McCullin on AIDS in Africa. Don McCullin, who is one of the world's leading photojournalists, said:

That is the crux of the matter. In the United Kingdom as a whole, HIV prevalence is about 0.11 per cent. and 450 people died from AIDS-related disease in 1999. In some countries in Africa the prevalence rate is more than 25 per cent., and in sub-Saharan Africa in 1999 more than 2.2 million people died from AIDS-related diseases. That is some 200 times the UK rate.

The disease is wreaking havoc in the developing world, especially in sub-Saharan Africa. In Zimbabwe and South Africa it is a catastrophe unlike anything

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since the second world war. In 1998 the International Development Committee was in Uganda. At dinner I sat next to a Minister who had just attended the funeral of the fifth of his wife's siblings to die of AIDS. Although it is an extraordinary thing to imagine, such circumstances are replicated in many, many families throughout Africa.

That man was obviously educated, and the problem can be disproportionately serious among educated people because it is related to travel. If one stays in the same place the whole time, without meeting many people from elsewhere, the virus is not spread. The infection is often contracted when one travels for education or work, as do many miners in South Africa. It can, therefore, have a disproportionate impact on the number of teachers or doctors in a county, although it could be said that such people should be better educated and aware, and therefore, perhaps, less prone to the infection.

There are already 13 million AIDS orphans in Africa, 95 per cent. of them in sub-Saharan Africa. That approximates to one quarter of the population of the United Kingdom; to put it another way, it is like finding that every person in Norway and Sweden had been orphaned by AIDS. Life expectancy in some countries of the developing world is dropping remarkably. In 1996, life expectancy in Zambia was 48.6 years. God knows, that is low enough. It fell, however, to 40.1 years by 1999. In the UK, life expectancy is more than 80 years.

Development, which was progressing in the second half of the 20th century, is starting to go backwards. There are more poor children. Many orphans are unable to go to school, perhaps because, as their parents are dead, they have to stay at home to look after siblings. Money is directed at the care of AIDS patients and away from other health areas. Diseases such as tuberculosis are very much on the increase because of AIDS. All that affects development. Poverty is greater. As we all know, the aim of DFID's policy is to reduce poverty in the developing world.

Such countries' economies are suffering. Our report examined that to a certain extent, but we are seeing only the beginning of it. Some work forces are literally dying and markets are getting poorer because there is less money in the market to buy goods. Investment that would have been channelled to some sub-Saharan African countries might now be channelled elsewhere, although that has yet to be determined. Agricultural production has also been reduced because of the number of deaths.

Some in the western, or developed, world might say, "That's all very sad, but it doesn't affect us directly", but political instability and possible social collapse and conflict are likely to arise. At a basic level, we could ask why people who are dying should obey the law. Also, in an earlier report that looked into the causes of conflict, we found that conflict and poverty are inextricably linked. It is self-evident that prosperous societies tend not to go to war in the same way that poor societies do.

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Greater instability in the world would be detrimental to us as well as to other countries. The United States has declared the epidemic a national security threat.

Mr. Andrew Rowe (Faversham and Mid-Kent): My hon. Friend paints an accurate picture of the appalling situation. As some infections, such as TB, get out of control in sub-Saharan Africa, they are mutating into forms that convey considerable risks to people in more prosperous parts of the world. Does he agree that that is a further repercussion for the developed world?

Mr. Robathan : I agree with my hon. Friend. That is why it is so important that the western, developed world appreciates the huge scale and pandemic nature of the crisis.

We found that HIV and AIDS are exacerbated by poverty--owing to health care problems--and, at the same time, exacerbate poverty. That can become a vicious circle leading to greater conflict. It is an awful problem.

Dr. Jenny Tonge (Richmond Park): Before the hon. Gentleman leaves the causes of conflict, was he as puzzled as I was that the cross-departmental report on the causes of conflict in Africa, which has just been published, makes no mention of the AIDS crisis?

Mr. Robathan : I confess that the hon. Lady has the advantage over me, as I have not read the report, but it is self-evident that the AIDS crisis plays a part. In Ethiopia and Sierra Leone, for example, there is evidence that AIDS is being spread rapidly by the conditions of conflict.

Botswana has the worst adult prevalence rate in Africa: 35.8 per cent., or more than one in three. Last month, I went to a meeting attended by the President of Botswana. His big plea to the UK and the developed world as a whole was for us to try to understand the impact of AIDS in his country and the effect that it is having in every nook and cranny of its national life.

The first purpose of this debate is to increase awareness and understanding. The need for that has recently been illustrated by coverage of the dispute in South Africa about anti-retroviral drugs and the patent case brought by pharmaceutical companies. However, although the issue of the production of generic drugs is important, it merely scratches the surface, because in most of sub-Saharan Africa there is no health service to distribute such drugs and there are insufficient doctors and nurses to educate people about how to take them. Moreover, even if the cost of the drugs is reduced by a factor of 10, they are still too expensive to distribute to the millions of people who have the disease. I am glad that the pharmaceutical companies have dropped the case, but that will not have an impact on the big picture that I shall describe.

Not only is the problem huge, but it may be getting worse. In some countries, good policies appear to have stopped the rise in prevalence rates, but in other countries there is no evidence of that. Although infection rates are uncertain, there is a real worry about countries such as India and China. Recent newspaper reports suggest that the prevalence rate in China--which was until last year the world's most populous

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nation--is a great deal higher than the authorities would have us believe. We have little knowledge of what is happening in China, but awareness is as important there as it is anywhere else.

The prevalence rate is still rising in much of Africa, but in Uganda it has been reduced. Having been top of the incidence rate for AIDS in 1993, it is now 14th. That is the result of good public policy. Uganda stands out as a beacon of hope in that respect. Its achievement was based largely on increasing awareness and understanding, causing behavioural change, and political leadership and education. The average age of first sexual intercourse has been increased by two years. That may sound like a paltry figure, but it is extremely important: it means that teenage boys are not having intercourse at the early age that had been customary. At the same time, male condom use has increased from 15.4 per cent. in 1989 to 55.2 per cent. in 1995--the most recent date for which I have figures. AIDS is not beaten in Uganda, but people there have started to turn the awful tide.

What can we do? There is a tendency to view such an enormous problem as insuperable, throw one's hands up in horror and have nothing to say. That would be wrong. We can help through education, and DFID does so, as it should. We have seen various schemes that DFID has assisted around the world. Development aid can be used to educate people and alleviate effects.

I remember visiting Kisumu high school in March 1998 with the hon. Member for Richmond Park (Dr. Tonge) and other Committee members and watching a rather good drama--a role play-- about the dangers of AIDS, performed by teenagers. It was a shock to discover that, by the age of 19--I think that I am correct--over one third of girls and 8 per cent. of boys at that school are infected with HIV. At least education has begun, even though it may be too late and perhaps insufficient. Girls are more vulnerable because in some developing countries they are coerced into having sex at an early age, often by older men, and they are often raped. They are coerced by money and pressures from their family, and for understandable biological reasons they may be more susceptible to picking up the virus.

Education must lead to behavioural change, which is much easier to say than to achieve. We have heard the argument that the habits of some developing countries are cultural habits, that it is important that people have always behaved in a certain way and that it is not for people in the west to tell others that being profligate in their sexual favours is dangerous. The truth is that such cultural behaviour is leading to the death of cultures and the death of a large number of people. Greater abstinence and fidelity would assist, but that, too, is easier to say than to achieve. We have also heard about the practice of dry sex--I shall not elaborate. We are told that that is something imbued in the culture of various African countries, but it is assisting in the transmission of the disease. That issue relates to health. Bad hygiene and poor health care, together with a large number of sexually transmitted diseases, contribute to the spread of this ghastly disease.

Women's rights, human rights, the impact of conflict, which we have dealt with briefly, and the response from DFID, which I look forward to hearing, will be discussed later. The first step towards changing the

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situation, in which we can assist today, is understanding. In future, history books will be written about this plague, just as they have been about the black death. It is too easy to say that the problem is too big for us and that we cannot do anything. Africa's schools have been emptied of teachers, its hospitals emptied of doctors, millions of children are without parents and societies are in a state of collapse. AIDS is the new black death stalking Africa and the human race. I hope that today's debate will push the issue up the public agenda.

11.18 am

Mr. Neil Gerrard (Walthamstow): I warmly welcome both this debate which has been initiated by the hon. Member for Blaby (Mr. Robathan) and the report by the Select Committee on International Development, which gave a balanced and thoughtful overview of the situation. The speech that we have just heard reflected the contents of that report. HIV is not just a medical problem; it reverses development gains in southern Africa, among other places. The spread of HIV in Asia and eastern Europe raises the prospect of development also being reversed in those regions. Without international action, the effects of the reverses will increase. I should like to focus my remarks on that issue.

I welcome the attention that the Department for International Development is giving to the issue and its promise of an HIV-AIDS strategy, which I look forward to seeing soon. However, there will be opportunities over the next few months for progress to be made and initiatives to be taken. There will be a special session of the United Nations General Assembly, in June, and a G8 summit, one month later, both of which will provide opportunities for the international community to start seriously to face up to the scale of the problem and to start to commit the necessary resources. An agreement in principle to set up an international fund was reached at the recent International Monetary Fund meeting. Whether that international fund will be of the required scale is debateable, but at least there are signs of progress.

I am concerned by how that fund might work and about whether there will be an appropriate international response to it. The hon. Member for Blaby referred to the court case in South Africa involving pharmaceutical companies. Concerns have been expressed in southern Africa about the approach taken by countries such as the UK and the US to that court case. Perhaps we were not seen clearly to support the South African Government's position.

In last week's International Development questions, my right hon. Friend the Secretary of State for International Development said she thought that the court case was ill advised. However, not much was said about the issue while the court case was in progress. Although the European Parliament passed a strongly worded resolution calling on the pharmaceutical companies to withdraw from the action, that position was not reflected in events in individual countries. Some activists in South Africa were disturbed by the impression--true or not--that the Government, and perhaps some other western Governments, were in the pockets of the pharmaceutical companies.

I agree with the hon. Member for Blaby that we must learn the lessons about the type of response that is necessary. Our response should not only be medical,

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because poverty reduction and education are other integral aspects of addressing the issue. In that context, I should like briefly to mention the consultation paper that the Cabinet Office performance and innovation unit produced, on 30 March, and which discusses in detail how such an international fund might be used.

The paper lists the following package of measures: a new global fund for health, including funds to purchase commodities and commitments to buy effective new products as they become available; tax credits to strengthen incentives for drugs donation and research; protection of intellectual property rights and support for tiered pricing; better co-ordinated publicly-funded research and development, including clinical trials support; streamlining drug approval and regulation; and action to strengthen and expand coverage of health care delivery systems. Looking at that list of six items, it strikes me that five of them concern drugs, medicines and medication, and that only one of them concerns the expansion of health care delivery systems. I am concerned that people in developing countries may think that the package contains a distorted set of priorities that focuses on the needs of the pharmaceutical companies and drugs provision, rather than on the wider response that we need and which the hon. Member for Blaby described.

I see little mention in the document of matters such as the supply of condoms, education, and the necessary social and cultural changes. In some countries, the empowerment of women is key to making a difference and dealing with the stigma attached to HIV. The hon. Member for Blaby mentioned the need to change the sexual culture, but, as he said, we cannot impose such changes on other countries. However, the example of Uganda shows that such measures, combined with political leadership, can work. Our response should involve using all the funds that are established not just to provide medicine and drugs, but to encourage other necessary developments. Of course we want medical solutions when they are available, and we should continue to invest in research to develop vaccines and microbiocides that might prove cheaper and more effective, but in doing so, we should remain focused on the other forms of response that are necessary.

We should set up global funds and use them to encourage social, cultural and educational changes. We must consider how to deal with poverty and embed the HIV issue in the development agenda. There must be a balanced response. There should be medical intervention when possible, and better and more effective research into drugs, but we must not put all our eggs in that basket. We must consider the entire range of responses. The Select Committee report clearly highlighted the responses that are necessary and which have made a difference. We should encourage those responses.

Finally, even if he cannot give the exact figures this morning, I ask the Minister to provide a clearer explanation of Department spending on HIV and AIDS. When responding to questions in the House last week, my right hon. Friend the Secretary of State for International Development mentioned a figure of £100 million for last year. However, in June 2000, an HIV-specific spend of £17 million was mentioned. In

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July, spending for 1998-99 was said to be £43 million, but was later said to be £53 million. I must say that I am a little suspicious of what those figures actually represent. How much is spent directly on HIV, and how much spending on other reproductive health programmes is being included in that figure? We need greater clarity on what is really being spent and where.

During International Development questions last week, my right hon. Friend the Secretary of State made it very clear that, in her and the Government's view, a wide range of responses was necessary to tackle those issues. She has also spoken frequently about the need to deal with poverty as an integral part of that programme--a point that has been made clearly this morning. I am pleased that we have had this debate, and I believe that the Select Committee has done an excellent job in producing its report. In the next year or two, I hope that we can move beyond this debate and use the report's recommendations to influence the United Nations and events internationally, and to ensure effective use of the money that would be generated by the international fund that the G8 is considering establishing.

11.29 am

Sir Norman Fowler (Sutton Coldfield): You caught me rather by surprise, Mr. Amess. I was going to intervene later.

I congratulate my hon. Friend the Member for Blaby (Mr. Robathan) on securing the debate. He spelled out the seriousness of the international crisis extremely well. In the past couple of months there have been two debates on the subject in Westminster Hall, in which a few of us have taken part, but although millions of people have been infected with HIV-AIDS and are dying of it, we have not yet had a serious debate on the Floor of the House. That is a pity, and I can think of no other crisis on such a scale that has not found its way on to the Floor of the House. I say that with no disrespect to Westminster Hall--thank God there is somewhere to raise the matter--but it is astonishing that we cannot find time to have a serious debate on the issue on the Floor of the House.

Much of the writing, debate and discussion in the past few months has concentrated on drugs and the case involving drug companies in South Africa. It should be emphasised that that issue is not remotely a panacea. The delivery systems of drugs are lamentably inadequate in many of the countries where the problem is most serious. It needs to be repeated that we still have no vaccine for HIV-AIDS and there is no cure for it. Drugs can extend life, but they will not cure the disease. We are a long way from acquiring a vaccine.

We should turn our minds towards the prevention of HIV-AIDS, which was a point made by my hon. Friend the Member for Blaby. We should be concentrating on public health education. We had our own public education campaign in this country back in the 1980s. We used television advertising, sent letters to every household, put up posters, and so on. It is absurd to believe that such a public education campaign could be replicated in Africa or India, but some elements of it could be. My hon. Friend was correct to say that when Governments start taking the issue seriously, there can be some improvement in the figures. That was

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established in this country and it is precisely what has happened in Uganda. The Ugandan Government have broadcast their concerns to the public, resulting in successful public education.

Mr. Rowe : Does my right hon. Friend agree that one of the paradoxical consequences of our highly successful public education campaign is that the new generation have almost forgotten the risks? There is clear evidence that the incidence of sexually transmitted disease in this country is rising sharply, and that will inevitably bring with it an increase in HIV-AIDS. Does my right hon. Friend agree that it is time for the Government to take seriously the risk of HIV-AIDS in this country?

Sir Norman Fowler : I am grateful for that intervention, which brings me to my next point. There is an example in this country, which is relevant to international discussion. We took the risk very seriously at the end of the 1980s and into the 1990s. I do not feel that we are taking it so seriously today. The Minister is not from the Department of Health, but he obviously keeps in close contact with it, and that Department promised a strategy paper on HIV, not one or two years ago, but four years ago. My point is not really party political. Everyone on both sides has been disappointed by the Department's slowness in producing that paper--we are still waiting for it.

I cannot believe that we would have waited four years for a consultation paper to deliver a strategy on a different kind of issue. Will the Minister give us some guidance on when the strategy will be published, given that we are probably in the last days of this Parliament? We have all been long-suffering and good humoured about the matter until now.

The Parliamentary Under-Secretary of State for International Development (Mr. Chris Mullin ): I can put the right hon. Gentleman out of his misery and tell him that the HIV-AIDS strategy will be published next week.

Sir Norman Fowler : That is very good news and I am extremely glad to hear it, but I take back not one word of what I said about the delay. Four years has been too long. I take it as a solemn promise from the Minister that the paper will be published next week, and I and the chairman of the all-party group on AIDS, the hon. Member for Walthamstow (Mr. Gerrard), will be very pleased.

Mr. Gerrard : I will be happy to see the strategy published. Is what is being published next week the DFID strategy or the Department of Health strategy? I suspect that my hon. Friend the Minister was referring to the DFID strategy.

Mr. Mullin : I am grateful to my hon. Friend. I meant the DFID strategy, for which I am responsible.

Sir Norman Fowler : I realise that I should not have believed that the Government would suddenly emerge from their slowness on the matter. They are not publishing the Department of Health strategy, which is, of course, what I was referring to. I said that several times and I underline it again. The Department of

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Health said four years ago that it would produce a strategy for HIV and AIDS. There is no debate on either side about that. The Department has been saying for a very long time that the strategy will be published shortly, and perhaps it will be. From what the Minister has said, however, there is no sign that it will be published next week. The international strategy might be, but the domestic HIV strategy paper is not due for publication, as far as the Minister knows.

My hon. Friend the Member for Blaby is entirely right: unquestionably, what is happening in Africa and Asia is more serious than the situation in the United Kingdom and in Europe. However, that is not a case for ignoring the state of affairs here and in Europe.

Although our figures are better than those of many other countries, including many of our European neighbours--thank God for that--we should take only limited comfort. The Public Health Laboratory Service estimates that today some 30,000 people are living with HIV in the United Kingdom. That equates to a prevalence among those aged 15 to 49 of about one in 1,000. It also estimates that the number of people living with diagnosed HIV is increasing by at least 10 per cent. a year. That is one reason why the disease was given the highest priority in the recent overview of communicable disease undertaken by the PHLS. Although HIV is an entirely preventable infection--that needs to be repeated constantly--the past two years have seen real cause for concern in this country. In January this year the PHLS reported almost 3,000 new HIV diagnoses for the year 2000, a number that is set to rise as more reports come in. It is expected that the number of new HIV diagnoses recorded for 2000 in the UK will be the highest ever, once all the reports have been collected.

That is the problem that the Government should be tackling. It is not remotely a party political issue, but it is one that many of us feel strongly about. We should hate it if the progress that has been made was not followed up.

There is no cause for complacency anywhere. Self-evidently, there is no cause for complacency in Africa or in many countries in Asia. The international situation is the most serious. However, I hope that we shall not ignore the fact that AIDS is an international problem and that it affects this country and others in Europe. I accept entirely what my hon. Friend the Member for Blaby has said; numerically, the major problem is in other countries. I also agree with the hon. Member for Walthamstow that there is a need for an international fund. However, I return to the point that we should not concentrate exclusively on drugs and treatment. We also need to try to prevent people from getting HIV in the first place. That must make sense. We need to make that an aim of our policy, and consider how we can most effectively put over the public health education message in other countries, not just in Europe.

11.43 am

Mr. Andrew Rowe (Faversham and Mid-Kent): In this age of e-mails, I understand that the Post Office service is now known as snail mail. With a small adjustment to the spelling, we might transfer the epithet to the Secretary of State for Health on the question of the AIDS strategy paper, which has not yet come out. The Select Committee report is full of suggestions about

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how the Department for International Development might assist the international community to take practical steps to alleviate this dreadful scourge.

Although I shall not spend long on the issue, I want to stress the fact that our big companies and banks could play a leading role in bringing together companies in sub-Saharan Africa to talk about how they can help to prevent the spread of the infection among their employees. They are not investing enough time, energy or money in that proposition.

We should all be challenged morally by the issue. It is easy to take what I would describe as the popular press view--if no British person is involved in a bus crash in Spain, it is not worth reporting--of the problem. If people in sub-Saharan Africa are the only ones who will die, does it really matter that much? However, we must remember that all people are equal in the sight of God and that we have a moral obligation to assist all our fellow citizens.

None of us on the Select Committee could remain unmoved when it was reported by the group that visited Cambodia, of which I was not a part, that in a conversation with a woman in a slum there, it became clear that, if she needed an operation to sort out her health, and she had other children to care for, the only way that she could pay for that operation would be to sell one of her children. None of us was unmoved. When, in this comfortable country of ours, we pontificate about moral attitudes and issues, we do so from a viewpoint that is often very far from the reality that gives rise to those attitudes. How does one argue with a woman who has other small children to care for, and who may die without the medical care that she needs, that she should not sell the only asset that she has--one of her other children? I would not wish to face such a dilemma in my household, and I do not think that anyone else would, either.

The problems will become increasingly acute as the epidemic sweeps across not only sub-Saharan Africa, but other parts of the world. We should always remember that Thabo Mbeki, whose reported views on the origin of HIV-AIDS are entirely wrong, is quite right to say, as my hon. Friend the Member for Blaby (Mr. Robathan) said, that it is inextricably linked with poverty.

The alleviation of the scourge is manifestly a matter of political leadership. The Select Committee's report described how, when a Minister of a Government fell ill with HIV-AIDS, he did not want any of his colleagues to come and visit him, because he could not stand the stigma that would be attached to his condition. I would have thought that the Commonwealth Parliamentary Association and the Inter-Parliamentary Union could both play a part in showing our parliamentary colleagues worldwide how important it is that they take the lead in removing the stigma from this dreadful condition.

I had a meeting in my constituency on Friday to discuss the question of drugs in one of the towns in my constituency--Faversham. The meeting was very interesting, not least because we had with us a number of families with members who were drug addicts and who had committed suicide or were in prison. Those

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families all told the same story. The children get bullied because their brother is a drug addict. The parents are shunned in the shops because one of their children is a drug addict, regardless of the fact that the others are not. If we, in this so-called civilised society, ostracise people for a misfortune that could happen to any of us, how much worse is it that whole societies overseas are ostracising people with a disease--even though perhaps as many as 30 per cent. of a given age group are falling victim to it?

Social attitudes to people with the disease are partly determined by the fact that it is the incidental infections, not the disease, that kill the victims. People can use that as a mask and pretend that TB or some other illness carried the victim off. If we cannot change those attitudes, we will not make the progress that we need. We as parliamentarians--perhaps I should say my successors as parliamentarians, because I am retiring--should take on board the thought that we can use the CPA and the IPU to increase awareness.

I am concerned about HIV in India. We are deluding ourselves if we believe that health service provision there will be robust enough to cope when the epidemic really takes hold. The health service in some states in India may well be able to cope, and I met a Minister in the national Government--he may have moved on by now--who had an intelligent strategy for dealing with HIV-AIDS. However, I believe that the disease will spread like wildfire in India, and the idea that there is a cultural barrier to promiscuity is a myth. It is interesting how all the nasties come from abroad--it's the foreigners wot brings them in. It does not matter which country one is in--it is never the native people, but always the foreigner who is responsible for importing the nasties.

Some of my colleagues went with me to what looked like a small housing estate on the outskirts of a town called Bogra in Bangladesh. That is a Muslim country where, as we all know, promiscuity is banned by the Prophet and, therefore, does not exist. It struck me as marginally improbable that that small housing estate, which was actually a brothel of about 800 prostitutes, could have been established solely to service the relatively small number of foreigners who happened to pass by. Until countries accept the fact that the behaviour in sexual matters of some of the population is perhaps not as anchorite as they pretend, we shall make little progress. If the population is more than a billion, the incidence of HIV-AIDS does not have to be high for a large number of people to be infected. If that happens, the disease is bound to get dangerously out of control. To return to the issue of our own self-interest, the links between this country and India are very good, and the interchange of personnel between us is legion. If the disease gets out of control in India, we shall be at much greater risk than we are even now.

Mr. Robathan : That relates closely to a recent outbreak of TB in Leicester, which is just next to my constituency. The TB came largely from people who had been visiting India or the sub-continent, at least. TB and AIDS are linked, although I am not suggesting that any of the current TB cases have anything to do with AIDS. However, HIV infection can easily be brought to this

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country in the same way as TB. From time to time, we should stress the need for self-interest more because altruism is not as prevalent as it might be.

Mr. Rowe : Indeed.

Finally, I stress an observation that the Select Committee made in its report. The international community set the international development targets before the extent of HIV-AIDS was understood. As the report says, it is terribly important to understand that it is no good simply revising a target every time one finds it difficult to reach. However, when the basis of international development targets has been knocked to pieces by a scourge on such a scale, it is unrealistic for us to continue with a rod for our own back. We cannot conceivably reach the targets that were set before the scourge was understood. We need an international agreement about working together.

I shall make one more quick point. For goodness' sake, let us pour some resources into south-to-south education. A wonderful non-governmental organisation in Uganda keeps together a group of young people who have agreed to be tested for HIV-AIDS. Whether they are diagnosed as positive or negative, they support one another, work together and get involved in public education to help change the nature of the debate there. We should make sure that they have the resources to spread their expertise to neighbouring countries, because many of those countries are quite rightly becoming weary of being told what to do by white people from a long way away.

11.55 am

Dr. Jenny Tonge (Richmond Park): I congratulate the hon. Member for Blaby (Mr. Robathan) on securing this debate. My only regret is that it is not longer, because I could easily speak for an hour on the subject; it was one of my specialties before I entered Parliament. I regret that I was not a member of the Select Committee when the report was being prepared, as I would have found it interesting.

We have heard many statistics about AIDS. My introduction to AIDS in the third world was, as hon. Members may remember, driving from Kampala airport into the capital of Uganda. I was mystified to see piles of rectangular boxes outside little shops in every village that we passed through. Some were tiny, some were big. I did not realise their purpose until I asked one of our Ugandan escorts, who told me that the best business in every village in Uganda was making coffins for AIDS victims.

One can see AIDS walking the streets not only in Uganda, but all over Africa. If one is a medic, one knows, because the victims are extremely ill, have sunken faces, and are thin, listless and weak. Many have open or closed TB. It is patently obvious that that continent is suffering terribly from the disease. I would not say that it was as obvious in Asia--not yet--but it is certainly obvious in Africa, where 34 million people have AIDS. There are families of orphans. One in five South Africans will die before the age of 15. That is the equivalent of one child in every family.

Before AIDS hit the world, the diseases that most affected developing countries, such as gastroenteritis and malaria, always killed the very young, the very old

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and the sick. The trouble with AIDS is that it hits the young, fit, economically active members of the community. That is what makes it so destructive, and so different from previous pandemics. Kofi Annan described it as a global security threat, for all the reasons that we have heard, which is why I was surprised that it was not mentioned as a cause of conflict.

What can we do? I want to concentrate on three aspects. First, I shall deal with the so-called triumph of the South African Government over the drug companies. I emphasise that it is a triumph, because cheaper drugs are needed in all developing countries. The agreement on trade-related aspects of intellectual property rights must be renegotiated--or at least, some detailed work needs to be done on it. Drugs are needed for TB, malaria and gastroenteritis. They are needed also to prevent the vertical transmission of AIDS from mothers to babies. That simple treatment can be given to pregnant women to stop their babies being born with AIDS. It is needed, and it is affordable.

The idea that developing countries can use the sort of retroviral regime that we use in this country--it involves a complicated cocktail of many drugs and is often combined with special dietary requirements and special medical checks--is utter nonsense. If people in those countries hear that there is a drug to cure AIDS, we are done for. All the messages about prevention will go out of the window, and everyone will let rip.

One has only to look at the history of antibiotics in our country to see how true that is. If an antibiotic is useful on specific bacteria that cause a specific disease, the pharmacological companies will promote it and people will all want it from their doctors. A good and useful antibiotic, septrin, one of the ingredients of which is trimethoprim, was overused and badly used some years ago. People do not take correct regimes of drugs, but stop taking them as soon as they feel better, instead of finishing their courses. That leads to resistant bacteria, which is the other danger of thinking that AIDS drugs will be the answer in developing countries. If they are not taken properly, there will be further variations in the virus and further problems in the spread of the epidemic that we will have no way to treat.

I emphasise caution in thinking that drugs will be any use. We should put in a little plug for the pharmaceutical companies, as I want them to develop microbiocides. Those will be an interesting development in the treatment of AIDS. I also want the companies to put money into the development of vaccines. In the long term, a vaccine for AIDS would be tremendous: a greater contribution than the smallpox or TB vaccines. Many vaccine projects are already taking place. The all-party group on AIDS went to Oxford to see the work of Professor MacMichael. In Africa, 10 different trials are going on for different strains of the AIDS virus that affect Africans.

I am told by the international AIDS vaccine initiative, however, that there is a shortage of money. We must tackle that problem, about which little has been said so far. The Department for International Development started two or three years ago by contributing £250,000. It has now upped that contribution to £14 million. That is a tremendous advance, and it shows that the Secretary of State for International Development is on-message on the AIDS pandemic. Another development in the spending review, announced by the Secretary of State

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and the Chancellor of the Exchequer, was the measures to encourage pharmaceutical companies to engage in vaccine research. I would like to hear more about that, as little on the matter has been said.

Prevention is the only tool that we can use at present against the disease. The only message that we can safely promote is that education, health education and the use of the poor old condom form practically our only defence against AIDS. I apologise in advance if I offend anyone in the Chamber, but I want to make a plea. The Roman Catholic Church has tremendous influence in the developing world. We all know--we have seen it on trips abroad--that Catholic charity workers all over the developing world promote the use of condoms. However, that is not the same as a clear message from the Vatican to say that condom use is acceptable. Would that not be a pro-life message from the Church, rather than an anti-life message, considering that millions of people die from AIDS because they do not use condoms?

I urge everyone in the Chamber to put pressure on the Catholic communities in their constituencies to try to get that message through. The Tablet, a Catholic magazine, is working hard to promote it. A Vatican announcement in favour of the use of condoms is vital and would have a huge effect on people in the developing world. At present, that is our only defence. We have seen wonderful projects, and hearing the hon. Member for Blaby talk about the play that we saw in the grammar school in Uganda took me back three years. A lot of us said at the time that our schoolchildren should be doing plays like that before the problem overtook us. A wonderful preventive message was going out and being taken on board by the children. We should push that message at every opportunity through health education and ordinary education.

That is why it is so important, as the right hon. Member for Sutton Coldfield (Sir N. Fowler) said, that we have a strategy for HIV-AIDS. We have waited four years, which is a long time. I do not know why we have had to wait so long. It is vital for the world that we have a strategy for the west, as well as a good strategy for the developing world from the Department for International Development.

Will the Minister tell us why spending on AIDS prevention has gone down in recent years, as noted in the Select Committee report? Last year, £700 million was spent on AIDS projects worldwide. The United Nations estimates that between £5 billion and £7 billion needs to be spent. If so, what initiatives will the Government promote at the UN Special Assembly in June? What will the money be spent on? Will it be for all projects remotely connected with AIDS or only for particular health projects, including vaccine research and drugs? I do not know, and we need more detail. What I do know, however, is that AIDS is one of the greatest catastrophes facing the world. It is a problem not only for the developing world, because what happens there will spread to us as surely as night follows day--and night is what it will be if the AIDS pandemic spreads through western countries as it has done through developing countries.

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I end with a quote from the Select Committee's report, which is excellent, although it does not mention the Catholic Church, as it would have done, had I been present. In its conclusions, the report states that the real crisis of the AIDS pandemic is the

12.8 pm

Mr. Bowen Wells (Hertford and Stortford): I begin by congratulating my hon. Friend the Member for Blaby (Mr. Robathan) on securing a debate on such an important subject. As the hon. Member for Richmond Park (Dr. Tonge) said, it is probably the most important issue facing mankind.

The Select Committee's report was the product of all the time that its members spent on the Committee. In each country that we visited over the four years available to us, HIV-AIDS was a major topic, and my hon. Friend the Member for Blaby illustrated how important that is. The report notes that there are 13 African countries with adult prevalence of 10 per cent. and that potential gains in life expectancy will regress 17 years. That means that instead of reaching 64 years by 2010 to 2015 as previously expected, life expectancy will regress to an average of just 47 years. That represents a reversal of most of the development gains of the past 30 years.

What do those figures mean in a country such as Malawi? They mean that more teachers are dying of AIDS-related diseases than can possibly be trained to replace them. The impact on Malawi's capacity to educate its people is huge.

The conclusions of our inquiry make grim reading. As my hon. Friend said, in 1999, 2.7 million people worldwide died suffering from AIDS, which is more than three times the combined deaths from war, murder and violence. HIV-AIDS is also having a disproportionate effect on the poor, as many hon. Members have said in powerful speeches. The facts are starkly shown in the statistics. Of the estimated global total of 34.3 million people who at the end of 1999 were living with HIV-AIDS, 24.5 million were in sub-Saharan Africa and 5.6 million were in south and south-east Asia. HIV-AIDS prevalence in sub-Saharan Africa was 8.5 per cent. in 1999, compared with less than a quarter of 1 per cent. in western Europe. Some parts of Africa, including South Africa, have a rate of infection as high as 40 per cent. It is hard to imagine what that means for the complete undermining of the social community and of society. It will certainly lead to serious conflict and violence.

The report argues that poverty and HIV-AIDS are inextricably linked. First, there is the crisis of the global HIV-AIDS epidemic and the tragedy that it brings in its train. Secondly, sub-Saharan Africa has appalling levels of prevalence; levels of infection are so high that in many countries the collapse of the entire system is a real danger.

As the hon. Member for Richmond Park said, the only medical intervention, or semi-medical intervention, that will prevent HIV-AIDS from spreading is the

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condom. What else can be done? The most effective action to reduce the effects of HIV-AIDS on a country is to reduce the number of transmissions by promoting effective prevention. The means of preventing or reducing transmissions of the virus are already known, but we lack the will to make them work on the necessary scale. Uganda was given as an example of a country where, from the President downwards, interventions have been made and have had the effect that the hon. Lady illustrated.

Another example is Thailand, where the army's general field marshal recognised that unless the AIDS problem, which had been rampant, was dealt with, he would not have an effective army to fight in a potential war and defend the country. With the total support of the Government of Thailand, he went to every brothel and place where HIV was likely to be transmitted and gave direct orders to every male in his army to use condoms. The result was a dramatic fall in the incidence of HIV-AIDS in Thailand. It is therefore possible to produce the result that we are looking for by human, if not medical, intervention.

The report also addresses the question of care. We noted that all too often the debate about access to treatment for HIV-AIDS is reduced to one about anti-retroviral drugs--an issue to which the hon. Lady also referred. No evidence to the inquiry called for the purchase and donation of anti-retroviral drugs to be a priority for donor funds. The Secretary of State told the Committee that even at cost price, such drugs cost in the region of $3 a day per person and, as the hon. Lady said, the care for those undergoing retroviral treatment is very complicated and unlikely to take place in remote villages and towns in South Africa or elsewhere in the developing world.

In many developing countries, annual health budgets amount to little more than $10 per person per annum. The use of anti-retrovirals in tackling the disease is completely irrelevant to the main causes that we are talking about, and we should remember that--although greater access is needed to cheaper drugs for opportunistic diseases such as TB, malaria and gastroenteritis, which are the biggest killers in southern Africa. The provision of anti-retroviral treatments to people with HIV in the poorest areas of the developing world is clearly not a practical or sustainable development intervention. Donor funds and activities should concentrate on the prevention of further infections, the development of basic health care systems, the provision of palliative drugs and basic treatments of opportunistic infections. However, the report does conclude that there is room for price reduction for drugs to treat opportunistic infections, and we welcome efforts to secure access to cheaper drugs.

An analysis of the expenditure by 10 major donors on HIV-AIDS showed an increase from $59 million in 1987 to $293 million in 1998. As spectacular as that fivefold increase appears, during the same period the number of infections rose from 4 million to 34 million--an eightfold increase. In per capita terms, expenditure on HIV-AIDS has fallen from $22 per person living with HIV-AIDS in 1988 to less than $9 in 1997. That is a massive fall. Expenditure on HIV-AIDS remains at less than 1 per cent. of donor countries' total annual overseas development aid budgets.

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In the report, we examined DFID's expenditure on HIV-AIDS. Here I must make a confession. I got my noughts in the wrong place when I asked a question at last week's International Development questions. We think that the figure is £100 million or thereabouts--although, as the hon. Member for Walthamstow (Mr. Gerrard) said, DFID gave us several different figures in the course of the inquiry. It is interesting to note that since the end of the financial year 1999-2000, DFID has made several attempts to assess its expenditure on HIV-AIDS, on each occasion increasing its estimate of the amount spent. In our first oral evidence session with DFID officials, we were told that expenditure was running at between £20 million and £30 million per year and that it was anticipated to rise to £40 million in 1999-2000. By the end of the inquiry, we were told that the figure for 1999-2000 had increased to £54.8 million--not yet £100 million--and in an answer to a parliamentary question in January this year, DFID claimed to have spent more than £84 million on bilateral HIV-AIDS related work in 1999-2000.

What is the Department including in those figures? How has it made them advance so much in such a short time? Last week, at International Development questions, the Secretary of State put the figure for the same financial year at £100 million. How do we get there? I was glad to hear from the Minister that the HIV-AIDS policy is to be published next week. The report called for its publication, and we believe that it is essential. One of the effects of the report has been to make DFID look carefully at the whole matter, which had been spread around a range of subject areas.

Although we naturally welcome the increased funding, there is clearly some confusion as to what constitutes HIV-AIDS spending. In an effort to examine DFID expenditure in this area, we examined a list of DFID-funded HIV-AIDS and sexual health initiatives from 1992 onwards. We examined bilateral expenditure between 1992 and 2003. Because most projects lasted for a number of years, we averaged such expenditure out--for example, we valued a three-year project costing £3 million at a cost of £1 million a year.

I refer hon. Members to the results of our findings, which are reproduced in a graph in paragraph 256 of our report. Although the graph is not an accurate representation of year-on-year expenditure, it provides us with a crude sense of the regional spread of DFID's HIV-AIDS work. The graph makes striking viewing, showing that bilateral HIV-AIDS expenditure in sub-Saharan Africa rose rapidly in the early 1990s to a peak in 1997, but that has been followed by a considerable decline in that region. Over the same period, DFID's expenditure in Asia has risen more gradually, but has now levelled off at fairly high amounts.

Obviously, the graph does not take account of any new spending commitments announced since the start of our inquiry and, if any such commitments have been made since that time, we would welcome them, but the basic point remains: bilateral expenditure should be increasing. Although we welcome DFID's prevention work in Asia, any decline on bilateral expenditure in sub-Saharan Africa is unacceptable.

DFID has considerable leverage in many of the countries worst affected by HIV-AIDS. In 1999, DFID was one of the top three donors in eight of the 10 countries with the worst HIV-AIDS prevalence in the

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world. Furthermore, there has recently been a change in the political climate in Africa, with countries such as Uganda, Senegal and Zambia making serious inroads into tackling the disease. The report also calls for DFID to develop an explicit HIV-AIDS strategy, which we look forward to reading about next week.

HIV-AIDS is not only a result of poverty; it also entrenches poverty still further. The Committee has, as a result of its inquiry, concluded that donors, including DFID, have much work to do in assessing the impact of HIV-AIDS on the spectrum of their development activity. There is an urgent need to redesign development programmes, policies and approaches, particularly in sub-Saharan Africa, to take account of the new realities caused by HIV-AIDS.

12.21 pm

The Parliamentary Under-Secretary of State for International Development (Mr. Chris Mullin ): The hon. Member for Blaby (Mr. Robathan) has raised an important issue and I thank him for triggering a good debate. The HIV-AIDS epidemic is perhaps the most important challenge facing the world in the foreseeable future. He and others have graphically set out the scale of the problem and I propose to concentrate on what my Department is doing about it.

I shall start by knocking on the head any suggestion that DFID is complacent about the issues. Contrary to what is sometimes suggested, there has been no decline in DFID spending on HIV-AIDS. On the contrary, spending on HIV-AIDS related work, which includes sub-Saharan Africa, continues on an upward trend from around £62 million in 1998-99 to more than £100 million currently. Furthermore, we expect that upward trend to continue.

Rather than getting in a tangle with the hon. Member for Hertford and Stortford (Mr. Wells) over figures in the limited time remaining, I shall write to him and attempt to clarify the funding issues, which are complicated for reasons that I shall touch on briefly. DFID is increasingly helping to tackle HIV-AIDS in the context of large sexual and reproductive health programmes and sustainable health systems. In those circumstances, it is often difficult to attribute spending to particular aspects of sexual and reproductive health. For example, the provision of condoms serves the dual purpose of HIV-AIDS prevention as well as family planning and protection against sexually transmitted infections. We strongly believe that a cross-sectoral approach to tackling HIV-AIDS is essential if we are to be successful, and I know that the Select Committee shares that view. The hon. Gentleman will understand the difficulties in attributing particular amounts of spending to particular problems.

DFID currently supports HIV-AIDS related activities in 39 countries throughout the developing world, including Ghana, Kenya, Malawi, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, Zimbabwe, China, Cambodia, India and Russia. Sub-Saharan Africa will nevertheless continue to be a priority region. Areas of growing concern include Burma, Vietnam and neglected vulnerable populations in central and south America and the Caribbean, where the epidemic is growing faster than anywhere else in the world.

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As national strategic plans to tackle the epidemic improve, we have begun to place our support within the framework of those plans. Our HIV-AIDS strategy, which will be published next week, aims to balance immediate local prevention and mitigation measures with support for long-term initiatives. I realise that the hon. Gentleman is interested in the Department of Health's strategy, but I cannot help him today in that regard. However, I shall make inquiries and write to him.

In global terms, DFID's strategy aims to build political leadership and national capacity, to tackle underlying causes, to maximise the contribution of all sectors, to encourage a comprehensive approach that addresses both prevention and care, and to support research and development. DFID is a significant contributor to the global fight against HIV-AIDS, but it is clear that we cannot succeed alone. If we are to tackle the epidemic successfully, there must be a comprehensive response from donors, Governments, non-governmental organisations, the private sector, faiths and communities. I wholly endorse the comments of the hon. Member for Richmond Park (Dr. Tonge)--who has had to leave early--about the need for a strong lead from the Catholic Church. In terms of HIV-AIDS, we are a major contributor to the efforts of the UN AIDS programme, the World Health Organisation, UNICEF and the UN population fund.

At this point I should say something about the recent court case involving the pharmaceutical companies and the Government of South Africa. The case was regrettable and it is sad that the dispute came to court at all, but we welcome the settlement that has been reached. One hopes that we have all learnt from the experience. In our view, the way to increase investment in, and access to, new and existing medicines to tackle the diseases associated with poverty lies in co-operation between the pharmaceutical companies, developing countries and the international community. We will continue to do all that we can to facilitate that co-operation.

In the past year, we have seen welcome reductions in the cost of anti-retroviral drugs for developing countries. However, as hon. Members have said, even at reduced prices those drugs remain unaffordable for the poorest countries. In addition, they are very toxic and complex to administer, and constant monitoring of the treatment regime is required. Tragically, health services in many poor countries do not have the capacity to deliver those drugs and other treatments safely and effectively. It is therefore vital that basic health systems are put in place to ensure that the poor can benefit from the availability of TB and malaria care, reproductive health care and HIV-AIDS care and treatment.

The Government are considering a range of policy options for improving the affordability of essential drugs in poor countries. As part of the global child poverty initiative, my right hon. Friends the Chancellor and the Secretary of State for International Development announced several tax measures and purchase fund options to increase access to medicines in developing countries. The UK is working with other donors to mobilise additional resources. This morning, my right hon. Friends are chairing a breakfast meeting in New York with Kofi Annan and representatives of developing and developed countries to build support for

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the establishment of a global health and HIV-AIDS fund to help developing countries tackle the diseases associated with poverty.

We are also encouraging developing countries to do more to facilitate lowering the price of drugs. Import duties, trade barriers, customs restrictions and delays all contribute to increased prices. It is crucial that we do not let dramatic headlines distract us from doing the things that work well, and that have already saved countless lives. I have no time to discuss the details, but our policy consists of four broad themes: raising the profile of the epidemic; prevention in, and beyond, the health sector; care for people infected with, and affected by, HIV-AIDS; and improving knowledge and technology.

In conclusion, I should point out that the situation is not hopeless. As hon. Members have said, Governments such as those of Uganda, Thailand and Senegal have already demonstrated that the tide can be turned. Progress has also been made in countries such as Zambia and the Dominican Republic. Above all, what is required is strong political leadership from Governments who are committed to the welfare of their people. For our part, the UK stands ready to increase its support for Governments and institutions that are seriously committed to tackling this dreadful disease.

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