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In general, that is a further area where the work of the Government and the Department for International Development has been excellent over the past few years. There is a general welcome for many of the things that the Department does. It has raised the bar for everyone and has produced a degree of consensus on the work done that is entirely appropriate when dealing with some of the worlds problems. There will continue to be challenging questions for those doing
that work, but in general there is much to be proud of. I just mention to the Chairman of the International Development Committee that it has played a significant role over the years, and it is excellent that that work is continuing. On behalf of the children most affected by this appalling plague, I hope that their voice also will be heard in the next stage of the work done to alleviate this dreadful suffering experienced by so many.
Chris McCafferty (Calder Valley) (Lab): I, too, congratulate the Select Committee and its relatively new chair, the hon. Member for Gordon (Malcolm Bruce), on the great deal of hard work done on this important report, and the Government on their response.
HIV/AIDS threatens to destroy a generation of leaders, workers, parents and young people and has created a generation of orphans in the worst affected countries. In many countries, the infection is creeping through the population and is preparing to strike full force. I think that prevention is about striking first. Sexual and reproductive health information, education services and supplies enable people to avoid HIV infection and to protect themselves, their partners and their unborn children from this deadly virus. We know that prevention works and we have a consensus among nations about the need for action. I, too, commend the Department for International Development on the important role that it played in securing international agreement on UNAIDS new prevention policy, Intensifying HIV prevention, and the EU-adopted statement HIV Prevention for an AIDS Free Generation.
However, let us face it: it is widely recognised that without a massive scale-up of HIV prevention, the upward trend in the number of people infected will simply continue. That will pose a major threat to the affected countries ability to sustain progress in tackling the epidemic, to prevent an explosion of the disease, and to provide AIDS treatment. The EU statement underscores the fact that prevention of new infections must remain the cornerstone of a comprehensive AIDS response.
I agree with the Select Committee report: the relatively new focus on treatment should not be allowed to displace the important work that has already been done on HIV prevention. We must talk about HIV/AIDS openly, honestly and directly and act to guarantee prevention, care and treatment for all those who need it. However, the reality on the ground is very different. There is limited funding available for HIV, prevention, treatment and care. I urge DFID not only to continue to balance work on HIV treatment with sustained attention to HIV prevention, but to continue to make prevention its top priority in a comprehensive AIDS response, with linkages between existing sexual reproductive health and rights, HIV/AIDS and health care services and systems.
As the Governments response states, critical components of a comprehensive evidence-based response are: universal access to sexual and
reproductive health information and services for women, men and young people; provision of accessible and integrated health promotion and harm-reduction services for drug users; reliable access to essential sexual and reproductive health commodities, including male and female condoms; universal access to education and the provision of life skills and sexuality education; the integration of HIV prevention interventions, including voluntary counselling and testing for HIV, into other health services; action to confront and address gender-based violence and to provide protection and support to victims of violence; and supporting investment in modern methods, such as microbicides and vaccines.
The ABC approachabstain, be faithful, use a condomadopted by the Bush Administration to assist prevention is not evidence-based. Research from Africa and Asia shows that marriage is not a protective factor. In fact, in some areas, married women are more likely to become infected with HIV than their unmarried counterparts. In marriage, abstinence is not always an option and women are unable, as we heard earlier, to ensure their partners faithfulness, or condom use. The ABC approach is further eroded by the Bush Administrations promotion of abstinence-only programming. Many NGOs receive substantial funding for HIV prevention, but with restrictions against comprehensive programming, particularly condom use, ABC fails to recognise the complex realities of comprehensive promotion. Therefore, prevention may need to be reinvented to place a greater emphasis on how each new HIV infection takes place within its own political and socio-economic dimension.
That brings me to vulnerable groups and access to treatment. Children, intravenous drug users and men who have sex with men are all mentioned in the report, but women are omitted. I draw hon. Members attention to the Global Coalition on Women and Aids, which makes the point that at least 57 per cent. of adults with HIV are women, and young women aged 15 to 24 are three times more likely to be infected than young men. Despite that alarming trend, which was mentioned earlier, women know less than men about how HIV/AIDS is transmitted, and they know less about how to prevent infections. What little they do know is often rendered useless by the discrimination and violence that they face within and outside the home.
High numbers of pregnant women visiting antenatal clinics are HIV positive. In many southern African countries, more than one in five pregnant women are infected with HIV. The overwhelming majority of children with HIV contract the infection from their mothers during pregnancy or delivery, or through breast feeding. The 700,000 new infections among children in 2003 represent an unacceptable and almost entirely preventable component of the epidemic.
In the UK, mother-to-child transmission has been reduced to less than 2 per cent. due to voluntary counselling and testing, antiretrovirals, elective Caesarean sections and alternatives to breast feeding. In too many places, VCT is still completely absent, and a mere 1 per cent. of pregnant women in heavily infected countries have access to services aimed at preventing mother-to-child transmission.
I commend DFID for the important role that it played in securing the G8 commitment to universal antiretroviral treatment provision by 2010. I hope that in the meantime antiretrovirals will reach poor women and their unborn children, as well as young children and wealthy men, and that prevention remains the cornerstone of all activities included in the comprehensive approach that is essential to tackling HIV.
Jo Swinson (East Dunbartonshire) (LD): Last week, the nation was shocked by the revelation that 10 new cases of HIV had been discovered in the space of a single month in St. Ives, Cornwall. Headlines grew more hysterical as the story unfolded of a single perpetrator who had, perhaps knowingly, spread the infection through the small town. An expert team of medics was sent directly, a helpline was set up, two new testing clinics were established and my hon. Friend the Member for St. Ives (Andrew George) issued a call for calm. My thoughts are with those 10 people and their families, whose anxiety must be unbearable.
However, it is not to belittle their suffering to say that that is the reality every single day for many families throughout the world. In the UK, about 19 people are infected with HIV every day. As my hon. Friend the Member for Edinburgh, West (John Barrett) said, that is still far too many, and it is worrying indeed if the trend of recent years has been an increasing infection rate. Perhaps the safe sex messages that were so strongly accepted in the 1980s and early 1990s are losing some of their resonance.
We are, of course, concerned about cases in the UK, but compare 19 a day with the figure for Africa, which is 8,800. Even taking into account the huge difference in population size, there is a clear disparity. Per capita, if the UKs infection rate was the same as Africas, every day in our country almost 600 people would be contracting HIV. That would be a major public health emergency. We would be dealing with it at the highest levels of Government. However, in Africa and in many other places in the world there is a much greater problem.
Botswana has one of the highest HIV rates; 37 per cent. of the adult population is HIV-positive. For those people there will be no crack team of medics, no special clinic, no helpline, and their contraction of HIV is by no means headline news. The sad fact is that for many communities in Botswana and across the world HIV is part of the daily reality. Having contracted the infection, the 10 people in St. Ives can expect an average of £15,000 a year to be spent on their care. In Africa, the average per person is £7.
The Governments commitment to funding antiretroviral drugs must be commended, and the Minister and the Secretary of State are to be congratulated on their work in pushing this issue up the agenda. The UK is the worlds second biggest bilateral donor on HIV and AIDS. In 2004, DFID said that over the next three years the UK would spend at least £1.5 billion on AIDS-related work. However, it is already clear that that is not enough. In June 2005, UNAIDS and the World Health Organisation estimated that 6.5 million people in developing
countries needed immediate antiretroviral treatment, and of those only 15 per cent. were receiving it. While the Governments commitment to aid is substantial, it is still out of balance with their spending on war; the £1.5 billion pledged to aid is dwarfed in comparison with the £3 billion already spent on the war in Iraq, and that figure is likely to rise to £5 billion by the end of the year. Our country must redress the balance of our spending on war and aid. Thirty years late, we are yet to meet the UN target of increasing international aid to 0.7 per cent. of gross national product, although I welcome the Governments commitment to meeting that in the coming years.
Furthermore, in the developing world war and health are inextricably linked. Aid to alleviate poverty and to improve health is an essential safeguard against the escalation of violence. Nowhere is this link between violence and the deterioration of health resources more glaring than in the Democratic Republic of the Congo, where easily preventable diseases are rampant because the war has destroyed hospitals and other areas of health infrastructure. The most recent report of the International Rescue Committee aid agency found that 1,000 people are dying every day from conditions such as malaria and malnutritionbasic, easily preventable diseases. When one adds HIV and AIDS to the situation, it is easy to see why the health services get stretched to the point where they cannot cope. In the DRC, there are 1.1 million HIV-positive people, which is about 4.5 per cent. of the population.
The report says that the international humanitarian aid to the DRC has been abysmal compared with the response to other disasters. In 2003, for example, Iraq received aid worth the equivalent of £75 per person and the DRC received the equivalent of £1.70 per person. There are some excellent aid projects under way to support the testing and treatment of HIV in the DRC, especially the work of the United States Department of Health and Human Sciences, with its Centres for Disease Control and Prevention global AIDS programme, but these projects need more attention from the UK Government. Several Members have spoken about the availability of antiretrovirals in the fight against AIDS. That is partly to do with health and the infrastructure in developing countries, but it is also partly to do with simply access to drugs and being able to afford them.
Unfortunately, the financial barriers faced by developing countries are not always simple. The issue that I believe currently needs most attention is TRIPsthe trade-related aspects of intellectual property rightswhich is dealt with in paragraph 12 of the Select Committees report. Protection must be in place to exempt areas that impact on the millennium development goals and global disease control. The current provisions have proved inadequate; we all remember the furore in 2001, when 39 major pharmaceutical companies tried to prosecute the South African Government for passing a law that allowed easy production and importation of generic HIV drugs. There was a good ending to that incident. Following immense pressure from the South African Government, the European Parliament and, not least, 300,000 people from more than 130 countries who signed a petition, the pharmaceutical companies were forced to back down.
I strongly support the Committees recommendation that the WTO must be persuaded to undertake a review of the implementation of TRIPS, and that DFID should continue to work to build the capacity of developing countries to use TRIPS safeguards, like compulsory licences and Government-use provisions, to facilitate the production and export of affordable medicines, particularly second-line ARVs, which are increasingly important, especially as the disease becomes more resistant and the first-line ARVs become increasingly ineffective. It is perhaps a sign of the difficulty that developing countries have working within the TRIPS provisions that no compulsory licences have been issued.
I am deeply concerned about the future of the agreement that keeps sub-Saharan African countries immune from TRIPS-plus agreements with the United States. Those laws go beyond the requirements of TRIPS to protect intellectual property and are often drawn up as part of bilateral trade agreements with the US, usually involving the US promising better trade and investment to a particular country in exchange for it introducing legislation to protect US intellectual property rights. That may mean restrictions on compulsory licences or parallel importing, and it could mean the extension of patents beyond the standard 20 years suggested by TRIPS.
An Executive order signed by President Bill Clinton in 2000 barred the US Government from asking southern African nations to sign such agreements. President Bush endorsed that when he came to office in 2001, but there is a danger that his Administration, faced with the fact that many generic plants now operate in Africa, will not keep their promise. If the UK Government wish to stand by the promises made at Gleneagles, I urge them to make it clear that such a possibility is intolerable.
We are all aware of the extent of the HIV/AIDS problem. I welcome the Select Committees excellent report and the spotlight that it is putting on the issue. The Government have made good progress, which is to be commended. I hope that Ministers will take on board the strength of interest that Members of this House and the wider public have in the issue. It is incredibly important that it is given a high priority within Government.
The debate has been useful and interesting. The International Development Committees report was also useful. I welcome the comments by its Chairman, the hon. Member for Gordon (Malcolm Bruce), about the intention to return to the subject repeatedly, because doing so would be useful. We have discussed whether the Department for International Development should be setting targets internationally. From the point of view of Parliament in scrutinising what is happening, if the Committee returns regularly to the subject, it would be of great value.
I am pleased that attention is being given to the impact of HIV/AIDS by those who are interested in international development. Eight, nine or 10 years ago, when I was getting involved in the subject in the House, people recognised that AIDS was a huge problem in Africa, but the international development connection was not made. It is made now, and everyone who is involved in such work accepts the central importance of dealing with HIV. That represents real progress.
I shall try not to repeat or to dwell on many of the things that have been said. Points have been made about drugs for children and the malignant effect of current US policy, which is starting to do damage in some African countries.
The commitment to universal access by 2010 is an amazing one when we consider what it involves, particularly if we compare the aim with the current situation. My suspicion is that we probably will not reach the target. We did not reach the three by five target, but that does not mean that it was not worth while. Setting the target changed some attitudes about what we should be doing and trying to do. The three by five target also changed peoples views about the ability to deliver antiretrovirals in relatively resource-poor settings. I recall debates on the subject only two, three or four years ago, in which people said, It is impossible. You cant deliver antiretrovirals in poor countries. It just wont work. People wont adhere to the drugs regimen. They wont understand what it means. All the evidence from the work on three by five is that that is rubbish. It is possible to deliver. People with the opportunity to take the drugs will adhere to the regimen. Rates of adherence compare pretty well with, and in many cases are much better than, rates in the UK, western Europe or the United States. That disproves some of what was said.
The target for four years time is a challenge. Even if we do not get thereI have doubts about whether we willthe existence of the target, particularly if interim targets are adopted, will lead to progress and change in some of the countries that most need that. We do not even really know the numbershow many people we aim to treat by 2010although we know that it is not the same as the number of infections. In many countries with high infection rates, there is not yet sufficiently detailed knowledge about numbers.
My hon. Friend the Member for Northampton, North (Ms Keeble) made important points about what has been happening in Kenya. The problem there is also a problem in other countries, and it will, in time, be a problem in more. If Governments are corrupt or incompetent, we cannot react by saying that we will do nothing for the people in those countries. We will have to find ways around those problems, and that will probably involve NGOs. We will have to find ways to get money and resources to people on the ground, even if Governments are incompetent.
Mr. Borrow: Does my hon. Friend agree that once treatment programmes have been started they must continue, irrespective of what happens to the Governments of the countries in question, or of the instability that might arise later, and that once people have been given the promise of continued life through a drug treatment programme, the developed world cannot take that away? It is a commitment not for five or 10 years, but decades.
Mr. Gerrard: That is absolutely right. We cannot take the commitment away because of a problem with the Government in a country. Howeverthis is another point about universal access by 2010, and the money that it is said is required to fill the gapbillions of pounds will be required not just between now and 2010, but year after year subsequently. It would be unthinkable and immoral to get treatment programmes running and then withdraw the money that allowed them to continue. That demonstrates the importance of prevention. If our answer is simply to pour in drugs and treatment, and if we do nothing about prevention and stopping the rise in the number of infections, the drugs bill will inevitably go up every year, for years ahead. It will not be possible to cope with that if we allow it to happen. It will not be a question of £15 billion or £18 billion a year, but double and treble that figure, if we let infection rates continue to rise.
Another issue that arose with respect to Kenyaagain, this is a matter of continuitywas the establishment in one or two places of successful pilot schemes funded bilaterally or by the Global Fund to Fight Aids, Tuberculosis andMalaria. At the end of the pilot period, the question arises of where the money for their continuation is to come from. In some cases the money has not appeared. That problem has led to people being given treatment and supportgiven hopethat is suddenly taken away. That is a difficult one. It is not easy. Sometimes when a pilot ends, it is decided that it has not worked and it is cut off. We cannot guarantee that a pilot project will continue for ever. However, if a pilot runs and is successful, there are questions about why it should not continue and how it should be made to continue.
The hon. Member for East Dunbartonshire (Jo Swinson) referred to TRIPS, which I agree are important. The TRIPS agreement was drawn up before antiretrovirals existed, although it was expected to cover lots of other drugs. At Doha, a waiver was agreed so that in some circumstances public health could override intellectual property rights.
However, that waiver is not an answer to the long-term problems in respect of TRIPS. The newer, more effective drugs will not come out of patent for a long time. Even the very earliest HIV drugs such as azidothymidine are not yet out of patent, although they may be getting pretty close to it. There is a long way to go before some of the newer drugs get to that stage.
I agree with the Committee about the need to assess where we are going. To some degree, the drugs companies have learned lessons from South Africa and the appalling, dreadful publicity it gave them. They will not readily go down that road again. However, that has not solved the problems, and I suspect that if there are no changes to TRIPS, we will be in the situation mentioned by my right hon. Friend the Member for Edinburgh, East (Dr. Strang), in which the generics and cheaper drugs will not be available and second line drugs will be required.
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