---

The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas): I congratulate my hon. Friend the Member for Northampton, North (Ms Keeble) on securing the debate and on the way in which she continues to campaign on the issue. I appreciate the number of oral and written parliamentary questions that she has asked on the matter and the considerable amount of travel that she has undertaken to investigate it, especially in Africa. I am also aware, from meetings that she has had with my right hon. Friend the Secretary of State and me, of her considerable knowledge of the challenges that we and the international community more broadly face when trying to scale up support for those orphaned by the terrible epidemic.

I also join my hon. Friend in paying tribute to World Vision and UNICEF, especially, with which I have held several conversations about the AIDS epidemic in general and specifically about how we should respond to the orphan crisis. I also join her in paying tribute to the organisations that she met on her travels in Africa to examine the issue to which she referred, and, indeed, to the National Children's Home and SABMiller.

The sheer scale of the AIDS pandemic is well know to all hon. Members. The number of people affected is truly staggering and, as my hon. Friend said, increasing each year. However, the matter that clearly concerns us today is the tragic plight of children affected by AIDS. The increasing numbers of poor children who are living with HIV, or orphaned by AIDS, cannot fail to move us, as the example that she cited in her opening remarks made clear. I visited the Dukhathole township in Germiston, near Johannesburg, in May 2004 to see a project that we are funding, which Christian Aid and the Anglican Church are running, so I know about the scale of the challenge in just that one township. Support is being provided to those who are helping orphans and vulnerable children to access primary education and helping people to claim benefits to enable the provision of healthy food and reasonable-quality lives. Remarkable women in the township support orphans, and grandmothers and other relatives, by looking after orphans and other vulnerable children. I completely accept the fundamental point behind my hon. Friend's speech: we need to do more.

My hon. Friend also talked about the social cost of AIDS, with many families losing one or two breadwinners. The number of children orphaned by AIDS is expected to grow from 12.3 million in 2003 to 18.4 million in 2010, and those figures are just for Africa. The risk of the AIDS epidemic taking off in a truly alarming way in Asia is fast gaining more international attention. The orphans crisis in Africa could perhaps become a significant problem there.

My hon. Friend has rightly focused the bulk of her remarks and campaigning work on sub-Saharan Africa. Already more than a third of households in Uganda are caring for at least one orphan. It is estimated that, by 2010, some 50 million children in Africa will have lost at least one parent and that nearly 40 per cent. of those losses will be as a result of AIDS.

There have always been orphans, of course, and in Africa they have always been cared for by their extended families. However, the effect of the AIDS pandemic is
 
5 Apr 2005 : Column 1395
 
undoubtedly stretching the ability to cope in many communities to breaking point. Orphans need caring for, so carers have to find extra resources from somewhere. As the number of orphans rises, less well-off carers have to make sacrifices. Children, most often girls, are taken out of school and families have to make do with less.

Increased poverty has a marked impact, not only owing to the immediate effects caused by poorer nutrition and poorer health, but also over the longer term. Children who are poorly nourished early in life will never reach their full potential. Poorer children often do not go to school. Evidence shows that, especially for girls, lack of education is associated with a higher risk of being both poor and of HIV infection. Hunger and poverty may lead orphans to exchange sex for money or food, so comprehensive sexual health services are thus fundamental to a truly effective and comprehensive approach. As my hon. Friend said, if we do not act to improve the opportunities for orphans and vulnerable children, poverty will continue to be transmitted down the generations, with millions denied the chances that they deserve.

The Government made their intention clear in the strategy on AIDS in the developing world, which we published in July last year. We have committed £1.5 billion of taxpayers' money over the next three years to tackling the HIV/AIDS epidemic, of which £150 million has been set aside for action to help orphans and vulnerable children. We shall also help orphans and vulnerable children through the doubling of our support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, bringing our total support to some £250 million through to 2008. HIV/AIDS orphans will also benefit from the additional funding of £36 million over four years that we provided to UNAIDS—the Joint UN Programme on HIV/AIDS—to support its global leadership work. That work focuses on the pandemic as a whole, but HIV/AIDS orphans are clearly part of that response. We are also providing additional funding of £80 million over four years to support the United Nations Population Fund's HIV prevention and sexual and reproductive health work with women. That, too, will help the fight against AIDS in the longer term.

My hon. Friend will know that our right hon. Friend the Prime Minister has said that the fight against HIV and AIDS and our work to highlight the needs of Africa will be the centrepiece of our presidencies of the G8 and the European Union. During 2005, we shall focus on two areas. First, our aim is to co-ordinate more effectively the money that is available for the fight against AIDS and to leverage in more of the resources necessary to fight AIDS in general, as well as to deal with the specific problem of HIV/AIDS orphans. Secondly, we want to maintain HIV prevention momentum and to ensure an adequate focus on balanced prevention strategies such as microbicides and vaccines to reduce HIV incidence globally. Again, that will help to provide further support for HIV/AIDS orphans in the long run.

Looking ahead, in September we will host the conference on replenishment of the global fund, back to back with a broader AIDS funding conference to
 
5 Apr 2005 : Column 1396
 
examine the needs of other parts of the international system. UNICEF will, no doubt, play a key role—my hon. Friend rightly mentioned UNICEF's crucial role in the fight against AIDS. Its strategic framework, which the UK was one of the first to endorse, provides guidelines for the global response to those issues. At the global partners forum in December in Washington, I was able to set out our initial thinking on how we will spend the £150 million that we have committed to children affected by AIDS. We are committed to spending £44 million of that support through UNICEF over the next three years.

Part of our funding will go towards supporting national Governments' analysis of the extent of the    problem and their planning of an adequate response. To date, 17 African countries have completed comprehensive national action plans to support children affected by AIDS. My hon. Friend rightly said that national action plans are welcome, but we must monitor how they are delivered on the ground. She was also right to focus attention on developing countries' capacity to respond to the challenges of HIV/AIDS. Whereas once the high price of anti-retroviral drugs constrained our ability to respond appropriately to the epidemic in many developing countries, the issue now is whether there are enough nurses, doctors and other workers to provide support on the ground.

Ms Keeble: Does my hon. Friend accept that although we have cheaper anti-retroviral drugs for adults, the same is not true of drugs for children? Getting the price of paediatric medicines reduced is also a major issue.

Mr. Thomas: I accept that absolutely. I would not want to suggest that we do not want to see more action to reduce drug prices further. I simply say that I think that my hon. Friend's point about capacity and the need to train up more people to help to provide support to orphans and vulnerable children, and more broadly to those who are HIV positive or have full-blown AIDS, is absolutely right.

In the context of the drugs that we can provide and are available at present to help children living with HIV, one of the things that we have been able to do to provide support through the £1.5 billion that we have set aside is to invest in trials of cheaper drugs. The particular one that I am thinking of is co-trimoxazole, which could halve the death rate for HIV infected children in Africa.

We have invested also in a new research programme to examine the provision of anti-retroviral treatment for children in areas where money, health staff and transport facilities are in short supply. We are already providing support to a range of civil society organisations, including organisations based in the UK—I gave the example of Christian Aid, which we are supporting in South Africa, which works with the Anglican Church there. There are other such organisations. We have recently increased our funding for those organisations with which we have long-term relationships. We have asked them, in a sense as part of their response to receiving the extra money, to prioritise additional work on HIV/AIDS issues.

My hon. Friend has brought forward a particularly interesting proposal. I am grateful to her for her recent letter, setting out her proposals to support the civil
 
5 Apr 2005 : Column 1397
 
society response to children affected by AIDS in sub-Saharan Africa. I can assure my hon. Friend that as a result of her letter we are considering her idea seriously. I have asked my officials to discuss it with other partners, including the UN and UNICEF in particular, to explore whether there are additional things that we can do in line with the idea that my hon. Friend has identified.

This is, as my hon. Friend has alluded to, a difficult area in which to reach the right partners in a sustainable way. There are real issues about how we provide support to community-based organisations that seeks to scale up sustainable support and allows the development of capacity on the ground.

It is right that we continue to prioritise the bulk of our funding on HIV-AIDS, so as to scale up the ability of Government to provide effective responses to the challenge in developing countries. However, I recognise that there are too many HIV and AIDS orphans in developing countries, particularly in sub-Saharan Africa, who are not getting the support that they need now. For that reason, my hon. Friend's proposal is timely. We are considering her idea seriously. We are
 
5 Apr 2005 : Column 1398
 
discussing it with partners. I hope that she will be willing to discuss the idea further with us at the Department, when our thinking has developed and after the election has taken place.

I believe that the £1.5 billion that we have made available over the next three years to scale up our response to HIV and AIDS orphans has set a template for others in the international community to respond to. I believe also that our replenishment conference for the global fund and our broader AIDS funding conference will help to scale up and to leverage additionally our funding for those members of the international community and those multilateral organisations that are playing such a key role in the fight against AIDS. HIV/AIDS orphans must continue to receive attention from Members of this place. My hon. Friend, as I have said, is a doughty campaigner on this issue. I look forward—

The motion having been made after Seven o'clock, and   the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.

---