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Westminster Hall

Thursday 7 May 2009

[Sir Nicholas Winterton in the Chair]

Children and HIV/AIDS (Developing Countries)

Motion made, and Question proposed, That the sitting be now adjourned.—(Mr. Frank Roy.)

2.30 pm

The Parliamentary Under-Secretary of State for International Development (Mr. Ivan Lewis): It is always a privilege to serve under your chairmanship on these occasions, Sir Nicholas. This issue unites the House, and could not be regarded as party political. We all share a tremendous passion and conviction for the UK’s work, and the leadership role that it fulfils around the world, on the fight against HIV and AIDS. The Government are proud of that work, but all parliamentarians can rightly feel a sense of pride in the progress that has been made as a result of the Government’s investment and the UK’s leadership in various international institutions.

We have led the way in calling for improved progress on the millennium development goals and in demanding that we do not forget the world’s poorest, despite the current economic crisis. As hon. Members are aware, we are consulting on a White Paper that will set out our vision for poverty reduction in the face of unprecedented global challenges—from the economic crisis to the threat from climate change. It is important to place on the record that the Prime Minister and the Government have made it absolutely clear that this is not the time to retreat from our commitments to developing countries and the poorest people in the world. The one lesson we should learn from the economic crisis is the interdependency of our world at the beginning of the 21st century. This is not just a question of global social justice or altruism; it is also in our interests to close the inequality gap that so scars our world. Britain must stay firm to its commitment to contributing 0.7 per cent. of gross national income by 2013, and we have made it clear that we expect and hope that other developed countries will equally honour their commitments to the poorest people and countries of the world.

At the heart of our vision for making progress on all our development investment and work is the aim of ensuring that we finally begin to win the war against HIV and AIDS. We must focus specifically on meeting the needs of children, who are often those most affected by HIV and AIDS. There are three reasons for that approach, the first of which is that we cannot meet the millennium development goals, particularly in sub-Saharan Africa, without progress on AIDS. Shockingly, 15 million children have been orphaned by the disease and therefore left more vulnerable.

Secondly, maternal and reproductive health are fundamentally interlinked with HIV, and we cannot tackle one without tackling the other. Many children catch HIV from their mothers, so it is essential to prevent mother-to-child transmission. Sustained improvements
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in reproductive, maternal and newborn health depend on functioning health systems, as do efforts to turn the tide of AIDS. That is why we promote a comprehensive, integrated, country-led approach, supporting Governments and communities, and why we are committed to investing £6 billion in health systems and services between 2008 and 2015. Such a seven-year commitment is very unusual, because the Government usually make investment decisions in three-year budgetary cycles. That approach illustrates the centrality of stability and certainty, if we are to achieve long-term change, in our investment of resources in this area.

Thirdly, the impact of the global economic downturn will be greatest on the poor and most vulnerable, including children affected by HIV. Past failures to prioritise strong health systems left the developing world ill-prepared for the arrival of HIV. It is crucial that we do not repeat the mistakes of the past, and it is particularly important that we celebrate the fact that our world leaders, under the leadership of our Prime Minister, insisted at the G20 that the needs of the developing world were given top priority when taking decisions regarding the International Monetary Fund, the World Bank and the vulnerability fund that is being created. The challenge now is to ensure that the international community honours the commitments made and signed up to at that summit. It is important to stress that this country retains responsibility for overseeing that donors and global institutions, working with developing countries, honour the commitments and pledges that were made to ensure that the poorest of the poor do not become even poorer as a result of the unprecedented economic crisis that we face.

In any debate on development, it is incredibly important to recognise the progress that is being made, in order to encourage those on the front line who are working hard every day to overcome serious obstacles. That progress is quite impressive. The percentage of the world’s adult population living with HIV has levelled off, and 20 times more people than before have access to life-saving treatment, with 3 million now on treatment. The price of first-line AIDS drugs has fallen considerably. The coverage of services to prevent mother-to-child transmission of HIV in low and middle-income countries has expanded from 10 per cent. in 2004 to 33 per cent. in 2007, and more than 30 countries have developed national plans of action specifically to help orphans and vulnerable children.

Ms Sally Keeble (Northampton, North) (Lab): The Minister said that coverage of medication to prevent mother-to-child transmission has increased from 10 per cent. to 33 per cent. in low and middle-income countries, but will he say what the breakdown was in those countries, and what is actually happening about coverage in low-income countries?

Mr. Lewis: Perhaps I may respond to that question in my closing remarks at the end of the debate, by which time I can get a more detailed breakdown for my hon. Friend. Let me pay tribute to her for her championing in this House the most vulnerable, particularly street children and orphans. She has often been a lone voice in saying that development policy needs to focus on the most vulnerable children. Arguably, the success of our policies will be judged by how well we do in reaching those vulnerable children and young people. I shall get
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the information that my hon. Friend requires and I will, I hope, be able to incorporate it into my closing remarks.

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): I welcome the good news the Minister is giving and I congratulate him and his staff on the huge progress his Department is making, but will he give us a picture of how far along the road we are toward meeting the two specific aims in MDG 6: to halt and reverse the spread of HIV/AIDS worldwide by 2015, and to provide universal access to treatment by 2010? How far along that path are we, and is there anything further we need to be doing?

Mr. Lewis: I thank the hon. Gentleman for that constructive intervention. I shall address that point directly in a moment.

I have focused on the progress we have made because it is important to have that as a platform, but equally, there are massive challenges ahead, and we have a long way to go before we can say that we have reversed the trend on AIDS. That is how I shall develop the rest of my opening remarks, and I shall try to articulate the measures we need to take and the scale of the challenges.

There are still more than 33 million people living with HIV, and despite progress in treatment, more than two thirds of those who need antiretrovirals still do not have access to them. For every two people who have been put on to treatment, there are five people newly infected with HIV. That is a shocking statistic. Every day, nearly 7,000 people are infected with HIV and nearly 6,000 die from AIDS.

We have learned much about the epidemic and we know what interventions work best, yet access to AIDS services in many places remains totally unacceptable. For example, most prevention strategies are accessible to fewer than one in five people who could benefit from them, and that number is even lower for marginalised groups, such as drug users and men who have sex with men. In some countries, AIDS has reversed decades of development progress towards better health, education and economic growth.

The challenges remain most acute in Africa. More than 67 per cent. of all people with HIV live in sub-Saharan Africa and, in Africa, AIDS is becoming feminised, because it increasingly affects women more than men. In sub-Saharan Africa, almost 61 per cent. of people living with HIV in 2007 were women. However, what concerns us today is the terrible disproportionate impact on children, which is the point that my hon. Friend the Member for Northampton, North (Ms Keeble) often makes.

In response to the hon. Member for Cotswold (Mr. Clifton-Brown), I want to mention two tangible areas where we need real change. First, children—especially those under one—are among those who are most vulnerable to HIV and AIDS, yet they are among the least well served. Mother-to-child transmission is the primary cause of paediatric AIDS, which occurs during pregnancy, labour or breastfeeding. We know that effective interventions to stop mother-to-child transmission are available and yet only 34 per cent. of women have access to those prevention services. Around 370,000 children are estimated to have become infected in 2007 alone and, without
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early treatment, around 50 per cent. of HIV positive children will die by their second birthday. What a waste of human potential! Once they are born positive, children who receive early treatment have much better survival rates, but diagnosis of HIV in children remains complex and costly. More needs to be done to get children diagnosed and treated early.

A second major challenge is that children suffer in a significant way because AIDS takes away their parents. In 2007, an estimated 15 million children had lost one or both parents to AIDS. Some 11.6 million of those children live in sub-Saharan Africa and, in some parts of Africa, more than 25 per cent. of children have been orphaned. UNICEF estimates that, on average, only 12 per cent. of households in which orphans and vulnerable children live are getting external assistance, because of the vast numbers involved and the funding bottlenecks. Those children are, of course, vulnerable to stigma, discrimination, poverty and abuse, and they are at risk of dropping out of school. In turn, that makes them more at risk of HIV infection, poor reproductive health and, for girls, early and often unwanted pregnancy; and so the cycle of despair continues.

In the face of those challenges, the Government’s commitment to universal access to comprehensive HIV prevention, treatment, care and support remains unwavering. Last June, we renewed our pledge with the publication of a new UK Government strategy, “Achieving Universal Access”, which sets out our vision of how to deliver that. Again, I can assure hon. Members that our commitment is unequivocal. Through working with others, we will intensify prevention efforts that have proven to be effective, such as mother-to-child transmission, and help with family planning, safe abortion and harm reduction. We will also pursue prevention efforts among adolescents and young people.

Over the next seven years, we will work with others to bring down the cost of treatment so that more people have access to life-saving drugs. The goal is that everyone living with HIV ultimately gets the treatment that they need. We will help our partners to build stronger health services, which are key to providing effective services now and in the future, and we will work in all sectors—not just in health—to address comprehensively the needs of those affected. We are committed to supporting countries to “know their epidemics” by investing in research, building the evidence base and helping to focus resources where they are most needed and will make the greatest impact. We will continue to champion sexual and reproductive health and rights, and fight the feminisation of the AIDS pandemic. The fresh approach to family planning and the prevention of unsafe abortion that has been signalled by the current US Administration will allow us to work collaboratively in areas where we have not been able to do so before. We have a moment of opportunity, and it is vital that we seize it.

Of course, rhetoric and policy must be backed up by money and other commitments. We are proud to be the second largest bilateral funder in the world of HIV prevention, treatment, care and support. We provided £1.5 billion between 2005-06 and 2007-08. More broadly, we will spend £6 billion up to 2015 to improve health outcomes in the developing world. That is in addition to the £1 billion we are giving to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which will provide that organisation with the long-term, predictable funding
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up to 2015 that is so necessary. In addition, we will also spend more than £200 million to support social protection programmes over the next three years, which will provide greater coverage and more predictable funding for households and children affected by AIDS. Our focus will be on working with Governments and civil society in eight African countries.

Of course, the UK has led on other interventions, through which we want to begin to achieve transformation, which is so crucial. This point, in a sense, speaks directly to the hon. Gentleman’s question about the scale of the challenge and how much progress we still have to make. Our Prime Minister has led the way on finding innovative ways of triggering new resources to put into health. In addition to the resources that donors spend and the resources that we expect functioning states to spend, money is spent through non-governmental organisations. Therefore the work of the high-level innovative task force is crucial in considering the range of new financial instruments needed to close the funding gap that we know exists for meeting our ambitions contained in the health MDGs. Towards the end of the year, we hope that there will be an international settlement from which we can pursue instruments globally to find innovative finance.

This country has also led the way in developing international health partnerships. They relate to the concept that any country that, in the end, wants to meet its population’s health needs, has to have a functioning health care system. In states where there is not a functioning Government, of course, we need to spend money on health centres and hospitals, and on getting health to the most remote and deprived communities. In the end, long-term change depends on having a national health system that can pay, recruit and train doctors, nurses, midwives and support staff, and that can ensure that the necessary supplies of drugs and medication reach every section of society. The model for IHPs is that, where countries do not have functioning health systems, we, as an international community, should be incentivising them to develop comprehensive and universal health systems, which offer universal access. We are making progress in that respect. I can provide the hon. Gentleman with a list of countries that have signed up if he wants me to; perhaps I can give it to him at the end of the debate.

Mr. Clifton-Brown: I want to ask the Minister about something that is directly relevant to this part of his speech. Does he agree that when we provide these health systems—as he says, often to countries that are extremely lacking in that respect—we also need to consider the latest technologies? Only 18 per cent. of pregnant women ever have an HIV test, although some fairly simple diagnostic tests can be used for that nowadays. There are even portable diagnostics that test for immunity to various antibiotic drugs. Such tests would have needed a huge room full of static diagnostics in the past. Does he agree that we need to use all the latest technology, and is his Department constantly evaluating those technologies?

Mr. Lewis: The hon. Gentleman is right and, to some extent, I will come to that issue. Of course we need to harness, or marry, human resources—there is no substitute for human resources—with the most up-to-date modern technology because, in the end, that is how we can accelerate progress on health systems. We have a strategy
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for how to make the best use of technology and how to ensure that, in a sense, the use of technology is not a side issue, but that it is integral and mainstream. In supporting developing countries to develop health systems, technology needs to be an integral part of utilising all resources so that we can make the maximum impact in the shortest time. He is absolutely right.

The innovative finance work and the international health partnerships are important, but we also must be much clearer in articulating how we can do better in fragile states where, frankly, the ability to have a comprehensive universal health care system is a long way away. Women and children in those countries cannot afford to wait until we are in a position to partner their Governments in the creation of health care systems. Therefore, it is important that in such circumstances we have a segmented approach. We need to work more with NGOs to find more innovative ways to build health services from the bottom up, rather than simply hoping that a state will become a functioning state. We need a segmented approach to get health systems to start functioning to best effect.

The best test of any health care system in any part of the world is how it treats children and women. Any health system that gets it right for young kids and women is a successful, functioning, high-quality system. This is not just about a minor part of a health care system. This is the ultimate test for HIV and AIDS, certainly, but also for infant and maternal mortality. If we start to make rapid progress in areas where, frankly, we have not made enough progress, it will demonstrate a significant improvement in universal health care systems more generally.

Having laid out the context and discussed the big picture and the systemic change that is necessary, I want to focus for a few moments on children. We clearly need a comprehensive approach that combines prevention of infection in the first place with appropriate treatment, care and support for children and their families.

We will intensify efforts to increase to 80 per cent. by 2010 the percentage of HIV-positive pregnant women who get the antiretroviral drugs that will help their babies to remain free from infection. That may help the hon. Member for Cotswold. We will work with others to scale up prevention services, as well as those for early diagnosis and treatment of paediatric AIDS. Services will follow internationally agreed guidelines.

Some key issues are inherent in that approach. Giving HIV-positive women the choice and opportunity to prevent unwanted pregnancies is a highly successful and cost-effective way of reducing mother-to-child transmission of AIDS and reducing maternal deaths. Evidence suggests that effective contraception in sub-Saharan Africa prevents many more cases of mother-to-child transmission than antiretroviral therapies. We are committed to working with others to intensify efforts to increase access to voluntary—I underline the word “voluntary”—family planning.

We also need to deliver effective, affordable and accessible treatments to those who need them. A test that can accurately diagnose HIV infection in infants at the point of care without the need for follow-up would allow many more children to be diagnosed and treated early. Again, responding to the hon. Gentleman, treatment for children is also constrained by the lack of antiretroviral drug formulations that are easy for them to take.

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That is why it is so important that we make progress on a patent pool. UNITAID is doing some important work in this area, but we need to apply pressure to see rapid progress. Also, all political parties in this House should ask serious questions of the big pharmaceutical companies and place responsibilities on them to come to the table, to put aside in a limited way their inevitable insecurities about competition, and to pool their resources, innovation and efforts and be willing to sign up to an HIV/AIDS drugs patent pool, which could prove transformational.

In the context of the current recession, we need to ask new questions about many of the economic orthodoxies that we had all signed up to over a long period. It seems perfectly reasonable to ask international pharmaceutical companies that make vast profits—we should not criticise or condemn those profits, which are important, necessary and the result of innovation—to be part of the solution, and to expect them to want to be part of it. Yes, we must consider that from an ethical, values and corporate social responsibility point of view, but in the long term, it would also be in their economic interest. If we can begin to discover new treatments and cures, a virtuous cycle would be created. It would be good if all-party pressure could be put on pharmaceutical companies to try to achieve some of those objectives.

Mr. Clifton-Brown: The Minister is very generous in giving way, and I hope this will be the last time that I trouble him. I shall give an example in my speech of a big health care company that has started work on a patent pool and has provided many drugs free of charge in order to meet the challenge. However, a relatively small number of antiretroviral drugs—I said “antibiotics” earlier—are of paediatric formulation, and that is a real problem. Will the Minister use his best endeavours to press the pharmaceutical companies to take the problem of HIV/AIDS in children more seriously?

Mr. Lewis: I must stop agreeing with the hon. Gentleman, as there is a danger that this debate will turn into a love-in, but to be serious, he is absolutely right. For example, a malaria drug has recently been developed that is making a real difference in paediatric care. If we could replicate that for HIV, the prize would be great. We have the evidence of the malaria drug, which specifically focuses on young children—the hon. Gentleman may be aware of it—so we should seek the same progress in respect of HIV. That message should be sent loud and clear from this debate to the pharmaceutical companies.

Improved linkages between prevention of mother-to-child transmission and child health services are vital to ensuring that children are tested, followed up on and given treatment. The strategy that we have adopted places the needs and rights of women, children and other vulnerable groups at its heart. It demands their empowerment at the centre of AIDS responses, alongside people living with HIV.

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