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HIV/AIDS Overseas

2 pm

Mr. Nigel Evans (Ribble Valley) (Con): It is a great pleasure to have had this issue selected for debate. A number of eyes will be on other matters now that the general election has been called, but, despite the fact that we shall all be busy with other things, I hope that we shall have time to reflect on the policies that an incoming Government—of whatever persuasion—will adopt to deal with the pandemic of HIV/AIDS. I am therefore delighted to see the hon. Member for Walthamstow (Mr. Gerrard) in his place. He has done such a lot as the chairman of the all-party group on AIDS in the House of Commons and I welcome him to the debate.

The subject has been debated several times in the House during this Parliament, but we cannot debate it often enough. If we debated it every week, that would not be too often. Indeed, the Minister is responding to another Adjournment debate about HIV/AIDS today. The hon. Member for Northampton, North (Ms Keeble) will be   looking at a particular aspect of the problem of HIV/AIDS—the increasing number of orphans in Africa, with all the problems that that creates.

I shall look at the raw statistics, so that we can remind ourselves of the pandemic with which we are dealing. Although everyone talks about Africa, the issue goes much wider, so I want to look at some other regions. If several other areas do not learn the lessons of what went wrong in many parts of Africa, they, too, could face the problems that Africa faces today.

Sub-Saharan Africa is the region hardest hit. Some 25.4 million people live with HIV. Last year, an estimated 3.1 million people became infected, while 2.3 million people died of AIDS. The AIDS pandemic has cut life expectancy at birth to below 40 years in nine African countries and the number of orphans is expected to double by 2010.

Let me put those numbers in context. The number of people currently living with HIV/AIDS in sub-Saharan Africa alone is nearly equal to half the population of the entire United Kingdom. In fact, even though the region holds just over 10 per cent. of the world's population, it contains nearly two thirds of all HIV/AIDS cases.

In Zimbabwe, the situation is especially bleak. Just last week, UNICEF said that one in five Zimbabwean children are now orphans. More chilling still is the fact that one Zimbabwean child dies every 15 minutes from AIDS. That means that six children in Zimbabwe will die of this preventable disease during this debate if it runs its full course. Clearly, that is an outrage that we should simply not tolerate.

South Africa continues to have the highest number of people with HIV in the world. At the end of 2003, an estimated 5.3 million people were living with HIV. Added to that grim number is the fact that HIV prevalence among pregnant women is more than 27 per cent. That means that more than one in four expectant mothers have HIV, and many of them will pass that death warrant on to their children. Unfortunately, there is no sign of a decline in the epidemic, and the most recent data suggest that prevalence is increasing in all age groups apart from one.
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Although sub-Saharan Africa is the region hardest hit, it is not alone in facing the spectre of HIV/AIDS . In the Caribbean, for example, AIDS has become the leading cause of death among people who would normally be in the prime of their lives—those aged between 15 and 44. By 2010, life expectancy at birth is projected to be 10 years less in Haiti and nine years less in Trinidad and Tobago than it would have been without AIDS. We can see what is happening throughout the Caribbean.

Eastern Europe and central Asia have also seen the number of people living with HIV rise dramatically in the past few years. By the end of last year, an estimated 1.4 million people had HIV—a more than 900 per cent. increase in less than a decade. If there is any good news in these statistics, it is that most of the outbreaks in the region are still in their early stages and, if we want to do something about the situation, clearly we can. I was looking at some World Bank statistics on Vietnam, where £35 million has just been given to fight the AIDS fight. An estimated 250,000 people were living with HIV by the end of 2003 but, if that is not arrested, by 2010—just five years away—the figure will reach 1 million, which is extremely worrying.

Asia has a relatively low percentage of people living with HIV/AIDS, but I am still uncertain about whether a number of the countries are owning up to the reality of the statistics. The fact is that their populations are huge. China and India are especially worrying cases. I will mention India in a moment in another context. It has a huge population of more than 1 billion people. It has 5.1 million people suffering from HIV and that number is growing. That must be worrying. All 31 provinces in China have HIV cases. That shows us exactly what can happen in a country with a population of 1.5 billion. We must pay attention to what is happening in Africa, but we must not forget countries such as China and India; otherwise, the picture will be incredibly stark.

In Latin America, more than 1.7 million people are living with HIV. Two countries in that region, Guatemala and Honduras, are especially hard hit, with national adult HIV prevalence of more than 1 per cent. However, lower prevalence in other countries disguises the fact that serious, localised epidemics are under way. That is another point. It is the same with India. We can talk about 5.1 million cases, but they are not spread throughout India; they are in specific parts of India. That is what we must watch.

Worldwide, the total number of people living with HIV last year was estimated at 39.4 million, the equivalent of about two thirds of the population of the United Kingdom. Approximately 4.9 million people became newly infected last year alone, of whom about 640,000 were below the age of 15. As would be expected from those figures, the death rate is depressingly high. Last year alone, about 3.1 million people died from AIDS, including more than 500,000 children under the age of 15. Let me put that in context. That is like 18 jumbo jets crashing into the earth every day. If 18 jumbo jets were crashing into the earth every day, the world would want to do something about it. To take the context that I mentioned earlier, we have started the general election campaign and it will last 30 days.
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During the period of the election, which we will all be fighting, 250,000 people will die because of AIDS. That is how significant the pandemic is.

Mr. Neil Gerrard (Walthamstow) (Lab): I am listening with interest to the statistics. Does the hon. Gentleman agree that one of the other areas that is of concern is eastern Europe? If we consider the infection rates in some of the countries of the former Soviet Union, including Russia and some of the Baltic states that are either in, or soon will be in the European Union, we cannot regard this epidemic as being far away and of no concern to us. It is on our doorstep in those cases.

Mr. Evans : I am extremely grateful for those comments. Clearly, there are no borders as far as HIV/AIDS is concerned. It does not matter where one happens to be. As I said, we concentrate on Africa and clearly that is a huge problem, but HIV/AIDS is everywhere in the world. The hon. Gentleman mentions parts of Asia and central Europe. He is absolutely right. The problem is growing. That is my fear. If I could point out today that the number of new cases, or the number of people dying of AIDS was decreasing, I would be more relaxed, but I cannot be relaxed. There is only one area in the entire world where the figures are stagnant. They are increasing everywhere else.

Between 2002 and today, the number of people with HIV/AIDS has increased. In Asia, the figure has increased to 8.2 million; in eastern Europe during the last two years the figure has gone up from 1 million to 1.4 million; in Latin America, it has increased from 1.5 million to 1.7 million; in Oceania it has gone from 28,000 to 35,000—the figure is relatively low there, but it is still increasing—and in the middle east, it has gone from 430,000 to 540,000. No one talks about the number in the middle east. In the one area where the figure is static, which is north America and western Europe—I know it is increasing in the United Kingdom—the number of women with HIV/AIDS has increased from 390,000 to 420,000. That is how stark the situation is, and that is why we should not just concentrate on one area of the world. This is a global pandemic—that is what the word means—and we have got to do a lot more to tackle it at every stage.

We know that there is no cure for AIDS at the moment, although antiretroviral treatments can extend the life of those who are HIV-positive. The World Health Organisation estimates that nine out of 10 people who need the treatments are not receiving them. That needs to be addressed. The best medicine in the world cannot work if it does not reach those who desperately need it. Even worse, if this situation continues, 5 million to 6 million more people will die of AIDS in the next two years.

As devastating as those numbers are, they will only be a teardrop in the ocean of misery unless strong action is taken immediately. That is because the devastation of HIV/AIDS goes beyond short-term health concerns; it is a long-term economic disaster for all those countries. A World Bank report released in 2003 found that AIDS reduces economic growth to the point of economic collapse. It does that by destroying human capital—the people who work—and accumulated knowledge and experience goes with it. It also wrecks the foundations of
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human capital—education and family—and creates millions of orphans, who are less likely to invest in education and job training for their future.

Shanta Devarajan, chief economist of the World Bank's Human Development Network, notes that in countries with severe HIV/AIDS epidemics

Moreover, the WHO points out the mutually reinforcing link between HIV/AIDS and poverty:

Not only is HIV/AIDS devastating the current work force, but it affects future workers. The report goes on to say:

In an attempt to examine further the future effects of the HIV/AIDS pandemic, UNAIDS recently produced a study that examined three scenarios for the future of AIDS in Africa. Each makes certain assumptions about how the world will react right now and then imagines how those decisions will affect the world in a quarter of a century. I could go through each of the scenarios, but I shall not do so. All I can say is that each is fairly grim in its own way. Even the most effective approach means that many more millions of people will contract HIV, which will turn into AIDS at a later stage. The report points out:

Obviously, each of the scenarios presented can do no more than make an informed guess about the future, but remember that even the worst-case scenario 15 years ago did not predict the devastation that has been brought upon us all by HIV/AIDS. This is a wake-up call for us all.

I congratulate the United States of America on its programme for spending $15 billion with President Bush's emergency plan for AIDS relief. On 21 September, he said:

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One area in which the US is spending money is in building capacity, which is essential. Providing money is one thing, but we desperately need to ensure that countries can spend that money effectively. I said that the US is focusing on 15 countries, but it is active in 96 countries. That is essential. It also supports other projects, through other funding, such as the Global Fund to Fight AIDS and UNAIDS.

I want to mention the "Conservative Manifesto for International Development: Action on Global Poverty", which was recently published. On page 3, it says:

That is important, because this is not a party political issue. I know that there will be 30 days of us slugging it out throughout the country, and I hope that international development will not be one of the issues on which Labour politicians will point at the Conservatives and say that there is a threat that we will cut money there, because that simply is not the case. I am delighted to read, further on in the report, about the areas in which we want money to be spent most effectively.

I am grateful to Help the Aged, which sent me its briefing on the report, which considers the impact of HIV/AIDS throughout Africa, particularly on the elderly. I talked about the number of people aged between 15 and 44 who have contracted HIV or are dying of AIDS and about the number of orphans, but we forget the price that is paid by the older generation who have to look after the orphans. We must reconsider the holistic approach to HIV. It is not enough simply to help to treat those with HIV. We must consider the orphans and the grandparents picking up the tab.

I pay tribute to the hon. Member for Walthamstow, who I understand is standing down at the general election.

Mr. Gerrard : Certainly not.

Mr. Evans : In that case, I will not make the comments that I was about to make—no, I pay tribute to him.

The report "Treat with respect: HIV, Public Health and Immigration" is an important contribution to the debate and what we do in this country. A lot of it deals with the immigration into this country of people who are suffering from HIV. How we deal with such people is important. I welcome the report's publication and its contribution to the discussion on how to treat those who suffer from HIV. The problem is a global one; it is as simple as that. We know that the increasing number of cases in this country is because of immigrants. We cannot wash our hands of that fact or turn a blind eye to it. That is the reality, and we must ensure that everybody is treated equally.

I also pay tribute to another person who is not standing down: the hon. Member for City of York (Hugh Bayley), who chairs the all-party group on
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Africa, of which I was a member. Its report "Averting Catastrophe: AIDS in the 21st century" was an important contribution to the debate and I used it when I spoke in conferences on HIV in Canada and India. The report made many important recommendations such as launching the international finance facility and pushing for a review of urgent cases of unspent funds in the European Union, to which I hope the Minister will refer. The quality of EU spending and its effectiveness worries me incredibly. Recommendation 24 states:

I shall refer to that later.

The group also brought out another excellent report entitled "The UK Government and Africa in 2005: How joined up is Whitehall?" It considers all aspects of the issue, although it admits that the report is not comprehensive. However, it looks at the pandemic and how there can be joined-up government in all Departments.

I spoke about India. From 31 January to 5 February, I attended the Commonwealth Parliamentary Association conference study group in New Delhi, which considered all aspects of HIV throughout the Commonwealth. It is staggering that, according to the United Nations Development Programme human development report 2004,

The footnote names those countries: Bahamas, Belize, Botswana, Cameroon, Kenya, Lesotho, South Africa, Swaziland, Tanzania and Zambia.

The report was comprehensive in its recommendations about what parliamentarians and legislatures should do. It asks for a multi-sectoral approach, which is right. It also suggests establishing a Select or Standing Committee on HIV/AIDS, which should produce a report on at least an annual basis. HIV/AIDS is so important that I hope that the incoming Government on 6 May will consider that recommendation very seriously indeed.

The report proposed:

One issue that was raised in India was the scandal of the number of doctors and nurses who are attracted from countries such as India and Africa to work in the health service here. Those trained health professionals should be retained in their own countries to deal with the problem of HIV/AIDS. I understand that some of our money is being used to train doctors and nurses in those countries, and that is all very well, but if once we have trained them they come to this country to work, that is a problem. We need to ensure that the doctors and nurses and professionally trained health-care providers are retained in their own countries.

I turn now to the issue of companies—British multinationals, basically—doing more throughout the world. One multinational springs to mind almost immediately: Coca-Cola. There is almost nowhere in the
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various parts of the world to which I have travelled in my relatively short time on this earth where I have not eventually seen the Coca-Cola sign. Its power in reaching out to the public in the remotest of villages is amazing. It can get its "Drink Coca-Cola" message across because its marketing expertise is second to none. It is better than many Governments in the countries in which it operates.

I was therefore interested to find out what Coca-Cola is doing in the battle to get the message across about HIV/AIDS and in helping to tackle it. It has set up the Coca-Cola Africa foundation, which is a partnership with UNAIDS specifically designed to make use of Coca-Cola's business systems. We must work out how Coca-Cola's strengths in marketplace infrastructure, local resources, marketing expertise and local community insights can be applied to other companies.

The Coca-Cola Africa foundation has supported programmes in 10 countries and assigned one of its marketing managers to work with UNAIDS. That is absolutely superb. It has rolled out projects in Kenya, Tanzania, Ethiopia, Egypt, South Africa, Nigeria, Morocco, Tunisia, Zimbabwe, Swaziland and Zambia, and plans are under way to do so in other countries. Not only Coca-Cola but the company's bottlers are involved. Coca-Cola estimates that it has 45 bottling partners in 54 African countries employing 60,000 people, so it can immediately get the message across to its workers.

I was also interested in the power of Coca-Cola's advertising and the ability to get the message across to their markets—the wider public. Celia Smith, who works for Coca-Cola in the United Kingdom, sent me a message saying:

We have to be concerned about the hard-to-reach districts that other people do not seem to be able to get to. Celia Smith continued:

That is leading by example.

I have also done some research into a number of other companies that I shall mention briefly. Barclays is everywhere in this country and, increasingly, in other
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parts of the world. It has its own programme that recognises that HIV/AIDS will have a potentially devastating effect on businesses, which will have a direct impact on the organisation, its employees and all relevant stakeholders. The company knows that that is in its own interests as well as its civic responsibility. BP has done exactly the same and has its own programme.

A few weeks ago, I met the HIV/AIDS director of SABMiller, the company that produces brands such as Castle Lager and Peroni. I had a lengthy conversation with him and I was impressed by what the company is doing for its work force to ensure non-discrimination and that all workers and families get educational packs. The scheme costs the company a fair amount of money. Anyone in SABMiller can be tested for HIV, and if they have got it, they will get all the necessary treatment from the company for free. That is absolutely superb. There is also confidentiality for employees so that not everyone knows that they have the condition. There is no discrimination whatever. I would like the sort of investment that SABMiller is making on behalf of its employees to be spread out.

I am delighted that we in the UK invest ever-increasing sums of money, as does the United States. However, the problem is absolutely massive. We cannot deal with it on our own, or even with the USA. We must be able to harness the huge power of companies throughout the world that operate in areas that are being devastated by HIV. That means looking at companies early on, in countries such as India and China, to ensure that they use their resources too.

I hope that the Government will respond to the Commission for Africa. The Prime Minister has already said that he will implement all the recommendations in the report, which we welcome. I hope that there will be a timetable and a proper audit, to ensure that all the recommended measures are effective.

I also welcome the Government's latest initiative—announced today, I understand—to provide £24 million to fund a trial to assess how well a microbicide gel can prevent HIV infection in women, which we now know to be the biggest killer in Africa.

The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas) : Just to correct the hon. Gentleman slightly, that money is to fund phase 3 clinical trials of one of the leading contenders for a workable microbicide.

Mr. Evans : I am happy to be corrected. We know that new infections are most prevalent among women. Everything that we can do to ensure both that women can access all the available treatments and that there is no discrimination between men and women in doing so is invaluable. The necessary research will cost a lot of money, and we should support it wherever it is conducted.

I conclude by asking the Government to ensure that their presidencies of the G8 and European Union are effective, and that they are audited, so that we can see what has been achieved. I mentioned the fact that by the end of this election campaign 250,000 people will have died of AIDS. To put that in context, let us imagine in that period the populations of Nottingham or Cardiff or Stoke-on-Trent or Plymouth or Wolverhampton being wiped out by AIDS. That is what we are talking about—that is how big the disease is.
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HIV/AIDS is a major crisis that requires immediate attention and action. As Professor Richard Feachem correctly argues:

He is right, but we are not doing the right things. Dr. Piot has argued that

HIV/AIDS is a pandemic that is not going away. We must act now. It is far too easy to pay lip service to the problem, to pose for cameras and to make speeches. We can all do that, but the victims of HIV/AIDS need more than that. They need real, practical action to save them and their future. They deserve nothing less and nothing less will do. Fortunately, failure is not inevitable and success is not impossible. Working hard, we can overcome the disease. Millions of people around the globe are looking to us to do something and we must not disappoint them.

Mr. Deputy Speaker (Sir Nicholas Winterton) : The hon. Member for Richmond Park (Dr. Tonge) has sent me a note to explain why she was unavoidably delayed, which I fully accept. As she is leaving the House, I am more than happy to call her to speak for the Liberal Democrats.

2.34 pm

Dr. Jenny Tonge (Richmond Park) (LD): Thank you, Mr. Deputy Speaker. My excuse was lame: my wires were completely crossed—I do not know how, but they were.

I welcome this debate, so late in this Parliament. We have had many debates on AIDS and I congratulate the hon. Member for Ribble Valley (Mr. Evans) on bringing the issue to the attention of the House again. He rightly says that the problem is massive. I do not think that in modern times we have ever faced such a weapon of mass destruction as the AIDS virus. It is quite extraordinary. We must not forget that what is Africa's problem today and perhaps the problem of India and south-east Asia tomorrow will be our problem the day after that. It is wrong for people to assume that this is a third-world disease—it is not. People are travelling, populations are mixing, and it will be our problem before we know where we are. Therefore, we must take great steps to deal with it, but we must take the right steps.

The one thing that I must get off my chest before I leave this place is the subject of antiretroviral drugs. I totally agree that if drugs are available in the west to keep people alive and allow them to live a healthy, productive life, they should be available to people in developing countries. There is no question about that. However, it is not a simple matter; it is not like dishing out aspirin. There is a problem with antiretrovirals.

As a medical practitioner for many years, I know how easy it is for intelligent people to forget to take their antibiotics once they are feeling a bit better—I have
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done it myself. They forget for a few days and then think, "Oh, golly, I've gone away for the weekend and forgotten for two days. Oh, never mind. I'm better anyway." The huge danger with antibiotic and antiretroviral therapy is that, at the very least, people will forget to take the drugs, even if the drugs are cheaper and they have access to them. If that happens, resistant strains of the virus will pop up all over the place, and the science will not be able to keep up with them.

So what do we need? We need a tightly organised health infrastructure if people are to take the drugs properly. It is in their and our interest that they are taken properly; otherwise, the drugs, which are our only weapon, will become useless. Can we have an assurance from the Government that they have discussed with their international voluntary and Government partners the question of making the drugs available only if there is a proper health infrastructure to deliver them?

I point the Minister to the really wonderful example in Botswana. The hon. Member for Ribble Valley mentioned Coca-Cola. Ever since I came into Parliament, I have been beefing on about how Coca-Cola reaches parts of the world that other things cannot reach, and asking why a big container of condoms cannot be taped on to every bottle as it is distributed. Coca-Cola gets everywhere, and the condoms should be going with it. That is a good example of industry helping in the fight against AIDS, and I welcome what Coca-Cola is doing.

When I went to Botswana, I was hugely impressed by a public-private partnership called Debswana, which includes De Beers, the Government of Botswana, Merck Sharp and Dohme, and the Bill and Melinda Gates Foundation, which is funding much of the cost of the drugs. They have come together for all the people who work in the diamond industry—it seems that that includes most Botswanans—and have drawn up a tight regime. The workers are rigorously tested and then have to sign a contract. If they break the contract—it requires them to take the drugs properly and attend for check-ups and testing—they are in danger of losing their jobs and livelihoods. They will no longer receive drugs through that public-private partnership and will no longer be in the programme if they break the contract. They must stick to it.

Multinational companies get such bad press. Everyone castigates big companies, saying that they never do any good, they despoil the environment, they do not uphold workers' rights, they do not obey the guidelines of the Organisation for Economic Co-operation and Development. If only such companies would say, "Okay. Everyone, everywhere we are operating, will be part of a campaign to combat AIDS." That is the first thing; I have got it off my chest. Please let us not throw millions of pounds at antiretroviral drugs that will be a waste and will make the pandemic worse.

The other thing that I have to get off my chest is the fact that the United States Government, who say that they are putting $5 billion into the fight against AIDS, refuse to fund any reproductive health programmes because of the involvement of abortion. They are withdrawing from many of them, and programmes all over the world are failing because of that. They also refuse to allow cheap generic drugs, and it seems to me
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that the $5 billion that they are ploughing into the fight against AIDS is going straight to the big drugs companies in the form of subsidies for antiretroviral drugs. It is an important issue. I know that my ex-medical colleagues feel strongly about it and would want me to impress on the Government the fact that we must not waste those drugs.

I want to mention how important women's health is in the whole fight. Again, the hon. Member for Ribble Valley mentioned that. If people are being treated for AIDS, it is often the man in the family who gets the treatment. If money runs short, he gets the drugs and the wife stops. In my experience, it is always the women who lose out in developing countries.

Women's health is integral. I am delighted that, following the work done by the all-party group on population, development and reproductive health, headed by the hon. Member for Calder Valley (Chris McCafferty), and the report that it published, the Government have accepted that women's health, particularly their reproductive health, is integral to the fight against AIDS. The two have to go together; we cannot fight AIDS without doing something about the reproductive health of women. Improving women's health means not only access to treatment, but better childbirth—fewer accidents in childbirth, more trained midwives and more village birth assistants. It also means better access to health care for women. It means treating intercurrent infections such as thrush, chlamydia and trichomonas—all of which make women more susceptible to the AIDS virus. It means continuing our campaign against female genital mutilation, which does such terrible damage to women and ensures that the first time they have intercourse, if it is with an HIV positive partner, they will catch AIDS for sure because of the damage done by simple intercourse.

Such measures are terribly important, combined with family planning and women's ability to limit the size of their families. Their health is dependent on being able to do that. We should also always remember that even in my family the best bits of food go to husband and children. I still have the nauseating habit of making sure that the men and the children have had enough before I serve myself. It is a sad fact, but that is the sort of mother I am—is it not beautiful? Everyone will know that a lot of women are like that. They tend to serve up the food and then have what is left for themselves. In developing counties, when one bowl of rice goes between all, women get very little food. We must tackle that. We must also tackle the fact that women inhale more smoke from burning wood. Wood is still the staple fuel in developing countries and that affects their physical health and respiratory system in a big way. We must make moves on that.

All such things, together with microbicides—the Government's work on those is terribly welcome—are important in the fight against AIDS. It is not just about antiretroviral drugs. In my view—I must say that I am a "glass half empty" person when it comes to the AIDS pandemic—we may well lose a generation of people to the pandemic. However, we need to concentrate on prevention for the next generation. That means education and male and female condoms. It is a simple measure, but the message must get through about education and the use of condoms. Please God that the new Pope will have a different attitude towards
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condoms, at least for the prevention of infection. We need a change of policy worldwide. It must become a sin not to use a condom if a person thinks that they or their partner are HIV-positive. Although we accept that many things must be done about the pandemic, education and prevention will still be the biggest weapon, all over the developing world.

I want to mention three other things, briefly. They are big issues, and I do not want the fact that I do not give them much time to lead the House to think that I do not consider them important. One is the number of AIDS orphans being created by the pandemic. That is building up one hell of a sociological problem for the rest of the world. Children are growing up without parents, with ageing grandparents.

I am a grandparent to six grandchildren, and the Easter holidays were very tiring, although I am a well-nourished, healthy woman. For a sick, elderly grandparent in the developing world to have to take on a host of grandchildren is quite something, and we must concentrate hard on that issue. That means considering the matter from the point of view of the orphans, but I understand that Help the Aged wants us also to consider the needs of the people who must care for those children.

Mr. Evans : Does the hon. Lady recognise that, if even one parent has died and that parent was the breadwinner, youngsters have to work to help the family to survive? We talk about the education that the youngsters need, but they are denied schooling from an early age because the family does not believe that it can be an economic unit unless the youngsters go out to work. The poverty is reinforced when one or both parents die.

Dr. Tonge : The hon. Gentleman makes a good point and it is true that children are often denied education because they need to work—something that we are not familiar with in this country. We have long forgotten, although it is not so long ago—perhaps 150 years—that children did have to work to prevent their families from starving. That goes on in probably two thirds of the world today.

Lastly, I want to put in a plea for more vaccine research. As a medic, I know that a vaccine is the only answer. We have conquered—touch wood—smallpox in this world. It should be possible, with the help of vaccines, to conquer the AIDS virus eventually. My final words in this speech should perhaps be to pay tribute to the international AIDS vaccine initiative, headed by Dr. Seth Berkley in the USA. It is a brilliant organisation which has done the most extraordinary work and has pushed and fought for more money to go into AIDS vaccine research and into the companies that will make the product when it comes on stream. There is a huge amount to do in that area, and I pay tribute to the people who have been working on it. I hope that the Government will continue to support them.

2.48 pm

Mr. Alan Duncan (Rutland and Melton) (Con): I think that it was five months ago when we met in Westminster Hall to discuss HIV/AIDS. I calculate that in those five months probably another 2 million people around the world will have been infected by HIV, and perhaps another 1 million will have died from AIDS.
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It is clear that the HIV/AIDS emergency is the biggest threat facing humankind today. It kills 8,000 people every day. More than 40 million people are infected and for too many people lack of access to treatment turns a lifelong illness into a guaranteed death sentence. Every new HIV infection that could have been prevented is not just a tragedy but a scandal, so it is right that we debate the issues today.

We are all grateful, I think, to my hon. Friend the Member for Ribble Valley (Mr. Evans) for initiating the debate. He has a clear command of the issue and has shown continuing interest in it, as one could tell from all that he said today. I am also glad, Mr. Deputy Speaker, that you were able to call the hon. Member for Richmond Park (Dr. Tonge), and I am glad that she was able to speak. We are sorry that she is leaving the House, and that was probably her valedictory speech, but we wish her well. I want also to acknowledge her long-standing interest in international development and humanitarian matters, and the contribution that she has always made to our debates and proceedings, particularly on matters of reproductive health. We have heard that clearly today with her sensible analysis of how to treat HIV/AIDS, primarily in Africa but anywhere that it might exist.

The battle against HIV/AIDS is a political as much as a medical challenge. Political will is holding us back more than the absorptive capacity of Governments of developing countries. The scale of the epidemic must compel us to act. When historians in the future examine how our generation reacted to the crisis, no politician will be able to use ignorance as an excuse for inaction. At a global level, the political response has not until recently reflected the urgency of the situation. We might as well be honest—40 million people need treatment, yet it seems that the international community will fall far short of achieving the target of treating even 3 million people by the end of the year.

Despite recent progress, there is still not enough cash for the fight against AIDS. UNAIDS has estimated that it will take some £6.6 billion this year to counter the spread of HIV, and so far only about half of that has been forthcoming. The G8 launched the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2001; now it has an obligation to ensure that it is properly funded. When existing programmes come up for renewal, we must ensure that the money is there to pay for them.

The British Government have shown initiative on HIV/AIDS. I admit that, and I salute the Department's decision to earmark £1.5 billion for the AIDS fight and to include HIV/AIDS in all its bilateral activities. However, let us face it, we have to do more and there is a real problem on the ground. Treatment costs about $1 a day. Many people have to live on $1 a day. So, they can either be treated and starve or eat and die of AIDS. That is not much of a choice.

The best way to tackle HIV/AIDS is through a combination of preventive education, the provision of condoms, help for universal primary health care, the extension of antiretroviral drug treatment—despite what the hon. Member for Richmond Park had to say about the dangers of not consuming those drugs consistently—and the continuing quest for a HIV vaccine.
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Governments in the rich world must take strong and swift action to stem the spread of HIV; equally the Governments of countries with affected populations must demonstrate the political will to tackle the crisis. Charities, civil society, enlightened private companies, which my hon. Friend the Member for Ribble Valley described, and the families of people affected by HIV/AIDS must all play an important role in the battle against HIV. Politicians and Governments control resources of the magnitude necessary to win the war on HIV/AIDS, however. Where the political will exists, the fight against HIV/AIDS is winnable. Places as diverse as   Uganda, Thailand and Brazil have succeeded in slowing the spread of HIV through effective programmes of prevention and treatment. Those examples show that ultimate political responsibility lies with the Governments of those countries affected by the pandemic.

Uganda has shown that where there is strong, enlightened leadership, the spread of HIV can be brought under control. Equally, the South African experience shows the damage that can be done when the men at the top fail to comprehend the seriousness of the threat posed.

So far the global political response to AIDS has been focused—quite naturally—on sub-Saharan Africa. However, there are terrifying signs of a nascent epidemic in India and China, which between them are home to more than one third of the world's population. India is likely to be acknowledged as the country with the largest number of HIV-positive citizens in the world during 2005. Decisive action by the Governments of India and China could save the lives of millions of people in the coming years, but historically, at least, the Governments of those two countries have not lived up to their responsibilities to their citizens. Donor countries must assert quite bluntly that India's leadership in particular needs to wake up. If we see an explosion of AIDS in China and India, let no one say that we did not see it coming.

Mr. Evans : Does my hon. Friend agree that part of the problem with all this is that Africa was in denial for many years? It was a taboo subject, so it did not mention it, and it denied that it was happening. If China and India go down that path, they will suffer the same problems that Africa is suffering now. They can avert the tragedy of sub-Saharan Africa now if they stop their denial, have good governance and put in place proper and effective programmes.

Mr. Duncan : My hon. Friend is absolutely right. Early action is effective action, and no action can be too early. With that in mind, I shall explore how the British Government should deal with Governments who refuse to take HIV/AIDS seriously. How do we use our diplomatic influence to encourage the Government of any such country to take action to help to stem the spread of HIV?

Clearly, that raises complex and difficult issues of morality and diplomacy. I do not pretend to have all the answers myself, and I approach the matter in a spirit of curiosity rather than of criticism. We need to tread carefully. Outside interference in the domestic affairs of some countries is likely to be resented and might even be
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counter-productive, but perhaps the Minister will agree that there is one option that we simply must not choose—the option to do nothing.

Surely we cannot stand by and watch while HIV/AIDS ravages an entire sub-continent. There is a positive precedent for action. The recent report by the Select Committee on International Development on the Department for International Development's activities in India states:

I am happy to acknowledge that it goes on to salute the role that DFID has played in shaping India's agenda on AIDS.

It continues:


I would be interested to hear the Minister's assessment of the most effective and productive ways in which the British Government can influence the Governments of affected countries to live up to their responsibilities to their people.

HIV/AIDS is inextricably linked to poverty, so the solution to the crisis is indelibly linked to the wider goals of poverty reduction. Political leaders here can do much to address that poverty. Zambia has 1 million HIV-positive people, but spends 30 per cent. more on servicing its debts than it does on health. Kenya spends $0.76 per capita on HIV/AIDS compared with $12.92 per capita on debt repayments.

As well as AIDS-specific funding at this year's G8 summit and EU presidency, we need action for faster and deeper debt relief, for better aid, and for freer and fairer trade. I hope that I get the opportunity on 6 May to implement those objectives.

The Conservative party has advanced concrete and ambitious plans for action on those key priorities. Conservatives will increase spending on DFID from $4.5 billion in 2005–06 to $5.3 billion in 2007–08. We will work towards meeting the UN target of spending 0.7 per cent. of national income on international aid by 2013. Any suggestion that we would cut spending would be a lie.

Our studies have shown that significant efficiency savings can be made in the way in which the aid budget is spent. Every penny that we save will be ploughed straight back into DFID spending. That money will lift more people out of poverty, because we will spend it more effectively, by focusing it on the poorest countries and channelling more through non-governmental organisations, and less through the wasteful EU. [Laughter.]

Dr. Tonge : I cannot resist saying this. If the hon. Gentleman becomes the Secretary of State for International Development after 5 May—if pigs fly—I shall be watching from the wings every single penny that his Government put into international development. I shall haunt him until he fulfils all of those promises.

Mr. Duncan : I look forward to being haunted by such a gorgeous and delicious ghost. When I am sitting in the
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Secretary of State's office, I look forward to inviting her to come and give me the benefit of her advice and experience.

As I said at the beginning, we consider international development an area of consensus. We can argue where we have differences, and there may be a difference of emphasis on free trade. We may not actually need to argue on the EU, because although the Minister laughed just now, an answer to a parliamentary question that I tabled said that his Department was not happy with the fact that EU spending was devoted too much to stability in neighbouring countries and insufficiently to poverty reduction, which is what aid should be all about. The Minister is laughing only at his own parliamentary answer.

We will also support small-scale, environmentally and socially sustainable projects rather than large-scale, prestige, big-ticket schemes. We will make free trade fairer and fair trade freer. A Conservative Government will support a multilateral, rules-based trading system overseen by the World Trade Organisation—

Mr. Deputy Speaker : Order. I know that everyone is tempted to indulge in electioneering, even in humble debates in Westminster Hall, but I must remind the hon. Gentleman that we are concentrating on Government policy on HIV/AIDS overseas and not on general overseas aid and development.

Mr. Duncan : The two are of course inextricably linked, but I accept your strictures, Mr. Deputy Speaker.

We have laid down everything that we intend to do in our manifesto document, "Action on global poverty", which is available on our website for all interested readers. The policies set out in it will help secure the ongoing improvements in living conditions, which will help to stem the spread of HIV/AIDS. By combining compassion and generosity with realism and practicality, we will help end poverty and stem the spread of HIV.

3.3 pm

The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas) : It is a pleasure to take part in such a debate, and I pay tribute to the hon. Member for Ribble Valley (Mr. Evans) for securing it and for the bulk of his speech. He set out the continuing challenge facing developed countries to help developing countries, and in his focus on companies at the end of his speech, he rightly challenged us to do more to work with companies and the private sector more broadly to fight AIDS.

I join the hon. Member for Rutland and Melton (Mr. Duncan) in paying tribute to the hon. Member for Richmond Park (Dr. Tonge) and her campaigning record. She has been a doughty champion on women's issues in general and on development. She is an opponent with whom one cannot relax, and that is testimony to her ability.

Let me join hon. Members who have spoken by highlighting some statistics that demonstrate the scale of the challenge before us. In 2004, more than 3 million people died of AIDS, and nearly 5 million were newly infected with the virus. We are seeing a reversal of the
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development gains that have been made in sub-Saharan Africa in the past 20 to 30 years because of the HIV/AIDS crisis. Today, nearly 40 million people worldwide are living with HIV, the bulk of them in developing countries, and in 2003, an estimated 12.3 million African children were orphaned as a result of AIDS. Sadly, we know that the worst is yet to come. The number of children orphaned by AIDS is expected to rise to 18.4 million by 2010, and a growing number of them will be double orphans—children who have lost their mother and father.

The hon. Member for Ribble Valley rightly alluded to the challenges in Asia and to the real worry that we shall see in India, China and the rest of Asia what we are seeing in Africa. Indeed, if nothing were to change, India would have a larger number of people with HIV/AIDS by 2010 than any country in Africa.

My hon. Friend the Member for Walthamstow (Mr. Gerrard) does an excellent job chairing the all-party group on AIDS and, like other hon. Members, he rightly reminded us of the challenge facing eastern Europe, with its rising incidence of HIV/AIDS. I should add that there is also a growing challenge in the number of people infected with HIV in the Caribbean. That epidemic is being fuelled by the stigma and discrimination that surrounds people with HIV/AIDS, and we must continue to challenge that.

The hon. Member for Rutland and Melton was absolutely right that political will is fundamental to tackling HIV/AIDS. There needs to be political will in developing countries, and he highlighted several countries where there has been strong political commitment to tackling AIDS. Uganda and Senegal are two clear examples, and Brazil is another. Political will is also fundamental in developed countries. As rich nations, we have to make more money available for the fight against AIDS. An increasing amount is being made available, but we clearly need to do more.

The hon. Gentleman mentioned India. As he suggested, the British Government, through my Department, have been having extensive, ongoing discussions with the National AIDS Control Organisation in India and with the new Indian Government, as we did with the previous Government. I pay tribute to the new Government for deciding to increase the amount that they make available to fight AIDS. I also welcome the appointment of the new head of the National AIDS Control Organisation, whom I met when I went to India to discuss HIV/AIDS in September and October last year. Things are beginning to move in the right direction, and we are beginning to see a step change in the fight against AIDS. As Dr. Quraishi made clear to me, however, much more still needs to be done, and donors such as Britain clearly need to do more to support that effort.

Mr. Evans : I too talked to an Indian Minister, who said that the Government were in negotiations with Coca-Cola to replicate and harness the ability that it had clearly demonstrated in Africa. If they can do that early on with a number of other companies—perhaps companies based in the United Kingdom with divisions in India—that would be very effective. I hope that the Minister will at least allude to some of the things that the
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British Government will be doing to contact British companies so that they are proactive in India and other parts of the world, as well as in Africa.

Mr. Thomas : I will do just that if the hon. Gentleman will bear with me. However, I wanted to answer the last part of the point raised by the hon. Member for Rutland and Melton about political will. He asked what we would do if there were problems with the attitude of a developing country Government, and Burma and Zimbabwe are classic cases. There are real concerns about the growing AIDS epidemic in those countries, and there is clearly a complete absence of political will at the top echelons of their Governments to tackle the AIDS crisis. In such cases, we have to recognise that we cannot work through existing Government mechanisms, as we can in other countries in the developing world. We have to work through United Nations organisations and NGOs, and that, indeed, is what we are doing in both countries.

The UK is already the world's second biggest donor of AIDS and sexual and reproductive health assistance. I hope that the commitments that we signalled last July, when the Prime Minister launched "Taking Action", the UK's strategy for tackling HIV/AIDS in the developing world, underline still further our commitment. In that document, we set out how the UK will respond to the challenge of AIDS by promoting a comprehensive response to prevention—hon. Members rightly said that we must continue to focus on that—treatment and care. Our response will also involve addressing the social impact of AIDS, prioritising the needs of women—as the hon. Member for Richmond Park rightly mentioned—and young people including orphans and other young children made vulnerable by AIDS. My hon. Friend the Member for Northampton, North (Ms Keeble) will make strong representations on their behalf in an Adjournment debate in the Chamber later today.

We have committed some £1.5 billion of taxpayers' money to tackling HIV/AIDS over the next three years. As part of that commitment we have doubled our support to the Global Fund to Fight AIDS, Tuberculosis and Malaria, bringing our total support to more than £250 million through to 2008. At least £150 million of that £1.5 billion will be spent on programmes to meet the needs of orphans and other children made vulnerable by AIDS.

We have given additional funding of some £36 million over four years to UNAIDS to support its global leadership role in the fight against AIDS, and we have provided additional funding of £80 million over four years to the United Nations Population Fund to support HIV prevention and sexual and reproductive health work with women. As the hon. Member for Richmond Park said, that is not least because of the growing recognition that AIDS increasingly has a woman's face, to borrow the words of Kofi Annan. We will also use some of the £1.5 billion to increase support for research into microbicides and vaccines for HIV prevention, of which more in a moment.

The hon. Member for Ribble Valley touched on our presidencies of the G8 and the EU. He rightly said that they represent a huge opportunity for us to bring the world together to make further progress on HIV/AIDS. He will be aware of the Prime Minister's commitment to
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putting Africa centre stage for our discussions at the G8 summit—the Commission for Africa feeding into that process.

In terms of HIV/AIDS, we will focus on two areas during the presidency. First, we will try to make the money that is available for AIDS, and further money that we want to see become available, work more effectively. In too many developing countries there are simply too many donor missions. That ties up resources as the countries have to respond to the needs of each donor mission. We need to ensure that there is much more effective international co-ordination of our support for developing country Governments in dealing with HIV/AIDS. Secondly, we want to maintain the momentum that has begun to build up around HIV prevention.

The hon. Lady rightly paid tribute to the international AIDS vaccine initiative and the leadership of Dr. Seth Berkley, whom the Secretary of State and I have met several times to discuss the hunt for a vaccine and how we can step up efforts internationally. At the Sea Island G8 summit in 2004, the Americans rightly prioritised the need to step up our efforts. It is our responsibility as the G8's host this year to take that issue forward. There have been a series of meetings building up to our summit in Gleneagles, considering how we can find additional resources for a vaccine. It is one area where we want the European Union to show additional leadership. We are in discussions with the EU about how it might do that.

We also want to secure further support for sexual and reproductive health and rights services and further financing to accelerate development of microbicides. Again, we are talking to the EU, which has shown some leadership already on microbicide financing, to see whether it can find additional resources. On 9 March in London, we hosted jointly with UNAIDS, the Americans and France a ministerial conference: "Making the Money Work: The Three Ones In Action". Its aim was to take us towards agreement on more coherent national and international efforts to co-ordinate a more effective response to each developing country Government in the fight against AIDS, as well as looking at establishing the necessary financing framework.

The key outcomes were an agreement to mobilise funding to narrow the AIDS funding shortfall, which we currently estimate to be at least $8 billion over the next three years, with some $20 billion needed annually from 2008. Further necessary work to underpin those figures has started, as well as a process of agreeing the division of labour between the various international organisations involved in the fight against AIDS. Under the UK presidency, we shall host the global fund's replenishment conference in September, which will take place alongside a broader AIDS funding meeting, building on the "Making the Money Work" event. It aims to narrow the financing gap for AIDS. By the end of 2005, we want agreement among donors and the international system on a well co-ordinated and funded plan to tackle AIDS, so that we can move forward on all the issues that I have described.

I want to deal with some of the specific points that hon. Members have raised. The hon. Member for Ribble Valley highlighted the capacity issue, which is now the biggest challenge facing developing countries in
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their response to AIDS. Drugs prices were once the issue, but the Department is now working on the capacity issue. It is to provide an additional £100 million to the Government of Malawi, working with them to see what we can do to increase the number of nurses and doctors. Malawi has fewer than 30 nurses per 100,000 population, compared with 85 per 100,000 in Tanzania, and 1,000 health workers per 100,000 in Europe. That gives a sense of the scale of the AIDS crisis and the capacity gap. We are seeking to increase the funding of nurses and doctors in Malawi, in order to help to persuade them not to seek employment elsewhere, including in Europe.

Dr. Tonge : I was in Malawi a couple of years ago, when there was a 40 per cent. vacancy rate for doctors and nurses. Doctors and nurses said that they were leaving not in search of better wages—they would like to stay at home if they could—but because the hospitals and health services, such as they are, were completely overwhelmed by AIDS victims, who are left at the gates by relatives. In the wards that I saw, people slept two in a bed and two under the bed; they took it in turns to lie on the bed. What we saw, in what used to be a decent hospital, was absolutely horrific. That problem must be addressed. AIDS victims could be treated or cared for in the community if there were a community nursing structure. That would help the hospitals return to normal work, and would keep the doctors and nurses in Malawi.

Mr. Thomas : I accept what the hon. Lady says. To amplify her point, of Malawi's 29 districts, 10 have no Government doctor, and four have no doctor at all. That demonstrates the truth of her comment. We are seeking not only to pay the existing doctors and nurses more money in order to retain them in Malawi, but to expand training capacity to recruit more people and to invest more in the health infrastructure. We are also looking at what we need to do in the hard-to-reach areas, about which the hon. Member for Ribble Valley has specific concerns.

Dr. Tonge : I am sorry to dwell on this point, but it is terribly important for doctors and nurses to have some sort of stimulus when they are working in medicine and surgery, and to do something other than treat AIDS victims. When I was in Malawi, they were acting virtually as mortuary attendants. There was little that they could do, and that was the major reason for their wanting to get out. If the medical and nursing staff are to be retained, someone must get the AIDS victims out of the hospitals.

Mr. Thomas : I accept the hon. Lady's point that we must not only focus on HIV/AIDS but look in the round at health care in developing countries. Over the past eight years, we have spent some £1.5 billion on developing health systems in developing countries. Clearly, it would be nonsense if we were to focus only on AIDS. We must look at the broader picture. In that context, our programme in Malawi will be helpful, not only to tackling AIDS, but to health service capacity more generally.

The hon. Members for Rutland and Melton and for Ribble Valley referred to the numbers of people needing treatment. From June 2004, there were only 440,000
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people on treatment in developing countries. By December 2004, that figure had gone up to 720,000—a 75 per cent. increase—which is directly attributable to the leadership that the World Health Organisation has shown as part of its 3 by 5 initiative.

Mr. Alan Duncan : Why has the 3 by 5 initiative been such a failure?

Mr. Thomas : The initiative has not been a failure. [Interruption.] Let me finish the point. It has focused attention on hard-to-reach areas and on what we need to do to increase people's access to treatment. We need to recognise the very low base from which things started. I am referring to the number of people in developing countries who were on treatment when the initiative was launched. The fact that, in only six months, there was a 75 per cent. increase in the number of people on treatment is encouraging. We have some nine months until the end of 2005. It will be pretty difficult to hit the 3 million target, but I do not think that we will be far off it, and without the initiative we would not have made the progress that we have.

Clearly, as the hon. Gentleman says, more work needs to be done by rich countries working in partnership with the Governments of developing countries to get more people on to treatment. Fundamental to that is increasing capacity in the health service. An example of that is what we are doing in Malawi, which we hope will help that country.

Mr. Evans : On the point about targets, we can talk about percentages, but the real problem is that we are starting from a low base. Since the Minister has been speaking, more than 3,000 people have died of AIDS. That puts into perspective the real problem that we face. Surely we should be far more ambitious about the targets. The approach has to be unified—integrated not only within countries, but throughout the world.

Mr. Thomas : We have to have ambitious targets. Sadly, the target of 3 million people on treatment by 2005 was very ambitious, but it has focused international attention on how we get people on to treatment. The 75 per cent. increase in only six months last year is encouraging in its general direction. However, the hon. Gentleman is right: given the numbers of people who will potentially need AIDS treatment, this issue requires immediate international attention. I hope that the financing conference that we host in September and the global fund's replenishment
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conference will help to lever further resources into the fight against AIDS and the fight to make access to treatment more widely available.

The hon. Gentleman rightly paid tribute to the companies that are working extremely hard to give access to treatment to their staff who are HIV-positive and, in some cases, to the communities where the companies are based. He named various companies, and I shall give two examples. Diageo pledged to provide all its HIV-positive staff in Africa and their dependants with antiretroviral therapy for life. Anglo American has launched a partnership with the global fund to extend prevention and treatment programmes to local communities in South Africa. One outcome of the conference that the Caribbean countries asked us to host on fighting stigma and discrimination relating to HIV-AIDS in the Caribbean, which was held in November, was an agreement to work with the private sector more effectively in the Caribbean to focus its attention on these issues.

The hon. Member for Rutland and Melton launched an attack on the European Union that was pretty typical of what comes from Conservatives. Although the EU needs to do more to fight AIDS and poverty, we should acknowledge the considerable progress and the huge contribution that it has made to the global fund, for example. That has helped to lever in additional money.

The hon. Member for Richmond Park touched on the importance of education. I am sure that she will have been pleased by the launch at the end of January of our increase in funding for girls' education. We shall continue to work, through the fast-track initiative, to focus on countries where the challenge on access to education is particularly severe. I have touched on the hon. Lady's concerns about vaccines and the work that we shall do to step up a gear in that respect.

The only sour note in the debate was the sanctimonious nonsense about the Tory spending plans on development, and I was surprised that the hon. Members for Ribble Valley and for Rutland and Melton chose not to mention their party's dismal record on international development issues. Nevertheless, I pay tribute to the hon. Member for Ribble Valley for securing the debate. It is always helpful for us to be reminded of the challenges posed by AIDS. The hon. Gentleman asked the Government to focus specifically on what else the private sector can do, and I undertake to continue to examine that issue.

Mr. Deputy Speaker : We have finished that debate a little early, but as the initiator of the next debate and the Minister responsible for responding to it are present, we can begin it some five minutes earlier than expected.
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