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Hugh Bayley: I thoroughly agree with the point made by the hon. Member for Carshalton and Wallington (Tom Brake), and with the hon. Member for Canterbury (Mr. Brazier) when he said that we must stop taking African countries' precious resource of skilled personnel. One possible answer is to train people to do an African health worker's job—to work as a barefoot doctor—or an African teacher's job, so that their skills are tailored to Africa's needs. Incidentally, as a result those skills would be less transferable.

Mr. Brazier: The hon. Gentleman makes a very powerful point, and such an approach would improve the situation from both angles. Training could probably be completed faster if it were tailored to the local situation, and the non-transferability would be of considerable benefit. Some international bodies would doubtless object to that idea, but it seems to me a splendid one.

Drugs are at the heart of this issue. The long-term search for a vaccine is vital—literally so; it means the difference between life and death for millions of people—but in the meantime we must focus on anti-retroviral drugs. It is a shame that more credit has not been given where it is due: to the pharmaceutical companies, which have shown considerable responsibility through their willingness to sell drugs in Africa at a tiny fraction of their market price. For example—perhaps I should not pick an example out, but this one comes to mind—six of GlaxoSmithKline's HIV/AIDS medicines are available in the poorest countries at prices that are discounted by up to 90 per cent. compared with developed world prices. We need to bring all the parties involved together to make this work, not just all Governments.

There is another small but important point. In order to establish whom to treat, we have to think about how to extend testing, which is a question not only of removing stigma, but of making the necessary resources available. Sadly, in some countries the ongoing disproportion between the resources available and the numbers of people involved make such discussions fairly academic. None the less, in countries where the situation is in the balance, and in those that are moving towards the 1 per cent. and 2 per cent. level, testing is absolutely critical in order to prevent that figure from increasing.

It is far too easy for us in the developed world to think of HIV/AIDS as somebody else's problem. On one point I do agree with the hon. Member for Walthamstow: although I am in favour of screening, it will never work completely. Doing something to tackle the problem is right not only in itself—all who are present today believe it right to do something—it is also vital to our own self-interest. It is easy to think of this as somebody else's problem, affecting nameless, faceless people who live a long way away. It is up to us not to pass the buck to another generation. We have to assist and educate; we have to nurture the sufferers and their orphans; we have to warn those who are not yet infected, but whose ignorance about the illness is one cause of its
 
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continuation. What our generation does about this problem will determine the course of history for a large part of the third world.

5.9 pm

The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas): It is a genuine pleasure to respond to what has been an excellent debate. I pay tribute to my hon. Friend the Member for Northampton, North (Ms Keeble), who has been a consistent advocate of more funding and more support for orphans and vulnerable children. I also pay tribute to my hon. Friends the Members for City of York (Hugh Bayley) and for Walthamstow (Mr. Gerrard), whose chairmanship of two all-party groups added considerably to the debate that preceded the preparation and presentation to the House of our strategy, entitled "Taking Action".

I am not sure that I would ever describe appearing before the Select Committee chaired by hon. Member for Banbury (Tony Baldry) as a pleasure, but I welcome the International Development Committee's emphasis on AIDS orphans, which helped us in our preparation and our work. I also pay tribute to the hon. Member for East Devon (Mr. Swire) for his helpful remarks in the debate. As ever, it is a pleasure to be presented with a long list of questions about what the Government are doing by the hon. Member for Carshalton and Wallington (Tom Brake), and it is also a genuine pleasure to be able to respond to the hon. Member for Canterbury (Mr. Brazier). I take this opportunity to congratulate the hon. Member for Rutland and Melton (Mr. Duncan) on his new position and to wish him a distinguished, but lengthy, spell as the shadow spokesman.

As all hon. Members have said, it is the scale of the AIDS epidemic that truly shocks. Some 25 million people are infected in sub-Saharan Africa alone, with 3 million of them becoming infected only last year. About 2.2 million people have died in Africa as a direct result of AIDS. If that were not blight enough, we can expect the 11 million orphaned in Africa to rise to 18 million by 2010, which is truly shocking.

It is right that the focus of our response to the epidemic is on sub-Saharan Africa, but the potential of AIDS to devastate communities in Asia, in the Caribbean, eastern Europe and central Asia must also drive our response to the epidemic. It is estimated that 7.4 million people have already been infected with HIV in Asia and that, outside South Africa, India already has the largest number of people living with HIV. We have a real window of opportunity now to prevent what has happened in sub-Saharan Africa from devastating India and other parts of Asia and the Caribbean. We must seize that opportunity.

I want to focus in my opening remarks on a comment made by Kofi Annan, who described the face of AIDS today as being increasingly that of a woman. It is worth mentioning that to the House. In sub-Saharan Africa, some 57 per cent. of infected adults are women, and some 75 per cent. of young people infected are women or girls. We know that women are more biologically vulnerable to HIV infection than men, but their susceptibility is reinforced by their lack of social, political and economic power in too many developing
 
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countries. That is why, as the hon. Member for Rutland and Melton mentioned, an abstinence-only response to HIV/AIDS is entirely inappropriate. Sadly, most HIV-positive women in Africa have been infected by their husband or sole monogamous partner. We need to recognise that in our response.

At the heart of the "Taking Action" document that we published in July are five aspects of what we believe to be the necessary response. First, political leadership is important. I hope that the House will agree that the fact that the Prime Minister launched the document with the Secretary of State is a sign of the UK Government's commitment to driving the issue up the international agenda. I shall provide more detail later of what we intend to do on HIV/AIDS during our G8 and EU presidencies. AIDS is consistently part of the agenda of both the Secretary of State and myself in our discussions with the Governments of developing countries.

In order to help promote our political leadership, I agree absolutely that civil society has a key role to play, as do faith communities. The hon. Member for East Devon rightly pointed out that some people far more famous than us, such as Bono and Bob Geldof, have played a crucial role in raising the issue high on the international agenda.

International action is the second pillar of our response. We must strengthen the multilateral system, which is one of the reasons why we have increased our funding to UNAIDS and to the World Health Organisation.

Funding is, of course, the most important factor that we must address in the coming months, and the commitment by the Chancellor of the Exchequer and the Prime Minister in the comprehensive spending review signalled to the international community the need to do more given the funding that the UK has committed. The EU has a role in providing more funding, and we will address the issue raised by my hon. Friend the Member for City of York on the European development fund with the Commission. It is worth putting it on record that the Commission and European member states have provided more than 50 per cent. of the global fund.

Fourthly, we need better AIDS programmes. Hon. Members and organisations outside the House rightly said that we needed to do more on orphans and vulnerable children. I hope that they recognise that we have listened to those concerns, and that orphans and vulnerable children have been raised up our agenda in terms of both funding and assistance that DFID country offices offer to developing country Governments.

Crucially, our decision, which the Secretary of State announced last September, to support the funding of treatment is a significant addition to better AIDS programmes and a more comprehensive response. The final element is better long-term solutions, including better funding for microbicide and vaccine research and—many hon. Members alluded to this point—consistent and continuing funding to develop health systems in country.

The hon. Member for Rutland and Melton asked a number of specific questions, and I shall try to address them. He asked about the support that we are giving to
 
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the National Aids Control Organisation in India. NACO has a new head, with whom I am scheduled to hold discussions when I visit India in three weeks' time, and NACO's attitude and response has changed. Sonia Gandhi deserves considerable praise for her speech at the world AIDS conference, which highlighted the fact that India must do more to respond to the threat of AIDS. Our official discussions with NACO and the ministerial discussions that we hope to hold will provide further opportunities to offer support in tackling the epidemic in India.

The hon. Gentleman asked about South Africa's attitude, which has changed dramatically, and that of President Mbeki in particular. South Africa has embarked on a comprehensive treatment programme on which 8,000 people are already being treated. The South African Government acknowledge that the implementation of their strategy has been slow because of weaknesses in some of their health care systems. Working with organisations in civil society, we have introduced a £10 million programme on AIDS in South Africa, and I hope that the experience of that programme will help the South African Government.

The hon. Gentleman and a number of other hon. Members asked about the National Audit Office report. The hon. Member for Banbury asked why DFID was particularly targeted, and it was a surprise to us, not least because we were about to start an internal evaluation of our response—perhaps the NAO got wind of it.

The hon. Member for Rutland and Melton asked whether we have a separate system for monitoring the impact of the money that we spend. The NAO report recognises that we monitor our response through our core business reporting systems in country. We recognise that we must respond to that specific recommendation, and we are looking to do so. It is also worth recognising that the NAO praised DFID's flexible and country-led response to the epidemic.

The hon. Gentleman asked about the US attitude. As the Secretary of State said, we must recognise the considerable contribution made by both President Bush and the US Congress and Senate in allocating some $15 billion to the fight against AIDS.

When President Bush visited the UK last November, he insisted on establishing with us a task force to look at how we can work more efficiently together in five African countries—Uganda, Kenya, Ethiopia, Zambia and Nigeria. That work is being taken forward. We have worked closely together to offer advice to the Kenyan Government, and all the relevant officers in the five countries that I listed are working with their American counterparts to provide the necessary advice and support.

I also wish to put on record my appreciation of the support and engagement extended to us by Randall Tobias, the American AIDS tsar. He has, quite rightly in my opinion, been the leader of the work to achieve co-operation.

The hon. Gentleman alluded to what he called the tension that arises when money is given to civil society organisations, as opposed to budget support. I think that there is a place for both options. The Government's
 
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funding of civil society organisations has increased by about 30 per cent. since 1997. By comparison, budget support represents about 15 per cent. of our bilateral funding programme. Where the conditions are right and there is good dialogue about AIDS and other matters, budget support is entirely the right option, but we must never forget the contribution made by civil society organisations, and especially those that are faith based. In many parts of Africa, they provide the tangible response and also the leadership that is needed in the communities that they represent.

Several hon. Members alluded to the huge benefits arising from the fall in drug prices. Clearly, we need to continue to work with the many pharmaceutical companies that have offered their support to the Governments of affected countries by, among other things, reducing the prices of anti-retroviral drugs. We need to continue to press for lower prices for those drugs, but we must also meet the challenge of getting anti-retroviral drugs out to the communities that need them. Continued support for strengthening health systems in those countries will be fundamental to that process.

Several hon. Members spoke about the need for better funding for vaccine research, and about the need for better co-ordination in the search for a vaccine. The House will know that the question of an AIDS vaccine was discussed at the American-led G8 summit at Sea Island. The British Government will lead the G8 summit next year, so it will be our responsibility to take that work forward. In due course, we will announce how we intend to progress the vaccine enterprise to which the G8 countries are committed.

I should point out that the British Government were the first donors to support the international AIDS vaccine initiative. In 2000, we offered some £14 million for that purpose and we are considering making further funding available to drive forward our response.

The hon. Member for Carshalton and Wallington asked a series of questions about the global fund. He was right to say that Britain will double the funding that it will make available over the next three years, and we have committed £250 million to the fund over the period until 2008. He asked whether the Government were entirely convinced about the global fund's effectiveness, and it is important that we recognise that the fund is still in its infancy.

Teething problems at country level are bound to arise. We have worked closely with the global fund to sort out problems highlighted by our officers, and we have had a very good response at all levels of the fund. Its director, Richard Feacham, has made a huge contribution to the fight against AIDS, and I want to place on record my appreciation of his work.

Improved and more effective co-ordinating mechanisms are in place. There is a problem-monitoring and evaluation strategy for the global fund's work, but we shall continue to work with the fund to make it even more effective in-country.

My hon. Friend the Member for Walthamstow asked whether we considered that we had got the right balance in our funding to the global fund. We must recognise that other international bodies have an important contribution to make in the fight against AIDS. That is why we continue to fund the WHO, and why we have
 
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offered additional funding to support that body's "3 by 5" initiative. It is also one of the reasons why we are continuing to support UNAIDS and have actually increased our funding. It is the lead international body when it comes to co-ordinating our response.

We are now offering the right level of funding to the global fund. We announced the increase at this point because the global fund is likely to have to go back to other donors next year to ask them for more money in advance to fund its further programmes. We are demonstrating our confidence in the global fund by committing double the level of support, and I hope that that will help to lever in further resources from other G8 donors and from the private sector for the global fund's important and crucial work.

The hon. Member for Carshalton and Wallington and my hon. Friend the Member for Walthamstow, and others, asked me about the G8 and EU presidencies and how AIDS will feature in them. In the call for action that we published in December, we said that we would make AIDS a centrepiece of both presidencies and that remains our intention. As I have said, we need to produce our response to the American-led initiative at Sea Island to promote a G8 vaccine enterprise, and we shall do so in due course.

During the Irish presidency of the EU recently, we worked closely with the Irish and Dutch Governments and the Commission to support events with a major focus on microbicides. We are committed to taking that work forward, not least because the prize of a workable microbicide is genuinely in sight. Those in the know suggest that we might be only four or five years away from that point. If we were to develop a microbicide that was only partially effective, some 2.5 million lives could be saved. The development of a microbicide is much more likely in the short term than a vaccine, unfortunately, and that is why we must not lose sight of the importance of funding for microbicide work.

My hon. Friend the Member for Northampton, North specifically asked about the issue of orphans and vulnerable children. In the evidence I gave to the Committee, I highlighted the fact that fewer than half the countries in Africa had completed a proper analysis of the AIDS epidemic in their country, only six had developed a national policy on how to respond to the OVC crisis, and only four had in place the protective legislation to make the policy a reality. One of our key tasks, which we pledged to undertake in the "Taking Action" document, is to work with UNICEF to put in place the proper responses in the 17 countries in Africa where we are working. I look forward to having the opportunity to demonstrate to my hon. Friend how that work is progressing.

Several hon. Members mentioned the impact of the private sector. The pharmaceutical sector has a crucial role to play and many British pharmaceutical companies are already doing considerable work. I welcome that. However, it is worth acknowledging how the pharmaceutical market is split at the moment. Some
 
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50 per cent. of the market is in the US, some 25 per cent. is in Europe and just 1 per cent. is in Africa. It is worth bearing in mind the scale of the work we have to do to even up access to medicines, not only for AIDS but for other diseases in developing countries. I look forward to helping to take that work forward.

My hon. Friend the Member for Walthamstow asked about the work of the cross-Whitehall group. We are working with the Department of Trade and Industry on a proper response from the British pharmaceutical industry. We are working with the Department of Health on our engagement with the World Health Organisation and on health worker recruitment, which other hon. Members also raised. We have a code of practice and we have worked to strengthen it. One of the problems so far has been that while it covered NHS organisations, it did not cover many of the private sector organisations that provide health workers for the NHS.

We are trying to address that by strengthening the code of practice. We have memorandums of understanding with a series of developing-country Governments where health worker leakage—for want of a better phrase—is not a problem. However, we must also recognise that there are many domestic reasons why health workers are leaving and try to address them in country. That involves continuing to focus on ways of strengthening the health systems in those countries.

The Foreign and Commonwealth Office has done an excellent job of ensuring that our embassies around the world emphasise the call for action and the strategy and highlight to their interlocutors in developing-country Governments what else they can do to promote action against AIDS.

HIV/AIDS is an enormous challenge and one of the greatest threats to eradicating poverty and achieving the millennium goals that hon. Members of all parties support. However, we believe that the challenge can be met. I hope that hon. Members acknowledge that the call for action and strategy that we published in July constitutes a significant step forward in Britain's response to the fight against AIDS. I look forward, as does the Secretary of State, to continuing to work with hon. Members in implementing that strategy.

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