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11 May 2006 : Column 160WH—continued

Some people understandably ask, “Why AIDS? What about all the other killer diseases, such as tuberculosis, malaria and smallpox?” The best answer
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to that was given by Professor Alan Whiteside of the university of Natal. He described HIV/AIDS as an “involutionary” event. For him, involution is the opposite to evolution. He describes how most viruses extinguish themselves because they end up killing the host that is carrying them. The evil genius of HIV/AIDS is that the host—the person who is infected—remains apparently healthy for long enough to be able to transmit the infection to many other people before they themselves become ill.

As HIV/AIDS is a sexually transmitted disease, the effect on young people is particularly devastating. A prevalence rate of 25 per cent. in a country means that the likelihood of a teenager getting the virus in their lifetime is 50 per cent. If the prevalence rate increases to 35 per cent., their likelihood of getting it increases to between 80 and 90 per cent. South Africa is heading in that direction. At current rates, by 2010 it is predicted that three quarters of its teenagers will not be able to expect to live until their 60th birthday.

In that context, the Government should be extremely proud of what they achieved at Gleneagles last year. The 2010 universal access commitment was championed by the UK and was not easy to achieve. I congratulate the Minister and the Secretary of State on their personal commitment to that. I am grateful that interim targets have become UK Government policy, and am pleased to see that they are one of the proposals that we hope will be adopted from the submissions that are going before the UN for the high-level meeting on 2 June. What is the Minister’s candid assessment of the chances of interim targets and milestones being adopted at that meeting?

If we are to achieve universal access, it will not be a question only of declarations and high-level commitments from the world community; a number of practical challenges will also need to be addressed, and I should like to touch briefly on some of them. The first challenge is money. This week, the Minister stated to me in a parliamentary answer that there will be a funding shortfall of $18 billion in anti-AIDS programmes during the next two years—only half the period between now and 2010. The international community is still not putting its money where its mouth is. What will the Minister do to try to persuade G8 countries other than the US and the UK, which have taken a leading role in the battle against AIDS—the Italys, Frances, Germanys and Japans—to play their role and contribute what they should to the battle against HIV/AIDS?

I do not want to pre-empt the hon. Member for Northampton, North (Ms Keeble), who is a great expert on paediatric drugs, but the second big challenge is the supply of paediatric drugs for HIV-positive children. The HIV virus is unusually and particularly aggressive in children, whose immune systems are undeveloped, yet fewer than one in 20 of the children who need antiretrovirals can expect to get them. When they do get them, by and large the portions, which have been chopped up, are not sized for them, but for adults. The regimen for antiretroviral drugs has to be administered extremely carefully, and that is a bad way of ensuring that children get the correct dosages. They very often have to rely on syrups and solutions, which, again, are not ideal because the dosage can be wrong and they have to be refrigerated.

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As the shadow Secretary of State for International Development pointed out yesterday in the House, there is no market for such drugs in the west so drugs companies have been very slow in developing them. The point of his question was this, and I ask the Minister to respond to it: if the Secretary of State asked to see the heads of the drugs companies, that would provide a major impetus for getting them to raise paediatric AIDS drugs up their list of priorities. Although I strongly welcome the discussions between the Department for International Development and the drugs companies, if such meetings were attended by the Secretary of State, the bosses of those companies would attend too and we would be far more likely to get progress.

The final challenge has not been talked about a great deal. How will fragile states in the poorest African countries, particularly conflict and post-conflict zones, reach the 2010 universal access target? Hank McKinnell, the chairman of Pfizer, one of the companies that manufactures a lot of antiretroviral drugs, said that if the cure for HIV/AIDS were simply a glass of clean water, we would not be able to get it to half the people who need it.

The development of health infrastructure is appallingly bad in such countries as Burundi, where there are only 300 doctors, a great majority of whom are in the capital. The Clinton Foundation recently estimated that if it were to get antiretroviral drugs to 57,000 people in Rwanda, it would need to double the number of doctors there. In the Democratic Republic of the Congo, where I went recently, outside Kinshasa there is only one doctor for every 30,000 people. That compares with one doctor for every 600 people in the UK.

There are two particular problems in conflict zones. First, there are food shortages. Some 17 million of the 53 million people in the DRC face such shortages, and antiretroviral drugs do not work properly if people do not receive proper nutrition. The second problem in conflict and post-conflict zones is the explosion of sexual violence. Indeed, while I was in the DRC, I went to one of the world’s only rape hospitals. The problem is a real challenge, and it, too, must be addressed.

It is easy to be overwhelmed by the problems, but I want to conclude on a slightly more positive note because I believe that AIDS can be defeated in our lifetime. Although we are unlikely to find a cure—unfortunately, HIV/AIDS changes the DNA of cells and is incredibly difficult to unravel—we can have much better prevention programmes. Hopefully, those will involve microbicides, which offer great hope.

We can also have a much bigger roll-out of testing programmes. We need to look at what is happening in Lesotho, which has an opt-out testing programme. The programme is not mandatory, but every child is automatically tested at the age of 12 unless they opt out. That happens to everyone, so the stigma of testing is removed, which is a positive step.

We need to bring down the price of antiretroviral drugs much further. In particular, we need partnerships between pharmaceutical companies and generic drug manufacturers. Just imagine what would happen to the price of antiretroviral drugs if China started manufacturing them. That would have a huge impact, and it is potentially round the corner.

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Finally, we might find a vaccine for HIV/AIDS. Michael Gottlieb, who discovered the virus in 1981, said that we could be trialling a vaccine by 2010 and that it could be widely available by 2021. My question, therefore, is simply this: given that we have the drugs to prevent AIDS deaths now, how many people will have died needlessly by then?

3.22 pm

Mr. David S. Borrow (South Ribble) (Lab): I am grateful for the opportunity to contribute to the debate. I congratulate the Select Committee on producing its report. I am an officer of the all-party group on AIDS, so I take a particular interest in the subject, and I am pleased that the Committee gave it high priority.

Other hon. Members mentioned Botswana, and I want to speak a little about that country. I have visited Botswana three times since I entered Parliament. I went once in 1999, on a Commonwealth Parliamentary Association visit, and again in 2004. At the end of March this year, the Government of Botswana invited me to visit, and I spent four days looking at their HIV/AIDS programme. Over those three visits, I have been struck by how a country can change its reaction to HIV/AIDS.

In 1999, I spoke to the Minister of Health in Botswana, and there was a sense that HIV/AIDS was not a problem. However, I also spoke to the manager of a diamond mine who had just completed the anonymous testing of the work force and discovered infection rates of 25 to 30 per cent. Clearly, there was a problem, and the Government of Botswana quickly changed their approach. A few years ago, they reached an agreement with the Bill and Melinda Gates Foundation and Merck to put in place a full programme of antiretroviral treatment for the population. That involved a $50 million contribution from Merck, the foundation and the Government. The Merck Company Foundation also provides the programme’s two basic drugs—Crixivan and Stocrin.

When I went to Botswana two years ago, the country was beginning to build the delivery mechanism. I visited the Princess Marina hospital in Gaborone, which was the main clinic at the time, and it was treating about 24,000 patients. When I went there a few weeks ago, it had rolled the programme out across the country. Drugs are being distributed at more than 30 centres, and there are more than 50,000 people on the treatment programme, which is provided free. In addition, just under 10,000 people are probably being provided with drugs by their employers—mainly the diamond mine corporations in Botswana.

It is interesting that 300,000 people out of a population of 1.7 million are estimated to be HIV-positive. The Government feel that if they can reach 110,000 through the drugs programme, that will meet the needs of those people who require the drugs. They aim to reach that target in the next couple of years, but because of the spread of the disease and the fact that some of those who do not need the treatment at the moment will need it in the future, they will eventually need to deliver the programme to 150,000 throughout Botswana.

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Botswana, as has been said, is a middle-income country with stable government and good infrastructure, and its health service is probably better than those of many other countries in Africa. Even with the deal that has been done, the money that has come in, the ability to deliver a drugs programme and a series of new testing centres, it is beginning to run into capacity problems in trying to use a western medical model to deliver the testing programme and the treatment programme throughout the country. I sense that even in Botswana they will struggle to have the capacity to do so.

Malcolm Bruce: The hon. Gentleman quotes a good case, and the Select Committee was in the same hospital just a few weeks ago. We were concerned to be told that 52.4 per cent. of Botswana’s development aid programme is going on the HIV/AIDS programme. As he says, the Government are struggling in one of the most privileged countries. That shows the scale of the problem and why it is such a challenge. He is right: Botswana is a success story in comparison with most other places.

Mr. Borrow: One of the things that I picked up and sensed from the visit was that if there is bound to be a struggle even in Botswana, we need to encourage new systems and new models of delivery of care.

We need to engage with the medical professions to see whether we can deliver pharmaceutical products, do the testing and so on without relying on everything being done by pharmacists and doctors, and to see whether there is a way of working with people with lower skills and qualifications to deliver what is needed. If we cannot succeed in Botswana, the chances of being able to succeed in the rest of Africa, however much money is given for drug treatment, are not very large. It is not simply a matter of getting drugs for free, or for very little, and providing millions of dollars in aid. In the end, each country has to use its human capacity to put in place the medical system to deliver the drug treatment programme.

We need to begin to see whether it is possible to develop a different type of delivery mechanism to the one that we would expect to see in western Europe and north America. That problem has to be tackled in Botswana. It will apply across the whole of the developing world, because I do not understand how we can reach our aim to allow everybody who needs treatment to get the drugs unless we find a different mechanism for delivery. That is one of the lessons that I have picked up.

The Chairman of the Select Committee, the hon. Member for Gordon (Malcolm Bruce), raised my next point, which is the approach to prevention and how we challenge people’s assumptions—ABC is the shorthand. A few years ago I was involved with UNAIDS and the Inter-Parliamentary Union in developing a handbook for parliamentarians on the subject. In all those discussions, what came across was the need to take a human rights approach to HIV/AIDS and to ask what in our legislation and prejudices gets in the way of tackling the disease. What do we as parliamentarians here, in Botswana, in India or wherever, need to do to enable AIDS to be defeated?

On a visit a few years ago to look into HIV/AIDS, I remember speaking to people in New Zealand, an
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affluent, western country. They faced a challenge in the late 1980s which meant they had to make decisions about drug users and men who had sex with men. It was necessary to change the law and change what was done to enable the problem to be tackled. I remember when the question of men who have sex with men was raised in Botswana, and the attitude was similar: “That is not something we really talk about.” It is difficult to challenge that in many African countries.

Ann McKechin (Glasgow, North) (Lab): My hon. Friend makes a thoughtful speech, but does he agree that cultural attitudes about the role of women—I have noticed this particularly in sub-Saharan Africa—are a major contributor to the problem? Many women are kept deliberately ignorant of how to protect their sexual health, and they are certainly not encouraged to seek the information. We need to build up a civil society movement for women in those areas if we are effectively to deliver treatment of the sort he describes, and introduce the mechanisms that will enable our goals to be achieved.

Mr. Borrow: I agree. I am always struck when I visit sub-Saharan Africa by the strong imbalance between the sexes, and the frequency of sexual relationships between older men and younger women. Economic imbalance feeds the spread of the disease. Older men have many sexual partners, who are often very young women, and that creates problems because of the women’s inability, as a result of the sexual imbalance in society, to insist on condoms or to say no. It is a challenge for us to ask countries in which the development has been different from ours to examine many of their belief systems when they get in the way of tackling HIV/AIDS.

John Bercow: The continued and extensive incidence of sexual violence, not least rape, is a related and legitimate cause for concern. Does the hon. Gentleman agree that donor countries must help recipient countries to address that problem, not least in the light of the fact that it is not merely the male rulers of those countries who regard that state of affairs as unexceptionable; it is a depressing reality that a large proportion of female citizens apparently still think that it is something up with which they have to put?

Mr. Borrow: I agree. A few years ago I visited a hospital in Addis Ababa in Ethiopia and spoke to women there. A culture clearly existed in which if a man wanted sexual relations with a woman or wanted to go out with a woman and she said no, it was legitimate for him to rape her, because she would then be no use to anyone and would have no choice but to become his sexual partner. That attitude was common, as was the attitude that a wife should expect to have nine children. That problem is particularly acute in the Ethiopian context, in which boys are fed much better than girls and women tend to be very small. As a result, many problems associated with the physical size of the woman occur in childbirth. I am well aware of that difficulty.

On a different matter, I am patron of a charity, the Naz Foundation International, which does work in south Asia to do with men who have sex with men. The
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Department for International Development contributes to projects there, and I hope that my hon. Friend the Minister, who is, I know, hoping to visit India in the near future, gets the opportunity to see some of those projects. In the south Asian context, it is interesting that infection rates are significantly higher among men than among women. That is a reversal of the situation in sub-Saharan Africa. It reflects a different pattern of sexual transmission. Although there is not what would be seen by western society as a gay community, it is not uncommon for men who are married and who have children to have sex with other men. That may be one of the links that creates the different pattern.

The legal situation in most of south Asia is not conducive to tackling the problem, which brings us back to the human rights issue and the fact that parliamentarians can put in place a proper legislative framework to help tackle such problems. I urge my hon. Friend to raise the matter if he visits India, because with that scale of population we need to do everything that we can to prevent an explosion of HIV/AIDS in south Asia. The risk is that such an explosion would be much larger than the explosion in Africa.

Several hon. Members rose—

Sir Nicholas Winterton (in the Chair): Order. Again, I want to help hon. Members. If they discipline themselves when speaking, I hope that everyone will have the chance to speak. It is important that all who hope to speak can do so, given that they have been patient and have prepared for the debate.

3.36 pm

John Barrett (Edinburgh, West) (LD): This is an important debate. We have heard a number of thoughtful contributions from all parts of the House. As the Select Committee report says, the HIV/AIDS pandemic is a full-blown global health emergency. When we consider the figures, it is impossible to disagree. The sheer scale of the problem is sobering. Since 1981, more than 25 million people have died of AIDS, and by the end of 2005 more than 40 million globally were living with HIV/AIDS. Of that number, 60 per cent. were living in sub-Saharan Africa, where the situation is most severe, and of the 5 million new infections recorded globally in 2005, 3.2 million were in sub-Saharan Africa.

Figures like those are difficult to appreciate fully, but they help to underline the scale of the problem. However, although Africa is bearing the brunt of the disease, no part of the world is immune to the pandemic. HIV/AIDS is not restricted to a particular country, age group or section of society. It is a global problem, and it requires and deserves a global reaction. It is in that context that I welcome today’s debate on the report “Delivering the Goods” and the Government’s response.

It is worth remembering that since 1999 there has been a steep rise in the number of HIV diagnoses in the United Kingdom. Reports show that at least 6,700 people in the UK were diagnosed with HIV during 2005, and that number is expected to rise. The welcome and rapid scaling up of antiretroviral treatment
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programmes in Africa, driven by international advocacy and supported by unprecedented global funding, offers hope to millions of HIV-infected Africans. It is important to realise how far the issue has moved up the priority list in the international community, which I welcome wholeheartedly.

I join those who have already spoken in commending the work of the Department for International Development, in particular its success in securing the G8 commitment to ensuring universal antiretroviral treatment by 2010. However, although Her Majesty’s Government are a worthy contributor to the battle against HIV/AIDS, one of DFID’s key roles must be to influence the approach of other nations, to ensure that the funds mobilised are used in the most effective manner.

I shall be brief, and I shall try to avoid repeating what has already been said. I wish to focus on the importance of prevention and the need to steer international efforts towards a greater appreciation of a more balanced approach to treating HIV/AIDS. First, I add my voice to those who have argued that prevention and treatment are two sides of the same coin. As “Delivering the Goods” makes clear, expanding access to HIV treatment should not be seen as a simple technical fix to the pandemic. A major scaling up of HIV prevention must form an integral part of all programmes to expand treatment. It could be argued that the overall international investment does not fully reflect that. In that regard, the Department’s approach is difficult to fault.

I was delighted to see the important role played by DFID in securing international agreement on UNAIDS new prevention policy and to see the Government throw their weight behind emphasising the importance of a properly balanced approach in that regard and the recognition that prevention must remain the cornerstone of a comprehensive response to AIDS. DFID has a crucial role to play, not simply to fill the gaps left by the US, as some have put it, but to lead and inform the US policy and approach. As the Committee repeatedly heard in evidence, continued research is needed on the complex range of factors that affect HIV transmission and determine the eventual success or failure of HIV prevention strategies. The crucial point is that any such strategies must be firmly based on evidence; there should be no political agenda to them.

As many hon. Members will know, the US Government’s PEPFAR fund—the President’s emergency plan for AIDS relief—has a strong emphasis on the provision of treatment and care for people with AIDS, with only one fifth of the money used for HIV prevention work. Many groups and workers on the ground have rightly been dismayed by the requirement that one third of those prevention resources be ring-fenced for spending on programmes promoting sexual abstinence before marriage. That is a good idea for those to whom it is applicable, but it does not work for all.

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