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1 Dec 2003 : Column 340


Motion made, and Question proposed, That this House do now adjourn.—[Paul Clark.]

8.56 pm

Tom Brake (Carshalton and Wallington): I am pleased to have secured this timely debate today, World AIDS day.

It is clear that unprecedented attention is being given to HIV/AIDS at this moment, so there is a great opportunity for increased funding and commitment. However, I believe that this window of opportunity is likely to slam shut shortly. World AIDS day contemporarily switched the media spotlight on to a global crisis that is killing millions and has orphaned 14 million children, but attention will soon revert to Iraq, where the scale of expenditure dwarfs the not insubstantial sums allocated to the battle against AIDS.

A range of initiatives are currently under way or have been launched recently on HIV/AIDS: the recent 46664 fundraising concert in South Africa; the 3x5 initiative, which will put 3 million people on anti-retrovirals by 2005; the Global Fund to deal with AIDS, TB and malaria. There has been comprehensive coverage of the issue by the BBC and in other media outlets in the past couple of weeks and there have been in-depth articles in many newspapers including The Guardian. We have heard from abroad that, for instance, Canada is looking at patent law changes that might well be relevant to the UK. Today, we have seen the launch of the Government's own statement, "The UK's Call for Action on HIV/Aids". The sheer range of initiatives highlights a risk that many of them might overlap.

There is also a risk that the appropriate focus placed on the AIDS crisis in the developing countries will perhaps lead us to overlook, or possibly neglect or minimise, the crisis that is still here in the UK. It is worth reminding Members of some of the statistics that relate to the UK. The number of people with HIV in the UK increased by nearly 20 per cent. between 2001 and 2002, and approximately 50,000 people are infected.

One third remain undiagnosed, so they are carrying HIV without knowing it, and without those close to them knowing. It is estimated that by the end of this year, 60,000 people will be infected. Gay men made up the highest number of people diagnosed with HIV in 2002.

There is another interesting point that relates to the UK statistics and makes the link with what is happening in developing countries. The majority—approximately 90 per cent.—of heterosexuals diagnosed with HIV in the UK actually acquired the infection abroad; some 80 per cent. acquired it in sub-Saharan Africa. That shows a clear link between what is happening in the UK and what is happening in the countries most badly affected by HIV/AIDS.

The international statistics are much worse, and much more alarming. More people became infected with HIV this year than in any other year since the beginning of the pandemic, and more people have died of AIDS than in any previous year. As hon. Members will know, treatment is not widely available, although it is here in the UK. Globally, only 300,000 people are receiving treatment—a fraction of the number of sufferers. In South Africa, for instance, 5 million individuals, out of

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a population of 40 million, are infected. We should all welcome the recent concert and the South African Government's belated recognition that this is a major issue.

This year, we have seen the highest level of spending on HIV/AIDS: $4.7 billion. That is welcome, given that spending in the previous year was $3.2 billion, but again, it is a drop in the ocean compared with what is required. I could read out other alarming statistics for many countries in the developing world. We are very familiar with what is happening in Africa, but something worse is coming down the road in terms of what will happen in Asia. Problems are already arising in eastern Europe, but given Asia's much larger population, the potential exists there for problems on a scale that we have yet to witness, even in Africa.

What has been the Government's response? First, I welcome the call for action, and the fact that the Prime Minister has formally backed it. That is only right, and it establishes the importance of this issue. The Prime Minister said:

He continued:

in the call for action.

That is welcome, but a memo leaked to The Guardian a few weeks ago—it was referred to in an article of 22 October by that paper's economics editor—stated that Britain was

I am willing to bet that, if my researcher had had time to do the necessary research this afternoon, she might also have found references to the UK presidency's being used to put the focus on reform of common agricultural policy, on raising environmental standards in the European Union, and so on. There may be a tendency to push more and more on to that agenda, and for the UK to say that it will focus on a range of issues. It is clearly impossible to make everything the centrepiece of the UK's presidency, and I hope that the Minister can say a little about how the respective priorities will be allocated to the very important issues that the UK will want to focus on during its presidency of the EU, and of the G8.

I state without reservation that it is clear that the Government recognise the risk of overlapping initiatives, and of duplication and double-counting; indeed, the call for action exists in part to address that issue.

The Three Ones initiative is one strategy and one commission, offering one way of measuring and reporting progress in different countries, which could help to streamline the funding process and ensure that the various initiatives do not overlap. However, it is worth examining the detail of some of the different programmes to illustrate some of my concerns.

The World Health Organisation's initiative is sometimes called the 3x5 initiative. The WHO will lead that effort and provide emergency response teams at the request of Governments. It will work with treatment implementers and establish an AIDS drugs and

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diagnostics facility to assist countries and implementers in their work. It will publish uniform standards and simplified tools to track the progress of ARV treatment programmes, and it will start the emergency expansion of training and capacity development for health professionals.

Let us examine what the Clinton foundation aims to do. The initial remit seems straightforward enough—and seems completely different and separate from the WHO programme—in seeking to reach agreement with drugs manufacturers on a major reduction in the price of AIDS medicine, which should obviously be welcomed. However, the agreement covers ARV drugs delivered to people in Africa and the Caribbean and will also contribute to working with Governments to set up countrywide integrated care, treatment and prevention programmes. One can see the potential there for some overlap. The Clinton initiative aimed to have 2 million people in receipt of medicines by 2008—a slightly different target.

The Minister might say that all those aspects are rolled into one programme and that although the different initiatives appear to talk about different components, if we add them all up together, they are all perfectly dovetailed. I would like to think that that is so, but it is not immediately evident from the work of the different organisations.

The Clinton initiative involves working in Africa—Mozambique, Rwanda and South Africa in particular—but the US emergency plan for HIV/AIDS relief will also operate in Mozambique, Rwanda and South Africa. Clearly, there is potential for overlap or for different programmes to operate in the same country. The American plan has a slightly different target, aiming to prevent 7 million new infections, to provide ARVs to 2 million additional people with HIV and to care for 10 million individuals, including orphans, with HIV/AIDS.

There is also the World Bank initiative on HIV, which looks into the scalability and cost-effectiveness of programmes and talks about working in different countries in Africa. I have not examined it in detail, but I suspect that it will overlap in respect of the countries that I just mentioned. The only programme so far that does not seem to overlap—it could be a reflection of the level of information that I have about it—is the Bill Gates Foundation programme, where the initiative seems to be focused on providing funds. However, the detail could reveal that it is also about setting up specific programmes, which could overlap with others.

I am sure that my simple question to the Minister will require a complex answer. How does the Department intend to work with all the different initiatives and what role will it and the Government have in attempting to ensure that they all dovetail properly, do not overlap, do not duplicate effort and do not double-count the number of people treated by the different programmes? As alluded to in the Government's call for action, some developing countries spend more time trying to negotiate with the different donor programmes and donors than in treating the epidemic itself—a key issue that the Government must deal with. The call for action partly addresses that, but we need to see more detail, which I hope will emerge from the Government's consultations.

There has clearly been a shift in the Government's emphasis.

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That is mainly the result of the welcome reduction in the cost of drugs, but it may also be due to the fact that the death rate is accelerating. There has been a move away from the development of health systems and human capacity in developing countries to an approach that incorporates the actual delivery of HIV/AIDS treatment. Can the Minister tell us how those approaches will be incorporated both at the country level and in terms of the budget allocations? The Department appears to have announced a shift in emphasis, or possibly an equal focus, so does it anticipate having a continued role in HIV prevention?

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