Westminster Hall
Thursday 11 May 2006
[Sir Nicholas Winterton in the Chair]
HIV/AIDS
[Relevant Documents: First Report from the International Development Committee, Session 2005—06, HC 708 and the Government’s response thereto, First Special Report, Session 2005—06, HC 922.]
Motion made, and Question proposed, That the sitting be now adjourned.—[Claire Ward.]
2.30 pm
Sir Nicholas Winterton (in the Chair): I call the distinguished Chairman of the Select Committee, Mr. Malcolm Bruce.
Malcolm Bruce (Gordon) (LD): Thank you for that encouraging introduction, Sir Nicholas. It is genuinely a pleasure and a privilege to present the International Development Committee’s first report of this Session, which, appropriately, we published on world AIDS day.
The Committee was extremely appreciative of the international community’s commitment to eradicate AIDS. When we published the report, however, it was clear that the international community’s first target—getting 3 million people on treatment by 2005 as part of the “3 by 5” campaign—would be missed. I have no intention of delaying hon. Members by quoting from the report, which they can all read, but I shall pick up a couple of points to which I hope the Minister can respond.
The Committee had quite a debate about how to achieve the 2010 target progressively, and the hon. Member for South-West Surrey (Mr. Hunt) will have something to say about interim targets if he catches your eye, Sir Nicholas. We recommended that the Department consider including a target on access to treatment when formulating the public service agreement for the next comprehensive spending review, which is currently under discussion, and I would be interested to hear what progress the Minister can report.
We identified a particular problem with the treatment of children. There is not enough investment in paediatric antiretroviral drugs—the issue was raised at International Development questions yesterday—and the pharmaceutical companies have no real commercial interest in the issue, although the international community, the children and their families do have an interest in it. However, the relevant drugs, where they exist, are up to six times more expensive than equivalent adult treatments and are not designed for children. Antibiotics are also not always appropriately targeted at children with HIV/AIDS. Again, we would be anxious to hear what progress has been made on that.
The witnesses who came before the Committee raised several issues, and the Government addressed them in their reply. Although I accept withoutdemur the Government’s real commitment to putting
resources into tackling the problem and their determination to meet the end target, there was concern about a possible mismatch between the Department’s global ambition and individual out-turns in different countries. The Government rightly respond that it is up to each country to set its targets, but they are the major provider of support in many countries, and we are looking for a partnership. We expect the Department to be able to define its targets progressively so that we can monitor how well we are doing. We do not want to reach the end of the process, only to find that we have missed targets, when we could have identified the problem earlier and taken appropriate action.
My last point relates to the role of the International Monetary Fund. I raise it because the Government agreed with us, and particularly because their policy is to use budget support as a major way of funding recipient countries. Some glib things are said about the IMF, but the fund and the World Bank are major institutions, which operate in a much more complex fashion than some of the more simplistic arguments might suggest. Nevertheless, there is concern that the IMF, in its overall policy of trying to ensure that countries operate within a sound financial framework, may inhibit the diversion of resources to deal with the AIDS problem in a particular country. The Government agreed that that was a cause for concern and hoped that the IMF would not do that.
A comment from the Minister would be helpful on how our role in providing budget support can come alongside the IMF or act as a buffer between the two. If we provide a country with money specifically to achieve its own HIV/AIDS target, presumably there is no reason why the IMF should try in any way to interfere with that.
The international community has set itself ambitious targets. Our Government are committed to being one of the leading contributors in tackling the problem and I am sure that the House is looking for leadership from the Department for International Development, as I am sure is the international community in many ways, although there are one or two contentious aspects of that to which I shall come later.
The Committee published the report at the end of last year and there have obviously been continuing developments. The statistics are still serious and the Committee had a chance to make visits, particularly to Africa where we saw some of the issues at first hand. Interestingly, we visited Botswana and the Botswana programme was mentioned in the House yesterday. What we saw was impressive in one sense. It is one of the richest, least corrupt, most competent and most well-run countries in Africa. However, it has one of the highest incidences of AIDS, and if it does not deal with that it will cease to be one of the most successful and dynamic countries in Africa. We saw an impressive hospital, which provides impressive treatment, encourages people to come in and reaches out to provide treatment throughout the country. However, two or three issues arose which I think are worth recording.
The first, which is obvious, is that when a huge amount of resources go into dealing with one major problem such as HIV/AIDS, which requires the combined commitment of health resources, clearly
other health problems fall down the pecking order. One point of concern is that it is diverting a huge health resource from other problems in the country, which are receiving attention but not the same attention as would otherwise be the case. Botswana is a rich country and the problems are multiplied in poorer countries.
The second issue is that in subsequent meetings with representatives of the Government and Government agencies we asked some probing questions about what was being done to reach some of the prime victims and problem areas, particularly homosexual men and those engaged in sex traffic and the sex trade. The answers were a little disturbing to say the least. In a nutshell, we were told that such activities are illegal, and the clear implication was that there is no programme to reach those people, despite the fact that they are a prime source of the problem.
Someone in the diplomatic community—I shall not identify them—said that in the process of employing a domestic member of staff they asked about her health, to which she said: “I understand what you are talking about and my health is fine. I have been tested and I am negative. However, my husband works in the mines in South Africa so he is away for weeks on end and I have no idea what he gets up to, but when he comes home he expects me to behave as any wife would so how long I will stay in that condition is indeterminate.” That raises another issue: the sharply rising incidence of AIDS among women and girls and the fact that they have much less control over circumstances than they should. They need to be empowered to enable them to take more positive control over the situation.
John Bercow (Buckingham) (Con): I agree, as so often, with everything that the hon. Gentleman has so far said. May I support and reinforce his observation about targets? Its importance seems to be underlined by what he has just said about the attitude of particular states to personal behaviour. Does he not agree that the Government need to take care not to overdo localism and decentralisation? If we are providing money, we are entitled to stipulate in some measure of detail what we expect by way of its effective use. In respect of disaggregation, does he not agree that it should not be necessary continually to press the World Health Organisation for disaggregation of data? What is the rocket science? It ought to be done.
Malcolm Bruce: I thank the hon. Gentleman for that intervention, and more will be said about that.
It would be fair to say that there was not entire agreement on the Committee—although there was no fundamental division—about the exact role of targets. However, we agreed that we needed to quantify what we were doing and pull it back together. One cannot leave these things to every country and hope that that combination will deliver what we have set. We agree about the objective, even if we have not focused on how best to achieve it. That is about attitudes.
There are some issues surrounding a survey that was conducted in South Africa about people’s knowledge and behaviour in relation to AIDS. It produced two or three disturbing statistics. Many answers represented what one would expect, and people’s knowledge was clear. However, one statement was:
“You can reduce the risk of HIV by having fewer sexual partners.”
Although 67.3 per cent. of both sexes agreed with that, 24.4 per cent. did not agree, which is an alarmingly high figure.
Within the survey, we also received an indication that the percentage of young women and men who have had sex before age 15 is high—on average about 25 per cent. It seems to be true of many affected countries. The other statement that was highlighted was that the percentage of young women and men aged 15 to 24 reporting the use of a condom the last time that they had sex with a non-marital and non-co-habiting sexual partner was 69 per cent.
In the context of Botswana, that statistic raises a contentious issue. Although DFID is supporting Botswana through the Southern African Development Community, we do not have a heavy engagement programme, because it is a middle-income country. As a consequence, the Americans are heavily involved in Botswana. The Gates Foundation is fine, but the President’s Fund is not quite so fine, because the American contribution through the President’s Fund places a heavy emphasis on abstinence and moralising. The statistics demonstrate that a significant number of people will not be reached by that approach. I know that the British Government do not share that approach, but if we are not there, for example, there are problems because we leave the field clear. When we are there together with the Americans, there is tension.
Although none of us has a problem with the basic idea that people should be encouraged to be monogamous, an over-moralising attitude will not reach many people. As the Secretary of State precisely and starkly said yesterday, we do not agree with the American position; and, as he put it, people should not die because they have sex—even in circumstances in which people disapprove of the fact that they have had it. If we are trying to deal with the problem on that scale, we must be realistic and we must engage robustly with those who tell us otherwise.
That approach did not work with drugs. The “Just say no” campaign has not stopped the advance of drug abuse, and it will not stop the advance of HIV/AIDS. Prevention is as important as cure, although our report is concerned to ensure that we get treatment to those people who need it.
Joan Ruddock (Lewisham, Deptford) (Lab): I want to share with the hon. Gentleman some information that I received yesterday. It is relevant to how we tackle the issue. In Zambia, where DIFD is involved in a great partnership on primary education, the removal of school fees has enabled girls to go to school, and there has been a shift: among girls receiving primary education, there has been a reduction in HIV infections, whereas for those who have not received primary education, infections continue at similar levels. Primary education—for girls, in particular—can have an impact, and is relevant to the issues that the hon. Gentleman has raised.
Malcolm Bruce: I am grateful to the hon. Lady for that intervention, because it reinforces the fact that the AIDS problem can be tackled successfully. There is
some evidence of that across east Africa, and not just in Zambia. I received similar information on the situation in Uganda, where it is not only education about HIV/AIDS that makes the difference; it is the fact that the girls are in school, and therefore less vulnerable to being preyed on than when they are out in the communities. So there was a double benefit from their being in schools. That is an immeasurable result, in terms of bringing the epidemic under control and reversing it.
I have one final comment on attitude. The acquittal of Jacob Zuma in a contentious trial in South Africa highlighted the cultural and social problems involved. I picked up a press report that says that, after his trial, he apologised for not having used a condom. That was an acknowledgement that he had been a bad role model, and a sign that he wanted to do something right. Indeed, the report says that
“he became visibly upset when a journalist challenged him on his admission made in court and widely reported in the media, that he had showered after sex to reduce the risk of HIV infection. ‘If you’ve been in the kitchen, my dear, peeling onions, you wash your hands afterwards,’ he said.”
That is not a very sensitive and sensible comment, but at least he has had the grace to acknowledge that, apologise, and state what he should have done; that is a step in the right direction.
I now come to the completely different issue of TRIPS—trade-related aspects of intellectual property rights—and patent rights. Again, that is a concern for the Minister. There is a Financial Times report about a march on the Indian Parliament yesterday against the application for a patent on an antiretroviral drug from Gilead Sciences. Such a patent would be completely contrary to the spirit of what we are trying to negotiate, which is the right for generic drugs to be manufactured to deal with the problem in individual countries. The final point in the report is:
“Indian drug companies, such as Cipla, have developed a low-cost generic version of tenofovir, priced in India at a seventh of international levels and would be likely to have to cease production or pay steep royalties if a patent was granted.”
Clearly, we have not completely won that battle, and I hope that the Government will use whatever influence they have to stop that sort of litigation. That litigation could lead to the deaths of tens of thousands of people by denying them affordable access to drugs, or could divert resources in the Indian budget away from where they are needed.
I am conscious that a number of hon. Members wish to take part in the debate, so I shall not take the matter further. I conclude by saying that the international community has made an ambitious commitment to tackling the problem. The United Nations is demonstrating a determination to keep on top of that, and at the turn of the month it will monitor where we are on the issue and will make further progress. From that, I hope that we will get an idea of what we have succeeded in doing and where we have failed, and that a recommended course of action is pointed out to help us to achieve our end.
We—and certainly our Committee—will have to take on board the fact that for many of the countries involved, the problem is social, humanitarian and economic. The economic problem has social dimensions. There is a suggestion that, by 2010, some
50 per cent. of all children in Zambia will be orphans. There is a huge issue of responsibility, in terms of who will look after those children, and how they will be brought up and maintained. That is assuming that they are not infected themselves or, if they are, that they can get treatment. A country such as Botswana could see its entire economic success wiped out if it does not get on top of the problem. I hope that the countries concerned have the capacity to do that.
With the greatest respect, although there is no difference of view between us and the Department, the Committee is so concerned about the need to demonstrate commitment that we shall put the Department under continuous review by publishing an annual report on our judgment of what progress has been made, in the hope that that will apply additional pressure. The Department might feel that that is unnecessary, but we think it desirable to ensure that there is an annual parliamentary report saying how well we are doing in achieving the overall objectives.
Mr. Jeremy Hunt (South-West Surrey) (Con): Does the hon. Gentleman agree that GDP growth figures often underestimate the economic impact of AIDS? They cannot encapsulate, for example, the effect of a reduction in life expectancy or the fact that a huge proportion of a country’s health service has to be devoted to tackling the scourge of HIV/AIDS rather than to other things. In that sense, even though the reductions in growth figures for African countries that are affected by HIV/AIDS might be relatively small, the impact is much greater.
Malcolm Bruce: The hon. Gentleman is right; indeed, the problem is even worse than that, because in many cases there is substantial under-reporting.
The negative effect of too much moralising—I do not deny that moral education has a value, but there can be too much of it—can add to the stigma and discourage people from coming forward. I see that ex-president Clinton—I think that President Clinton is still his title in the United States—has called for mandatory screening in all countries and has demonstrated that that gets rid of the stigma, because it happens to everybody. People who need treatment are identified and they receive it. I do not know whether that is the answer, but it is an interesting contribution to the debate. We need to identify the problem, quantify it and solve it. That will require every sinew of every major country in the world, in partnership with the countries most affected, to deliver those end products.
The Committee is proud of what the Government are doing. We appreciate the commitment and the lead role that we are playing. We hope that they will use that lead role to help shape the outcome in ways in which we have more confidence than the largest donor to the programme does, the United States. We have to work with the United States, but we have to make it clear that we have a reason for our different approach and that our approach must reach the people that otherwise will not be reached.
2.53 pm
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