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3.28 pm

John Barrett (Edinburgh, West) (LD): It is often the individual stories that stick in our memories. Although we speak about millions of children suffering, detailed accounts, such as that given by the hon. Member for Northampton, North (Ms Keeble), are the ones that last, and I thank her for her excellent speech.

At a time when swine flu is dominating our television, radio and press news headlines it would be easy to forget the scale of the subject of our debate, and the problems facing developing countries because of HIV
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and AIDS. I welcome the debate because it is our duty to lead, and to debate issues that do not necessarily make the headlines.

Within the developing countries it is, as we have heard, the most vulnerable who are hit the hardest. Those are usually the women and children. It has been good to hear from the Minister that the battle continues on behalf of those children, even if the news does not make the headlines. Early this afternoon in the main Chamber there was a debate and update on swine flu, while in Westminster Hall we have this debate on HIV and AIDS. I can guarantee which one will make the 6 o’clock and later news headlines. Nevertheless, it is good to hear about the Government’s record, which is a good one. Having visited several of the countries that have been mentioned, I am pleased that the work being done on the ground by the Department for International Development, the UK taxpayers’ money that is being spent, and the expertise that is being used, are proving effective. In the economic downturn, to which the Minister referred, we must justify to our hard-pressed taxpayers why we are advocating that more money should be spent. Part of the problem is that with its decreasing value, the pound does not go as far as it did a year ago. If we can guarantee that the money is being spent effectively, and that it is a matter of life or death for many people, we can argue for more resources for overseas aid and development.

As we have heard, the problem is worldwide. Even on our doorstep too many new cases of HIV/AIDS are diagnosed every week, but children in developing countries face specific problems because of the scale of the numbers involved and because those countries often suffer a wide range of other serious problems, including poverty, drought, food insecurity, conflict, and wider health problems. I shall concentrate today on sub-Saharan Africa, not because the problem is less of an issue elsewhere, or that the numbers affected in, for example, India are not significant, but because the UK Government have a long and a good track record of work in many areas of the African continent. However, much more must be done.

The number of people affected by HIV in sub-Saharan Africa is staggering. At the end of 2007, an estimated 22 million people were living with HIV, with AIDS being the leading cause of death and killing an estimated 1.3 million people in 2007 alone. In the same year, another 1.7 million people became infected with HIV. The epidemic is wiping out development gains, orphaning millions of children, fuelling the spread of other diseases, including TB, and even threatening to undermine national security in some highly affected societies.

Over the past decade, I have visited a number of African countries and seen at first hand the suffering and devastation that AIDS can bring to regions, villages, families and individuals. In the slums of Kibera in Nairobi, I met nursing mothers in a clinic and we were informed that every mother was probably HIV positive. The potential for stopping mother-to-child transmission is great, but for many mothers, it was too late. I welcome the Government’s action in that area. In the slums of South Africa, an estimated 5 million people are living with HIV/AIDS and there are 1.4 million orphans as a result.

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We often see images of an orphanage in Malawi now that Madonna is a regular visitor, and we often see happy, smiling children. I have been to that orphanage and seen its work, but few images appear on our televisions of the real suffering of children who die daily. We do not see that, and it might be better if we did. We did not see what happened during the bombing in Gaza and Iraq, but it might strike home if we saw some of the problems of HIV/AIDS sufferers in greater detail.

One problem in Malawi is governance, and ensuring that our AIDS money is spent effectively and that those involved plan for the long term. When I was a member of the Select Committee on International Development, we had a long and heated debate with Ministers from the Malawi Government, and I could not understand why they did not think about the long term. There was so much short-term thinking, and we were trying to stress long-term planning. It was suggested to me afterwards that 60 per cent. of those Ministers were estimated to be HIV-positive. If most of them do not have a long life expectancy, perhaps it not surprising that their prime consideration is for the short term and the families whom they may leave behind. We must press for long-term thinking because it is vital.

I want to put on the record the number of children who are affected, because it is staggering. According to UNAIDS, at the end of 2007, 2 million under-15s were living with HIV/AIDS throughout the world, and during the year an estimated 370,000 children became newly infected with HIV. Of the 2 million people who died of AIDS during 2007, more than one in seven were children. Every hour, around 31 children die as a result of AIDS. Hundreds of thousands of children throughout the world become infected with HIV every year and without treatment they die as a result of AIDS. Most children living with HIV—around nine in 10—live in sub-Saharan Africa, but many also live in the Caribbean, Latin America, India, and south and south-east Asia.

I have focused on sub-Saharan Africa, but it is important to acknowledge that the problem is not solely an African one. Indeed, many countries in northern Africa have lower HIV rates than north America and parts of Europe, so to characterise the problem as an African one is as unhelpful as it is unfair.

As we have heard, many millions more children who are not infected with HIV are indirectly affected by the epidemic, as a result of the death and suffering that AIDS causes in their families and their communities. It is difficult to consider the effect of HIV on children as distinct from its wider effects on society, because a child’s life can be decimated by HIV regardless of whether they were born with HIV or contracted it. In countries with a high incidence, it is a depressing statistical reality that a parent or other family member is likely to be HIV-positive. Sub-Saharan Africa has 11.6 million AIDS orphans and a child is orphaned by HIV every 15 seconds.

One impact of HIV in children is that it blurs the boundaries of what it means to be a child. As the number of AIDS orphans grows, more and more children become the head of their household and their family’s principal breadwinner. Many more find themselves acting as carers for sick parents. HIV and AIDS not only debilitate and kill children, they erode the very concept of childhood in many of the worst-hit countries.

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I am in regular touch with a young boy whom I met many years ago. He and his sibling are orphans. He is still alive, still surviving, and still shining shoes part time and attending school part time, but I have no idea whether he is HIV-positive or whether he has a long-term outlook. One can only hope for the best. HIV may affect a child’s life not just in the family, but in their community, because many schools lose teachers as a result of HIV, and children are unable to access education. Children who have HIV in their family may be stigmatised and suffer discrimination.

Preventing children from becoming infected and mitigating the impact of HIV and AIDS should be straightforward, but lack of necessary investment and resources, including adequate testing, antiretroviral drugs and prevention programmes, as well as stigma and discrimination, mean that children continue to suffer needlessly. Around 90 per cent. of all children living with HIV acquired the infection from their mothers during pregnancy, birth or breastfeeding. In sub-Saharan Africa, one in three newborns infected with HIV die before the age of one, and most are dead before they are five years old. In developed countries, preventive measures ensure that the transmission of HIV from mother to child is relatively rare, and even when it occurs effective treatment means that the child can survive, often into adulthood. With funding for trained staff and resources, the infection and death of many children in lower-income countries might easily be avoided. Sadly, it seems likely that in some of the worst-hit countries there will be a struggle just to continue treating those who are already on antiretrovirals. Countries are understandably reluctant to remove treatment from those who are currently receiving it, but that severely hampers prevention efforts and our capacity to treat new sufferers.

I know that the Government are the biggest contributor to tackling HIV per capita, and the second largest donor overall. We should all be proud of that. I was pleased to hear that DFID has committed £200 million for social protection programmes, and I understand that £80 million of that is new money. However, in the excellent report by the International Development Committee, “HIV/AIDS: DFID’s New Strategy”, legitimate concern was expressed that social protection programmes and direct cash transfers would not necessarily guarantee outcomes for children and that measuring the impact would be difficult. I would appreciate hearing the Minister’s response to that concern and, in relation to aid effectiveness, what we are doing to ensure that we get value for money from both Government and NGOs.

I am sure that we would also appreciate updates, because the economic downturn will continue. The Minister mentioned the impact that that will have on DFID funding, but as the global recession is likely to continue in the year ahead, it would be good to hear how things are developing during that period. He will be aware of reports from the World Bank that drug treatment for up to 1.7 million people with HIV is under threat because of funding pressures triggered by the global financial crisis. I am encouraged by assurances that DFID will be honouring its G8 commitments on meeting the millennium development goals in relation to HIV/AIDS, but we must wonder what we can do to encourage other countries that made similar commitments to hold to those commitments, because it is feared that some are backtracking on those statements.

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I know that DFID has had discussions with the United States on its HIV programmes in the past, particularly on the PEPFAR—President’s emergency plan for AIDS relief—projects. I would appreciate hearing how the Minister expects the American approach to tackling HIV in developing countries to change now that the new Administration are in place.

We have talked about money for drugs, but perhaps the biggest thing that we can do for children is to educate the next generation about HIV, how to avoid contracting it by having safe sex and, for those who are infected, how to live with it. A country’s relationship with its HIV rate is often complex, but by better educating the next generation, particularly on sexual habits, it will have a better chance of improving the situation. As has been said, empowering women and putting them in control of their own bodies in high-incidence countries would go a long way towards tackling the problem. Conflict and state instability can often wipe out progress on HIV rates. It is important that DFID’s programmes to tackle HIV/AIDS are tied into a bigger-picture strategy for security and development in the region.

It is estimated that 31 children die every hour from AIDS. That means that during this debate, if it runs for the full time, 93 children will die. Later this month, 91 children from my constituency are coming down to visit me. If something happened to kill every one of those children, we would leave no stone unturned in the search for a solution to the problem. We would say that it was unacceptable and must never happen again. Children in other countries are no less important. We in this place must ensure that they are never far from our thoughts.

3.42 pm

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): I am pleased to serve under your chairmanship, Sir Nicholas. I am also delighted to have heard the excellent contribution from the Minister. It was a very heartening exposition. As the hon. Member for Edinburgh, West (John Barrett) said, it is often the personal examples that stick in one’s mind. The speech from the hon. Member for Northampton, North (Ms Keeble), who explained that she could not stay for the final part of the debate, was particularly heartening. It is amazing how one suddenly finds that a colleague in the House has a huge amount of knowledge and has done a great deal of work on a subject that one never knew they were involved in. It was a delight to hear her speech. The hon. Member for Edinburgh, West also dealt with the subject comprehensively. Inevitably, therefore, my speech will cover some ground that has already been covered.

The problem that we are debating is a dreadful one. Before I launch into my speech on children in the developing world, I shall just mention that I happened to pick up a free newspaper on the tube today and one of its articles stated:

So although in this debate we have been dealing exclusively with the developing world, we must not forget what is going on in our own backyard, as well.

Of course, the focus of this debate is the effects of HIV and AIDS on children, and the statistics are particularly heart-rending. They have been cited before,
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but I make no apology for citing them again. They are in the relevant DFID report. There are 33 million people living with HIV. As the hon. Member for Edinburgh, West said, 7,000 more are infected every day, 40 per cent. of whom are young people aged between 15 and 25. What a tragic waste. There are 1.8 million children in sub-Saharan Africa suffering from the disease. They account for 6 per cent. of the infected population but, tragically, 14 per cent. of the deaths. Each day, nearly 6,000 people die from AIDS. It is estimated that 15.2 million children have been orphaned as a result of AIDS. Those are tragic and mind-boggling figures, to which we should all pay very close attention.

However, the effects of this dreadful disease cannot be fully expressed by the statistics, as anyone who has witnessed its effects in countries where HIV/AIDS is endemic can report. Last summer, I was in Rwanda, teaching English teachers how to teach and write English. I had a class of 55 people. On the last day, this nice young girl came up to me. She had made quite a good contribution in the class throughout the fortnight and she said, “I want you to know I have AIDS.” I said, “I am desperately sorry to hear that. Are you getting any treatment?” She said, “No. My diet is too poor; the drugs that are supplied are too toxic.” I would not mind betting that she had just a month or two to live. So the millennium development goal of universal access to treatment by 2010, even if we do not get there—the Minister realistically outlined today that we might not fully achieve it; we might get only to 80 per cent.—is still hugely important.

As many others have said, HIV does not discriminate in whom it affects, but it will consistently devastate. It tears families apart and communities are decimated. A person’s chance of pulling themselves and their family out of desperate poverty is quashed, a nation’s economic growth is hindered and the cycle of decline continues. However, the children suffer worst, because they are the innocent victims. As the Minister said, their bodies are least able to resist the ravages of the disease. Even if they do not have the disease, they will suffer if their provider dies. I mentioned in an intervention on the Minister the problem of paediatric formulations of the existing drugs. Drug companies need to pay much closer attention to the problem affecting children.

There have been a number of welcome improvements. If I may say so to the Minister, DFID’s employees must be congratulated on their work, as must their colleagues in similar Departments in other countries, along with charities and health workers, who have worked so hard in this fight. The future of our country’s involvement in combating HIV is shown in the DFID publication “Achieving Universal Access—the UK’s strategy for halting and reversing the spread of HIV in the developing world”. However, that plan must be held up to scrutiny and I hope that we hear from the Minister today a response to some of the issues that I will raise.

Before turning to specifics, I want to raise the issue that was noted by the Minister and remarked on by the International Development Committee. It stated that

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It would be interesting to hear the Minister’s reply to that. The Government’s strategy paper was released in June 2008, almost a year ago. I hope that he will tell us exactly what steps have been taken towards providing answers to those questions, and what the answers are. They are, after all, questions relating to a programme committing a huge amount of funding. We were all very heartened to hear that DFID was committing that funding—£6 billion directly and another £1 billion through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

There are a number of excellent multilateral agencies—for example, UNICEF, which the Minister mentioned, and the World Bank. There are very good and knowledgeable NGOs doing excellent work, such as Save the Children. There is the charity of the hon. Member for Northampton, North. Many charities and NGOs are working in the field of HIV. However, as the Minister said, some companies are becoming involved with providing patent pools. I met representatives of an excellent company yesterday called Abbott Pharmaceuticals, which is one of the biggest pharmaceutical companies in the United States. It does not yet have a high profile here. In 2006, it provided more than $170 million of free HIV drugs, and it is participating in the patent pool arrangements to which the Minister referred. Indeed, an increasing number of multinational companies are taking part in excellent corporate social responsibility programmes, some of which are involved in the HIV field.

The Minister may have mentioned this, but I put it to him that one of the key players in the fight against HIV must be the US Government. Given the recent change of Administration, it is important that we interact with them. Indeed, the recent announcement by President Obama that Dr. Eric Goosby, a man with more than 25 years’ experience in this field, will be the next US global AIDS co-ordinator, has been welcomed by the Joint UN Programme on HIV/AIDS. As I say, the US is bound to be a key player, and it would be of great interest to hear what interaction the Minister has had with the US.

One country that has not been mentioned is one of the most seriously affected: South Africa. One in six of the world’s HIV sufferers live there. Thabo Mbeki, the previous President, had a chequered history in tackling HIV/AIDS, and the newly inaugurated president Jacob Zuma has already caused controversy on the matter. I hope that the Minister will enlighten us on his perception of the effect of the change of leadership in South Africa.

I turn to the important matter of monitoring the processes being brought about by DFID’s many policies. In an intervention on the Minister, I cited the terms of millennium development goal 6, which are well known. They are to have halted and reversed the spread of HIV/AIDS by 2015, and to have achieved universal access to treatment for HIV/AIDS by 2010. Given that 2010 is fast approaching, it seems that we will run short of the latter target. Nevertheless, it is important that we continue to concentrate on those targets.

I was heartened to hear from the Minister something that I did not know—that the UK has a worldwide role in co-ordinating the efforts of NGOs and multilateral agencies in other countries in the fight against HIV in sub-Saharan Africa. That is of great credit to the Government.

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The Select Committee report states that

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