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11 May 2006 : Column 181WH—continued

I come back to testing and prevention. As I said, we cannot solve the problem by just throwing in drugs and money, because it will go on and on. A false dichotomy used to be presented—that testing and prevention were one thing and drugs were the alternative. However, the approach has to be of a piece; there has to be
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treatment, testing and prevention. It is pretty obvious why. We cannot persuade people that there is much benefit to being tested if there is nothing to offer them if they test positive. We will have much more success in persuading people to test if there is something to offer them as a result.

Development of testing on a bigger scale is a key to prevention as well. When so many people may suspect but do not know that they are HIV-positive, why should they be too worried about taking precautions against passing on the disease? When we talk about prevention, we focus all our attention on sending messages to uninfected people about how to avoid becoming infected. For some time, I have thought that that is true of this and other countries. We do not do enough to talk to infected people, yet they are the key to prevention, as they can pass on the infection. We do not give that enough attention.

It is not easy. People have to be careful not to blame or stigmatise somebody because he or she is infected. However, there is no question of not paying more attention to effective prevention work with people who are already infected.

Malcolm Bruce: Picking up on something mentioned earlier, does the hon. Gentleman agree that we as parliamentarians, with our contact with parliamentarians in other countries, ought to support those who demand rights and respects When the Committee was in Malawi, the chairman of the social affairs committee there said that it wished to debate violence against women and the rights of women to discuss their sexual rights, but the men on the procedures committee said that that was not important and should not be given parliamentary time.

Mr. Gerrard: That is right. The debate on HIV/AIDS has moved on a long way from regarding it as a medical problem. It is far wider than that: it is a human rights issue and a women’s rights issue. We need to face up to that fact.

At the 2001 United Nations General Asembly Special Session, I was with the previous Secretary of State, my right hon. Friend the Member for Birmingham, Ladywood (Clare Short), at a meeting where there was a Minister from another country, which shall remain nameless. When we tried to discuss groups such as gay men, who were at high risk, he said, “Well, we don’t have a problem. We don’t have any gay men in our country: it’s illegal. It’s not possible.” My right hon. Friend’s response, which I thought was a good one, was to offer him a bet on that, which absolutely crushed him, rather than try to have an abusive argument.

I hope that when the Select Committee comes back to address the subject it will look broadly across what is happening in the world. We rightly focus a huge amount of attention on Africa, because of the devastation there. However, we should be looking more closely at what is happening in Eurasia. We are now getting general infection levels of 1 per cent. in Russia, elsewhere in the Commonwealth of Independent States and in some of the Baltic states, and an epidemic is growing in India and China, where the capacity for an enormous number of people to be infected is obvious.

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We are still at a stage at which, if we get things right, we can avoid an epidemic developing in India, China and Eurasia which will reach African proportions. However, we have a pretty narrow window of opportunity. While looking at what happens across the world in future and returning to the subject in subsequent years, I hope that the Select Committee will take account of that.

4.43 pm

Susan Kramer (Richmond Park) (LD): I join those who have congratulated and endorsed the Committee on its work and its conclusions.

The quality, depth and knowledge in the speeches have meant that, as someone who is trying to come up to speed on this and a range of other development issues, I have had a brilliant afternoon, sitting listening to hon. Members speaking with such a level of expertise. I appreciate it. Every voice seems to echo the others; this is an area where we are very much united, which means that we must be able to be more effective.

A number of people have laid out the size of the problem that we face. I shall not stand here and start to repeat strings of numbers. I thank the right hon. Member for Edinburgh, East (Dr. Strang) for setting out the framework and context that we need to understand.

I want to pick up on a point about numbers made by the hon. Member for Walthamstow (Mr. Gerrard), who spoke about the importance of not looking only at sub-Saharan Africa. Although the numbers are devastating and we recognise that 64 per cent. of new infections occurred last year in sub-Saharan Africa, we should bear in mind that the increase in eastern Europe and central Asia was 25 per cent. We are looking at a burgeoning epidemic, as that 25 per cent. increase brought the numbers up to 1.6 million infected. It is right that we have that broader scope.

As others have said, the world community is starting to respond to the HIV/AIDS tragedy. It is happening among global leaders and political leaders of countries that have had severe problems, and crucially in civil society. It is right to congratulate DFID on raising awareness at all levels, pushing the issue forward, leading the campaigns and especially securing the G8 commitment to universal antiretroviral treatment provision by 2010. As has been said, however, we must pay attention to global funding.

Only a few weeks ago, the global health fund board approved a sixth round of funding—the United Kingdom seconded that motion—but when I last looked at the papers, no other country had committed funds. The replenishment conference for the global fund will take place in Durban in July, and I ask the Minister to tell us a little about the efforts that he intends to make with other donor countries to ensure such replenishment. If it does not happen, we will be looking at an extremely significant and serious problem.

I want to comment on a couple of the report’s recommendations. Monitoring and evaluation have been mentioned in various forms this afternoon. I was rather surprised by DFID’s comments in the
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Government’s response. I reread the paragraph in question two or three times, but I could not work out quite what was meant. Nevertheless, I sensed a real resistance to those two factors.

We all know the value of scrutiny. It is critical. If we are going to spend the sort of money that we are discussing on HIV/AIDS, we and our parliamentary bodies must be confident that the programmes are delivering what is intended. At the global level, we must be confident that they are delivering what is expected. I wonder whether the Minister can give us some understanding of why the Department is resisting a much more detailed and, I assume, more precise approach to monitoring and evaluation.

I do not understand DFID’s resistance to talking with the European Commission about developing a way to lobby the WTO for a review of the TRIPS programme. We heard of two major relevant examples today. The hon. Member for Gordon (Malcolm Bruce) spoke about his recent experience in India, where it seems that the TRIPS structure would in a sense permit the undermining of the generic drug that is so vital in dealing with AIDS in India. The right hon. Member for Edinburgh, East and several other Members underscored the significance of developing second-line—soon it will be third-line and fourth-line—retroviral drugs in generic form at affordable prices. If we do not do that, our past work will rapidly be undermined. I do not see why a review of WTO’s approach, to discover whether it is working or whether it needs to be adjusted, should be resisted.

A number of hon. Members spoke about the architecture and the way in which the International Monetary Fund and others impact on the world of HIV/AIDS support. In a sense, people are worried about the health infrastructure. The Minister will be aware of rising concern about the way in which HIV/AIDS money is delivered and the functions of the global fund are potentially obscuring the need to build core health delivery systems. How will that balance be addressed?

We have fundamental concerns, as everyone has said, about the lack of care workers. They go out into rural communities, where health structures are almost non-existent and the needs are extreme. Many of the programmes of developing countries are focused on urban centres and capital cities, and vast areas have become an abandoned hinterland.

Ms Keeble: Does the hon. Lady accept that in addition to the acute centres, we need a network of community-based care, which can sometimes be provided by faith-based organisations? The real issue is providing drugs, supplies and food through those networks, and ensuring that they are properly utilised and delivered to people in the community.

Susan Kramer: The hon. Lady made that point eloquently when she described her experiences in Kenya. The development of civil society and the ability to deliver at community level over a much wider range of issues than just HIV/AIDS are crucial, as others have said.

There is much mention in the report of joined-up thinking across Whitehall and integration with other
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Departments. I heard on the news earlier this week that the Department of Health is to cut the number of places for nursing training in the UK, on the grounds that there is not a need to keep nursing training in the UK at the levels that it has reached in the past year or so, having been built up from a low base. Two thoughts immediately come to mind. Is the assumption that we have enough nurses going through training and can therefore cut training on the basis of continuing importation of nurses from developing countries? If not, what is the potential to use those spare places to train people who might go back to the developing world at some point? Again, it would be exceedingly helpful if the Minister could say something about joined-up thinking among the various Departments.

A number of hon. Members have referred to the US programme PEPFAR. I hear almost universal concern about its distortion of the delivery of a response to the AIDS crisis in many vulnerable countries and, in particular, about its bias towards treatment over prevention and about a definition of prevention that works with the A and the B, but restricts as much as possible the delivery of the C, the condom, which most people think is the most effective element.

The Government Accountability Office of the US Congress, which is a very influential body, has just issued a serious rebuke to the US President and PEPFAR. I wonder whether DFID could say whether the potential exists to work within Congress to see whether a rebalancing of that programme could be achieved. If the GAO is willing to stand out and make such comments, there must be an underlying potential within Congress itself.

I should also like to ask DFID how it has responded to that reshaping of the delivery of aid by the United States—in effect, that was the question that my hon. Friend the Member for Romsey (Sandra Gidley) asked yesterday. Has DFID picked up some programmes that would otherwise have been abandoned? Has it changed the way in which it delivers aid in certain circumstances, in order to become the C, where the United States is playing the role of the A and the B?

Much of the discussion this afternoon has been about vulnerable groups and gaps in treatment. We have heard probably one of the most brilliant speeches that many of us have heard, from the hon. Member for South-West Surrey (Mr. Hunt), on paediatric ARVs and the lack of diagnostic tools. Other hon. Members brought that subject up too. I am sure that we all feel quite stunned that it takes only a single dose of a retroviral at the onset of labour, followed by a second dose when a child is just a few days old, to reduce the transmission of AIDS and HIV by 50 per cent.

I am going to become a grandmother twice this year, and the moment I hear of a child who is ill or suffering from HIV, it is obvious to me that we should put effort and emphasis on the problem and call on the Government to set targets and begin to take it on. However, when I looked at transmission from mother to baby, I was shocked to discover that in almost all cases where intervention takes place during labour and again three days later, so that the child has a good chance of being born HIV-free, there is no treatment for the mother. Women have been saying, “Of course I want to take the drug to benefit my child, but tell me
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what the value is, if in two years’ time I’ll be dead myself.” We have to start focusing on mothers.

Ms Keeble: Does the hon. Lady agree that it is also important to make sure that organisations can supply infant formula feed to mothers, so that they can substitute for breastfeeding? Does she agree that it is outrageous that at present they get only ordinary skimmed powdered milk, and not infant formula?

Susan Kramer: I can only agree with the hon. Lady. Obviously, the issue of formula raises the issue of clean water and, as we have said, issues of community support and civic society. I very much take her point.

In 2005, some 17.5 million women were living with HIV and, of those, 13.5 million live in sub-Saharan Africa. Women are disproportionately represented in the rising numbers of those exposed to AIDS and, as others have said, for many women in some countries, AIDS is in effect a death sentence. When we face that situation, we get some sense of the scope of the work that we have to do on the hidden shame of AIDS. I have heard anecdotally from a couple of colleagues who recently travelled to a number of countries in Africa that because of that shame, it may well be the women who go to the clinic, have themselves tested and are identified as having AIDS. They receive retroviral drugs, which they are to administer themselves, and bring them home, but it is their husband who uses them or else the drug is shared between family members. In effect, that undermines everything that the programme is intended to deliver.

I know from talks with various groups that are active on women’s behalf that the problem cannot be tackled unless we challenge the whole issue of the status of women—their education and human rights, and their position and status in local society—and tackle head-on the issue of violence against women. I hope that DFID can give us some assurances on the share of AIDS money that goes to women, because if that issue can be managed, surely it will begin to play a large role in dealing with that imbalance.

Somebody mentioned Zambia—I apologise, but I did not note who it was—when dealing with the subject of women. A recent survey said that in Zambia, fewer than 25 per cent. of women surveyed believed that a wife could refuse sex to her husband, even if he had had multiple partners, and only 11 per cent. thought that they could ask their husband to wear a condom.

I know that I need to bring my remarks to a close, but I briefly want to mention one last issue that I raised in International Development questions yesterday—sexual exploitation. All of us probably took great note of Save the Children’s report on Liberia and what it said about aid workers and the military exploiting their positions of power by having sex with young girls who see that as the only way to continue to survive and receive aid that they should receive for free. I asked whether safeguards were in place for money that DFID passes on, either bilaterally or through multilateral agencies, in order to ensure that that does not happen. Sexual exploitation is part of a much wider and bigger picture within many cultures, but I do not have time to explore that. However, I would very much appreciate the Minister’s response on that issue.

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4.58 pm

Mark Simmonds (Boston and Skegness) (Con): I join hon. Members in congratulating the Select Committee on putting together an excellent and thankfully brief report, which is pithy and to the point. I also congratulate hon. Members on this extremely high-quality, well informed and knowledgeable debate. I have been impressed by how well travelled they are, and also by their first-hand experience of the problems that we are discussing.

It needs to be said that the Chairman of the Committee, the hon. Member for Gordon (Malcolm Bruce), who has been in that position for just under a year, has a growing and excellent reputation. He has done a fantastic job in coalescing the views of the diverse and disparate Members on the Committee. That is a great skill, as is making sure that the Committee comes out with a unified position on this and many other important matters.

The hon. Gentleman’s opening remarks were an excellent summary, and I want to draw on four key points. He was right to highlight the discussion on mid-term targets and the differences of opinion between Committee members. He was also right to highlight the complexities of that issue. We all accept that targets do not necessarily always achieve, or contribute to, the ends that they are supposed to achieve. In addition, he rightly highlighted the problem with treating children and orphans.

The hon. Gentleman was correct to assess the complications that exist with budgetary support and targets, and in the relationship between the International Monetary Fund and individual country performance. DFID and the Minister would probably acknowledge that much more work needs to be done on those.

The hon. Gentleman rightly analysed the abstinence argument, and I draw hon. Members’ attention to what happened in Uganda. A little while ago, the main thrust of its programme to control HIV/AIDS was the use of condoms. Relatively recently, it changed to more of an abstinence argument, and the impact has been a growing prevalence of HIV/AIDS. I understand the moral arguments of that approach, but there is growing evidence that it does not work in practice. On that basis, my party agrees with the strategy supported by DFID, the Secretary of State and the Minister.

My hon. Friend the Member for South-West Surrey (Mr. Hunt) made a superb speech. It was not only intelligent and informative, but moving in parts. He was absolutely right when he said that antiretroviral drugs are not enough, and he went on to explain why. He was also correct to highlight mother-to-child transmission, something discussed by the hon. Member for Richmond Park (Susan Kramer), and to highlight the problems in conflict areas, giving the DRC as an example. Darfur and northern Uganda should also be mentioned, because rape and sexual violence are used there as weapons of war. DFID and other international donors must co-operate with the United Nations and military forces on the ground to try to eradicate that appalling behaviour.

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