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The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas): Absolutely.

Tom Brake: Well, as we have a fair amount of time for the debate, I am sure that the Minister will be able to set out the Government's role in some detail.

On Government funding, the Minister will know that Dr. Peter Piot announced on 25 November that HIV has received an unprecedented amount of political attention this year and that funding had reached its highest level—$4.7 billion, compared with $3.2 billion in the previous year. The Minister will also know that Kofi Annan said that the amount needed to deal with the pandemic is between $7 billion and $10 billion per annum. Should not more resources be allocated to tackle the pandemic, which risks reaching a massive scale in India and China? Should not that investment be made now? Is sufficient funding going to the global fund to fight AIDS, tuberculosis and malaria, and to other funds?

The Government say that they plan to double the amount going to UNAIDS. Can the Minister tell us exactly how much that will be and when that doubled core funding will be made available? It would be helpful if he could write to me setting out the Government's precise funding commitments to address HIV/AIDS in the developing countries for this year and the next five years. That would give us a clear picture so that we can see what those commitments deliver in future years.

Can the Minister comment on some joined-up government issues? The plan of action is welcome, but it is difficult to see how much co-operation there will be between departments on tackling HIV/AIDS. The Minister will know that there is a link between HIV/AIDS and food poverty—one can lead to the other. What discussions are taking place between Departments about issues such as the small arms trade? Conflict has a major impact on poverty and HIV/AIDS and on Governments' ability to put resources into tackling a major health crisis. If the UK continues to play its current role in supplying arms to developing countries, there must be greater controls to ensure that such arms do not end up in the hands of different militias—the ensuing conflict would exacerbate the health problems.

What else is needed? I hope that the Minister can comment briefly on whether the UK Government have considered the Canadian Government's initiative: to look into legislation that would allow Canadian manufacturers of generic drugs to export cheap copies of patented AIDS drugs to poorer countries. I understand that the Canadian measure would comply

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with the World Trade Organisation agreement on trade-related aspects of intellectual property rights. It is the first proposed by any G8 Government to meet the drugs needs of developing countries.

I know that there is a slight difference between our manufacturing industries, in that Canada has a strong generic drugs industry, but there is no reason that the UK could not initiate similar developments.

Have the Government received any representations from generic drugs manufacturers asking them to consider what Canada is doing, or from other drugs manufacturers asking them not to consider any such changes?

The announcement by the Department for International Development today, which was backed by the Prime Minister, is a rousing call to action. It reminds us that we ignore at our peril the warnings from the international community about the ravages of AIDS, and it also reminds us that we must not let the Government forget their pledge to make AIDS the centrepiece of the G8 and European Union presidencies in 2005. If we forget, we will have on our consciences the preventable deaths of millions of our fellow world citizens, and humanity would never forgive us.

9.15 pm

The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas): I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on securing this debate. He has done the House a favour by allowing us to discuss this issue on world AIDS day. In the past few days, we have had a series of key reports and announcements of further action by Governments and donor agencies across the world. I, too, wish to take this opportunity to pay tribute to the excellent concert initiated by the former President of South Africa, Nelson Mandela. Those announcements represent a significant moment in the mobilisation of resources across the world to fight the HIV/AIDS epidemic.

In the United Kingdom, we are beginning to step up our effort significantly, but much more still needs to be done. That point was emphasised by my right hon. Friend the Secretary of State for International Development when he attended the launch last week of the 2003 United Nations report on the state of the AIDS epidemic. The scale of the epidemic is, as the hon. Gentleman suggested, truly horrific. Some 20 million have already died from HIV/AIDS. This year, some 5 million have become newly infected, and some 3 million will die. On average, 14,000 new infections have occurred every day this year, almost 2,000 of which are in children under 15.

Some 14 million children have already lost one or both parents, a figure that is expected to rise to some 25 million by 2010. In the worst affected communities, children are often left to rely on elderly grandparents as their only support. Income in such households is likely to be lower than average. Households fostering orphans in rural Zimbabwe were found to earn on average more than 30 per cent. less than non-AIDS-affected households. Orphans are at much greater risk of HIV infection. They are less likely to attend school and more likely to suffer poor health. They are much more vulnerable to physical and sexual abuse. Evidence from Mozambique shows that non-orphans are three times more likely than orphans to be in school.

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People who are politically and socially marginalised, including women, migrant workers, sex workers and injecting drug users, are less likely to have access to health services and the public health information that they need to prevent infection. They are, therefore, much more vulnerable. In sub-Saharan Africa, women are 1.2 times more likely to be infected with HIV/AIDS than men. More than one in five pregnant women are HIV infected in most countries in southern Africa. Women, most of them elderly widows, shoulder most of the burden of caring. In Zimbabwe, more than 70 per cent. of carers are women over 70. Women are less likely to be cared for or to have access to services. Unfortunately, women with HIV or whose husbands have died as a result of HIV infection may lose inheritance and land rights, because of the discrimination that still exists.

The hon. Gentleman is right to say that countries in conflict are particularly affected by the epidemic. Young women and poor children are more likely to enter into sexual bartering and are acutely vulnerable to sexual violence. About 11 per cent. of Nigerian peacekeepers and 60 to 70 per cent. of the South African army are HIV positive. Demobilisation can also lead to an increase in HIV prevalence, as soldiers return to their home communities, taking HIV/AIDS with them.

Unless urgent action is taken, the epidemic will continue to turn the clock back decades in the battle against global poverty. It is worth touching on the sheer scale of the impact of HIV/AIDS on the very public services that we would expect to help in the battle against the disease. Education and health services—two of the key public services that one would expect to help in that battle—have been hardest hit. In Zambia, for example, teacher absenteeism because of HIV infection is expected to cut the number of teaching hours by about 20 million between 1999 and 2010. In Botswana, estimates suggest that up to a third of health workers may have been infected in 1999 and that up to 40 per cent. could be infected by 2005.

HIV/AIDS is not only weakening the capacity of public services, but placing new demands on them because of the number of people infected. There is a need for better education and better health services. HIV is already generating a tuberculosis epidemic, again increasing the pressure on already overstretched health services. There are indications that, in the worst affected countries, the ability of the state to ensure law and order has been compromised, as the bodies charged with maintaining stability are affected by HIV/AIDS and mortality.

Kofi Annan has again recently highlighted the need for leadership on the issue. Some countries have had considerable success in combating the epidemic, and one of the key reasons for that success is determined political leadership. For example, Brazil has managed to control its infection rate to a little over 0.5 per cent.—half that projected. Uganda has cut the prevalence of HIV/AIDS from a peak of 15 per cent. in 1991 to just 5 per cent.—still too high—in 2001. Early action in Senegal has kept the infection rate at 2 per cent. Strong political commitment and leadership has been at the heart of the response in those countries. President Museveni played a key role in leading the Ugandan effort to get early and decisive action from the different agencies of the Ugandan state.

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Other aspects of the political commitment that is needed include engaging a broad range of stakeholders in mounting a response. Civil society, local community leaders, religious groups and people living with HIV/AIDS all need to be brought on board, and the private and public sectors need to be lined up too. International donors are also clearly important in supporting those national efforts.

Leadership is essential in reinforcing strategies to combat this dreadful disease and in helping to deliver not only the access to treatment that is needed, but effective prevention work, which the hon. Gentleman rightly said must be at the heart of the international response. Leadership is also needed to minimise the economic and social impacts of HIV/AIDS on the rest of a country's people. Leadership is particularly important if we are to challenge the stigma and discrimination that prevents countries from making effective responses to HIV/AIDS. Where that stigma is pervasive, people will not come forward for testing or treatment. A major factor, for example, in pregnant women not finding out if they have HIV/AIDS is that they fear the reaction of their husbands, families and communities. We will certainly not be able to achieve the target of 3 million people on treatment by 2005, unless we continue to challenge the stigma and discrimination that those with HIV/AIDS face.

The hon. Gentleman asked what the United Kingdom is doing. So far, according to UNAIDS, we are the second largest bilateral donor on HIV/AIDS. In the past six years, our funding has increased from £38 million in 1997–98 to more than £270 million in 2002–03. Our contribution accounts for some 28 per cent. of all projected bilateral spending on HIV/AIDS—second behind the 35 per cent. from the United States. We are active in nearly 40 countries, and our bilateral funding supports the national HIV/AIDS strategies of developing country partners, involving all relevant parts of government.

In addition, we have provided £1.5 billion in support to strengthen health systems more generally in developing countries. Internationally, we have worked successfully to push the crisis up the agenda of all international bodies, including the United Nations, the G8 and the European Union. We have provided strong support for research, including more than £70 million for microbicides research, and some £40 million for the international AIDS vaccine initiative. We are also working in all 40 countries with non-governmental, private and multilateral partners to improve prevention, treatment and care programmes.

The hon. Gentleman rightly identified the need to look beyond sub-Saharan Africa, and to recognise the rising scale of infections in Asia, Europe and central Asia. To give an example of what we are doing, the UK has committed £123 million to India's national AIDS control programme and is supporting hundreds of Government-led programmes that are having a major impact in halting the rise in infection. A programme in Calcutta, for example, has seen condom use among sex workers rise from 1 per cent. to 90 per cent. In conjunction with the BBC World Service Trust, a popular television series has been developed there with strong HIV awareness and reproductive health education measures at its heart, reaching audiences of some 150 million people.

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The UK also works extensively through multilateral organisations including UNAIDS. As the hon. Gentleman said, we have increased funding to UNAIDS from £3 million to £6 million, which will kick in from 2004. We were a prime mover in setting up the global fund to fight AIDS, TB and malaria and we have already committed some $280 million over seven years to ensure that it has long-term, stable funding. By working through the World Trade Organisation, to which the hon. Gentleman alluded, the UK secured an agreement to enable those countries without manufacturing capacity to access cheaper medicines.

I am sure that the House will be pleased to know that the Prime Minister, as the hon. Gentleman mentioned, has accepted Kofi Annan's challenge and has already shown considerable leadership on this issue. On 20 November, with President Bush during his visit to this country, talks were held with African Health Ministers and other opinion leaders and NGOs on HIV/AIDS in Downing street. Next week, we will raise HIV/AIDS with other world leaders at the Commonwealth Heads of Government meeting in Nigeria. I can also confirm that the Prime Minister has accepted an invitation from the International AIDS Trust to become one of its co-chairs, alongside former Presidents Clinton and Mandela. The IAT has already played an important role in bringing together political leaders, parliamentarians, private sector leaders, women's leaders and business leaders to focus on HIV/AIDS.


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