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Ms Keeble: It is of course important to think seriously about what might happen in China or elsewhere in Asia if an HIV/ AIDS epidemic got out of control, but there is a difference between what is happening in Asia and
 
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what is happening in sub-Saharan Africa, where high rates are compounded by dire poverty and, in some instances, collapsing economies.

Tom Brake: I agree to an extent, but we should not neglect the potential for an epidemic in Asia or eastern Europe. Irrespective of the conditions that prevail, there is still the potential for an epidemic on the scale that we have seen in many African countries.

Many populous regions in west and north Africa do not yet have generalised HIV epidemics, yet there is considerable migration in those areas. Let me mention in passing that I recently returned from a visit to Ghana with the previous Conservative spokesman on international development, the hon. Member for Buckingham (Mr. Bercow). I suggest that I should not share a visit with the hon. Member for Rutland and Melton, as the consequence appears to be a downgrading.

It was clear that the Ghanaian authorities were responding positively to the epidemic. A range of posters and billboards were on show. One billboard displayed the bottom half of a man's body—clad in trousers, I hasten to add—and the caption "If you can't keep it zipped, keep it covered". I thought that that conveyed the message very effectively. There was also a poster recommending abstinence, so there was an equal balance between the different views on how the problem should be tackled.

The Secretary of State mentioned education. I am glad that he has agreed to meet me, along with the former Conservative spokesman, to discuss our visit. Let me put on record now that there are problems with the fast track in relation to Ghana. Ghana has delivered a plan for education, but is short of funds. I hope that the UK Government will be able to respond.

I spoke earlier of the need to tackle the frontier of the epidemic. There is clearly a rationale in favour of focusing investment in HIV prevention on vulnerable countries where the epidemic is not yet general. In many such places, particularly throughout Asia, eastern Europe and the Caribbean, the HIV risk is not uniform. Key populations are especially at risk, including injecting drug users, men who have sex with men, and sex workers. When the Minister responds, will he tell us how much DFID is providing for the frontiers of the epidemic, as opposed to areas such as Africa where, regrettably, it is already well established? I should also like to know about the Department's policies and strategies for working with the populations that are most at risk.

Hugh Bayley (City of York) (Lab): I am slightly puzzled by the hon. Gentleman's references to the "frontier" of the disease. The one encouraging aspect of all this is that every child who is born without HIV has a chance of that continuing until puberty. Is not every one of those children the "frontier"? Should we not respond in a way that helps people at the frontier, whether they are in Africa, Asia or eastern and central Europe?

Tom Brake: Obviously I cannot disagree with that. I am simply saying that we need to focus on countries where HIV is prevalent, but also take account of countries where, although it is not yet prevalent in the same way, the potential is there.
 
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HIV/AIDS is causing death and destruction on a scale not seen since the plague. The UK Government are taking the lead in the fight against HIV/AIDS. They deserve credit for that—I am happy to put that on the record—but even the UK is falling short in its contribution to initiatives such as the global fund.

With the presidencies of the G8 and EU, the UK has a unique opportunity next year to right that wrong and thereby to help unlock the wallets of less generous donors. I urge the Government to exploit their presidencies ruthlessly. If they do not, tens of millions more people will die.

3.40 pm

Mr. Neil Gerrard (Walthamstow) (Lab): I welcome the fact that we are having this debate and can discuss the strategy that DIFID published in July. I was a bit worried when the Minister started to flatter me earlier because that does not usually do me much good with people whom I associate with politically, but I return the compliment by saying that it is important that there is political leadership. Both Ministers in the Department and the officials in its HIV team have made some important changes in the past year or two. There has been a shift in priorities in the Department.

The strategy was inclusive in the way in which it was produced. There was a lot of discussion during the development of the consultation paper and the strategy with people who work in the sector, with non-governmental organisations and with hon. Members whom the Department knew were interested. That makes a difference when such strategies are produced. It is a lesson that one or two other Departments could learn when developing policies. If there had been a little more inclusion of that sort, we might have avoided some of the problems that we have had in other policy areas in the past year or two.

Tom Brake: Top-up fees.

Mr. Gerrard: That is a perfect example.

The strategy said, and the Prime Minister has said this on a number of occasions, too, that the G8 and EU presidencies next year would be critical from our point of view, that, during those presidencies, the UK would ensure that AIDS was at the centrepiece of what we were doing, and that it was an issue of high political importance. I hope that that will be true for the Commission for Africa, too. I hope that, over the next few months, the Department and perhaps the Prime Minister will give some more detail of how we will ensure that, while we have the presidencies of the EU and G8, we will do something in terms of the global HIV strategy. I want to see what was said by the Prime Minister and in the strategy actually happen next year.

Tom Brake: Does the hon. Gentleman agree that time is short in relation to the UK's presidencies because they start in January and the Government need to be doing the ground work now?

Mr. Gerrard: Clearly, those presidencies last a fairly short time. I am sure that work is being done. It needs to be done now, so that we can move in and be able straight away to have the sort of influence that we want.
 
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The other issue that I want to raise in relation to the strategy is about co-ordination. The Secretary of State talked about donor co-ordination and the three "ones". Another thing that the strategy mentions is the need for coherence in the UK's development of policy. Page 3 of the strategy refers to improving

"coherence across UK policy-making on AIDS by establishing an informal cross-Whitehall working group on AIDS".

Perhaps the Minister can tell us what progress has been made on that. It has been said already this afternoon that AIDS is not just a health issue. We want to see action by other Departments, including the Department of Trade and Industry and the Department for Education and Skills. The all-party group on Africa report, which I have no doubt my hon. Friend the Member for City of York (Hugh Bayley) will talk about later, referred to what could be done perhaps by the Department for Education and Skills to help to train people and to develop skills that will be relevant in African countries.

So perhaps we can hear a little more about what is being done to set up the cross-departmental working group, so that we can ensure that all the relevant Government Departments are involved in implementing the strategy.

The third issue, which I have raised for the past two or three years, is our level of commitment to the global fund. I certainly welcome the doubling of our commitment, but despite that doubling, some 10 per cent. only of our spending on HIV/AIDS is going through the global fund. I wonder whether that 10 per cent. versus 90 per cent. spending balance is quite right. Important initiatives that have already been mentioned, such as the "3 by 5" initiative, are going through the global fund. At the present rate of progress, we will get nowhere near the "3 by 5" initiative commitments. That is very sad, and it sends an important political message. The making of big commitments not just by the World Health Organisation but by all the Governments who signed up to the "3 by 5" initiative was symbolic. If we fall well short of them, we will send a really negative message.

I do not want to dwell on statistics but it is worth considering one or two of the current figures. Of course, all figures are somewhat speculative because they depend on the extrapolation of diagnoses; however, most people who are infected with HIV do not know that they are infected. Our figures depend on such extrapolations to whole populations, on the diagnoses that do take place, on the testing of pregnant women, and so on. This year's UNAIDS report, produced at the Bangkok conference, suggested that between 34 million and 42 million people are currently living with HIV, the median of which is about 38 million. Some 58 million people have been infected at some point, 20 million of whom are already dead.

The report of the International Labour Organisation, which was also produced at Bangkok, suggests that some 26 million of the international work force are infected and therefore at risk. That shows the potential scale of the economic impact. I was also struck by a figure from South Africa, the scale of which is difficult to comprehend. Johannesburg, a city with a population half that of London, is intending to build five new cemeteries of 120 acres each to cope with the anticipated deaths and burials over the next decade.
 
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I want to say a little about the figures for the rest of the world, but to do so is in no way to diminish the importance of what is happening in Africa, which my hon. Friend the Member for City of York will discuss in due course. The situation in eastern Europe and central Asia gives real cause for concern. In 1998, some 30,000 people in that region were diagnosed as being probably HIV-positive. In 2004, that figure has risen to 1.5 million—a fiftyfold increase in just six years. In India, 5.1 million people are already infected. The rate of increase in infection in eastern Europe and central Asia is indeed frightening. To date, there have been 58 million infections throughout the world, yet according to the latest estimates, there could be 70 million new infections in Russia, India and China alone by 2010.

That is only six years away, which is a huge cause for concern.

I may be straying a little beyond the terms of the debate, but I want to say a few words about Russia—not usually talked about as a developing country. More than 250,000 HIV infections have been reported in Russia, but the real number is probably three, four or five times that. In the Ukraine, 70,000 infections have been reported, when the real figure could be as many as 500,000. We are already starting to see the impact on the economies of those countries and on health spending. It is possible that, purely as a result of HIV infection, Russia's general domestic product could be 10 per cent. down in a few years. The population decline that is already happening there could be grossly accelerated by new infections.

Russia is reaching the point of having a 1 per cent. infection rate in the general population, and I recall another country being mentioned earlier where it was 0.9 per cent. That 1 per cent. rate is usually regarded by UNAIDS and other UN development programmes as being the point at which the epidemic really tips over into the general population. We have seen what has happened before to infection rates in other countries. Once that 1 per cent. threshold is exceeded, it can be incredibly difficult to turn things back.

We need to be really concerned about these emerging epidemics. If we do not act now, we could see similar problems developing elsewhere as happened in sub-Saharan Africa. We need to reflect on the lessons of what has worked elsewhere, which is not easy because there is little hard evidence about what interventions appear to have worked in certain places. It is not that easy to take an approach that has worked in one country and transfer it to another. The reasons are often highly complex.

Uganda is cited again and again. One of the biggest problems there was probably the ending of the civil war. There is no doubt that the spread of HIV has been associated with civil war in parts of Africa. Whatever the reason, it is certainly complex and it is never easy to transfer across to other countries, but we have to take those risks. We need to look at what has worked before and be prepared to spend a bit of money. We are sometimes too demanding in what we expect from experimental programmes that we invest in. We need to be a bit more relaxed. Yes, we are expected to justify the spending of taxpayers' money, but sometimes I feel that we are too demanding in the degree of success that we
 
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expect. We should be prepared to take a few more risks because the nature of the crisis is such that, if we are not prepared to do so, some countries will be overwhelmed with the problem.

I hope that the Department for International Development will, over the next few years, become much more engaged with what is happening in the countries where epidemics are emerging—India, China and eastern Europe, for example, where there is real potential for disaster if we do not act. If we act now, we may be able to do something, but in three or four years' time, it may be too late.

My final point is about the consequences for us in the UK. Both the existing and the emerging epidemics have serious consequences for us. A very high proportion of those infected are in Commonwealth countries. If the epidemics develop as they might in Asia, even more people will be infected in Commonwealth countries, and many people in or on the borders of the EU could be infected. It is futile to pretend that international mobility will decrease.

I am sure that the opposite will happen, and with increased international mobility it is pointless to believe, as some on the right would like us to, that we can stop the spread of HIV through physical borders and migration controls.

People in the UK sometimes discuss "imported infections", which worries me, because it suggests that they think that we can put up barriers and insulate ourselves. We must recognise that the growing infection rate in parts of the world with which we have close connections and increased international mobility mean that we are part of the international epidemic. Too often, we talk as if what is happening in the UK is completely different from what is happening in the rest of the world, but there is one epidemic. The HIV virus does not care about immigration controls and international boundaries.

I hope that the Minister will confirm that we will not try to impose mandatory testing on people who enter this country, which would be bad for public health. The hon. Member for Canterbury (Mr. Brazier) raises his eyebrows, but mandatory testing would encourage people to avoid testing and find ways around those tests, such as producing false test certificates, which is a good way to spread infection.

We want people to take the test and receive treatment. I know that we cannot act as the NHS for the world and that we must have rules on who is eligible for treatment, but it will be extremely bad news if we go down the road of mandatory testing. Mandatory testing would sit strangely with the Secretary of State's opening remarks about the need to deal with stigma and discrimination on HIV, and I hope that the Minister will tell us that mandatory testing will be rejected.

I welcome the development by DFID of an HIV strategy, which is a significant step forward. Let us give the Chancellor credit for the last couple of spending reviews, which have provided big increases in funding. Some of us who have been involved with HIV for a good number of years are pleased by the political interest in the matter. A debate such as this would not have occurred 10 years ago, but now we have a strategy, Ministers who are interested in the subject and a Prime
 
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Minister who says that the issue is central to the EU and G8. I want to see the maintenance of that priority status and the implementation of the proposals in the strategy.

3.58 pm

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