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Whatever the Bill says, the kind of problems that we will end up with were exemplified by the point made by the noble Lord, Lord Turnbull, about how best to protect the National Statistician when he or she has exercised technical judgment to the best of their ability. Is that best done by the board saying, “Actually, it was our decision and not just hers”, or is it best done by the board saying, “We employ her to take that responsibility; we have looked at the way in which she has exercised her responsibility; she has done it in a perfectly proper way and we support it”? Those are two ways of dealing with that problem and neither delivers a knockout blow to the other.

I welcome the fact that the Minister is prepared to take all these concerns away for further consideration and deal with them on Report. Bearing that in mind, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Evans of Temple Guiting: I beg to move that the House be resumed. In moving the Motion, I suggest that the Committee stage begin again not before 8.45 pm.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.

HIV/AIDS: Children

7.42 pm

Baroness Northover rose to ask Her Majesty’s Government what action they are taking to combat AIDS across the world and its effect on children.

The noble Baroness said: My Lords, I am very grateful to have such an array of distinguished speakers with long commitments to the fight against AIDS speaking in this short debate. It is a mark of the importance of the subject. I often think that, if HIV/AIDS were at the same level in Britain as it is in southern Africa, we would have nothing else on the agenda. In some places in southern Africa, two-thirds of the adult population are infected. A whole generation is being decimated. How can that not be seen as catastrophic?

I want to focus on the long-term implications of HIV/AIDS and, in particular, on the impact of the epidemic on children and the future of those countries that are already badly hit by HIV/AIDS or where the full impact is fast coming down the track. As UNICEF

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points out, the AIDS epidemic puts children at risk physically, emotionally and economically. Children may themselves be infected with AIDS; they may live with a chronically ill parent and be required to work or to abandon their schooling while they look after that parent or earn money. Many also become orphans. There are already 12 million orphans in sub-Saharan Africa alone. They may live with a grandparent, often in extreme poverty and deprivation, and be rendered even more vulnerable on that grandparent’s death.

Then there are the even wider implications of societies being undermined as large numbers in the working population die, of culture not being passed on and of working practices, such as those in agriculture, not being taught to children because their parents are sick and dying. One can draw a parallel—I have done so before, but it is worth emphasising—with the plague that struck 14th-century Britain, when enormous economic and social change followed. Some of that change was positive—it sounded the death knell for the oppressive feudal system—but villages died, people moved and rebellions occurred. The social and economic impact of AIDS cannot be overestimated. Surely it is a greater threat to peace and security than terrorism.

There was a time when the emphasis was on prevention. It was felt that those who were affected were beyond help because of the cost of drugs and the lack of infrastructure in countries to deliver treatment. It was laudable and extremely significant that the G8 at Gleneagles made the commitment that everyone who needed it should be on treatment by 2010. That recognised the injustice of not doing everything possible to get the kind of treatment to people that in the West has meant that AIDS is something you can live with, not die of. But it also recognised the need to look after communities, and children in particular, whose lives and futures were being shattered by this disease.

I gather that DfID is about to open a consultation on AIDS, and there is a question mark over whether children should continue to be a focus of its aid. I ask the Minister for her views on that. It seems to me that it is vital to look at their particular needs, and I hope that DfID will continue to do so.

Children, too, are infected with HIV, of course. Globally, there are 2.3 million children with HIV, the majority of whom live in sub-Saharan Africa. Over 90 per cent of paediatric infections are the result of mother-to-child transmission. For most children infected with HIV, the chances of survival are slim. More than half of those babies will die before their second birthday, yet paediatric HIV is almost entirely preventable.

In high-income countries, such as our own, where ARV drugs are given to women during pregnancy and labour and to infants, and where there are safe delivery and feeding practices, mother-to-child transmission rates are less than 2 per cent. There is a global commitment to offer appropriate services to 80 per cent of women who need this by 2010, but in developing countries in 2005 the figure stood at just 11 per cent. What can the Minister tell us about progress on that? Will Angela Merkel, leading the G8, put effort behind this project, as is rumoured?



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When I went to South Africa last year, I was told that the cost of treating children had not been factored into the costings of providing mother-to-child treatment, yet the costs are considerable. When I visited a paediatric hospital in Mozambique, I could see not only the cost of treating the child but also the cost to the family, as parents often nurse sick children, thus being unable to work or to look after their other children. Prevention of mother-to-child transmission is known about, is extremely urgent, and must be properly funded and supported. Where a child is infected, treatment is still rarely available and is a blunt instrument, although there have been some welcome developments through the Indian generic drugs industry. But I was told by one UNICEF worker in southern Africa that drugs companies do not see investment in treatments for children as being worth while financially because they see the market as time-limited once mother-to-child prevention is widespread. What are we doing to ensure that research in this area is undertaken if the drugs companies are reluctant to undertake it?

There are enormous challenges in this area. There is the problem of accessibility, especially in rural areas and among women. There is the need to extend testing. In Lesotho and Botswana, people have to opt out of testing rather than opt in, which is surely welcome, but easier tests are required. Social and financial support needs to be given to vulnerable children, who suffer the effect of diminishing household income. Widows’ and orphans’ rights to land are rarely protected. Sometimes children are taken into households and used as little more than slaves, and any property rights that they had are taken from them. Orphans are less likely to be enrolled in schools than other children and they have poor nutritional status. More orphans end up in female-headed households; some end up in child-headed households; and some, of course, end up with grandparents, who may die before the children are 18.

It is very clear that children are likely to flourish better with relatives or in communities. There are difficulties with those situations, but they are much better than having the children live in institutions. There are many reasons for not wanting residential facilities for orphans, including high staff turnover, care deficits, lack of high standards and clearly worse physical and mental outcomes. Much more therefore needs to be done to give financial help to carers. I note that the global fund is supporting one such scheme to help grandparents in Swaziland, which is welcome.

The provision of cash transfers to older people has a positive effect on the well-being of children. In Namibia and South Africa, many older people spend the greatest proportion of their pension on food, clothing, education and healthcare for their grandchildren. A southern African study found that receipt of pensions by older women had a significant impact on the growth of the girls whom they looked after. In Zambia, a cash transfer scheme to older people caring for orphans has resulted in better school attendance. What plans do the Government have to extend these sorts of schemes?

We must not forget the enormous difficulty of getting help to children who fall outside these arrangements. Street children are especially vulnerable

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to HIV and AIDS. They live a transitory lifestyle, are unsupervised by adults and have little access to health, education or social services. Can the Minister comment on this particularly vulnerable group?

As UNICEF observes, in recent years there has been a surge in leadership and resources in the fight against AIDS. The UK has played its part. UNICEF says:

I am therefore glad that we are having this debate tonight and that it happens to come at the beginning of an extensive consultation on the matter. I hope that the enormous implications for children of this appalling disease will be recognised and that even greater efforts will be made to improve their life chances.

7.51 pm

Baroness Whitaker: My Lords, the noble Baroness, Lady Northover, is to be congratulated on again raising the urgent matter of dealing with the global scourge of AIDS. I see four main attributes of effective programmes: enabling willingness to talk about the problem; educational campaigns, particularly for young people; mechanisms for delivery of treatment; and the medicines themselves.

I was impressed by one programme in rural Namibia, where people became too weak to farm and feed themselves. The project got communities to discuss easier farming and other ways of earning a living at the same time as dealing with AIDS. So the illness was discussed in the context of income generation, with plans to support widows and orphans built in as the issues were examined. As people began to talk, more felt able to go for testing, which helped to remove stigma. The upshot was 50 income-generating activities in operation across two regions, combined with increased capacity to reduce HIV/AIDS. This model has now been taken up for the whole of Namibia. For an outlay of just under £2 million over four years, DfID has helped to change culture, nutrition, health and economic productivity, and, most effectively, it has helped to get people to talk.

I also heard about a television drama series for east Africa, “Makutano Junction”, produced with advice from the “EastEnders” people, which reached 5 million viewers in Kenya alone and inserts into the story—rather as “The Archers” does for farming techniques—educational information about safe sex. DfID is now funding research on the impact of the programme.

In Malawi, out of £100 million invested in the health service over five years, we have put £45 million into AIDS-related services. For this to work, however, the Government had to stop the doctors and nurses leaving and replace those dying of AIDS. So in an innovative programme, funds also go to improve pay and conditions. The number of nurses has doubled, that of doctors has tripled and 700 nurses who left the health service have now returned. The number of people tested for HIV more than doubled last year to 440,000, and the number of people on ART has increased from 4,000 in 2003 to over 80,000. Malawi’s former high infection level has now stabilised at 12 per cent.



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Declaring an interest as a trustee of UNICEF UK, I saw an effective UNICEF campaign in Uganda to prevent mother-to-child transmission of HIV, which causes 90 per cent of child infection. The campaign minimises stigma by testing mothers as part of routine antenatal care and making treatment available during the birth. The cost of medicine was a huge barrier. DfID therefore backed a new international drug-purchasing facility, UNITAID, to help to lower drug prices through predictable and long-term funding. This has contributed to over $61 million for paediatric anti-retroviral therapy, previously scarce because research went on the needs of the developed world and adults at risk.

Are these strategies making a difference? There are some striking improvements. However, children still represent 15 per cent of AIDS deaths worldwide, while only 6 per cent of those get treated. So we must keep the focus. We must be sure what the decisive factors are. Can my noble friend tell us how work on evaluating impact is developing?

7.56 pm

Lord Fowler: My Lords, I congratulate the noble Baroness, Lady Northover, on raising this important subject. My only regret, rather like hers, is that it does not have a more prominent position in the debates organised by the House. I am sure that she is right that, if this were raging in the United Kingdom and Europe as it is raging in Africa, it would have more prominence.

Let us remember that we are dealing with a situation in which there are, globally, 2.3 million children with HIV. Every day, almost 1,500 children under the age of 15 become infected. Last year, almost 400,000 children died of AIDS-related illnesses. By any standard, that should touch the conscience of the developed world. One factor makes the situation even more acute. In years past, we became accustomed in debates on HIV/AIDS to saying that action was difficult, even impossible, because we did not have the knowledge or medicine. It is true that there is still no cure or vaccine for HIV/AIDS, but today there are drugs for preserving and prolonging life. Medical science has achieved wonders, although, tragically, those drugs are still unavailable for millions living in the developing world as opposed to in developed countries.

We have made progress in treating illness. We have generally failed, however, in preventing the transmission of HIV. We can treat; prevention has not proved so easy. That is why mother-to-child transmission is so important. We can prevent paediatric HIV almost entirely. Anti-retroviral drugs given to women in pregnancy and labour and to infants in their first weeks of life, combined with safe delivery and feeding practices, have reduced mother-to-child transmission to less than 2 per cent in the richer countries. The knowledge is there and the means are there. All that is required is the will to do something about it. There is an international pledge that mother and child services will be available by 2010. According to UNICEF, however, that target will simply,

That is the challenge. It involves not only helping to finance the provision of drugs but also improving weak health systems so that women and children can access adequate healthcare; it involves helping to train and build up the number of health workers in countries that urgently need them and not taking them from those countries to work in other countries, as, regrettably, we have sometimes done here. The challenge is profound, but we are talking of newly born babies being protected from HIV. I hope that the Government will recognise and respond to that challenge. If we fail to give help to children when such help is available, future generations will not forgive us.

8.01 pm

Baroness Masham of Ilton: My Lords, I thank the noble Baroness, Lady Northover, for this debate on the overwhelming catastrophe affecting so many children across the world. Some years ago, a young child stood up on a stage in South Africa explaining that he had HIV/AIDS as did many other people in his country, and that something had to be done about it. The Government and president of South Africa had denied that fact time after time.

I am a founder member of the All-Party Group on AIDS, which goes back to the early days of 1985-86, when this terrible infection was presenting. That young boy in South Africa who stood up to be counted opened the eyes of many people and had my greatest admiration. I am sure that he touched the hearts of many people across the world.

I once heard a missionary nun say that she knew of a grandmother who had buried 17 members of her family who had died of AIDS. So often, the working members of the family die, leaving orphan children and the very elderly.

I have met children who had haemophilia and had been given infected factor 8 imported from America. One father told us at a meeting that he had promised his affected son and his friend, aged about seven, a trip to Disneyland but, because the children had HIV, they were denied entry. How do you think the father felt trying to explain that to the disappointed children?

The noble Lord, Lord Fowler, and I attended a United Nations luncheon a few weeks ago, here in London, which brought together people from many countries interested in trying to do something to combat AIDS. I was fortunate to sit next to a most enthusiastic Minister from Barbados who is running successful music campaigns, getting the message of the dangers of AIDS across through calypsos and songs.

In his Question of Monday, 16 April, the noble Lord, Lord Fowler, said that the number of new diagnoses of HIV had risen by 165 per cent since 1998. I wonder how many of those affected are children. We need a Minister like my luncheon companion who will run dynamic campaigns across Britain to alert those at risk that the problem has not gone away.



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Over the years, progress in the treatment of HIV/AIDS has been remarkable, and the dedication and humane treatment of the specialists working in this field of medicine have been outstanding. The many research projects in the USA for HIV are very impressive. It is important that progress is shared across the world.

Preventing a mother from passing HIV on to her baby is so important. She can pass it on during pregnancy or delivery, or by breastfeeding. Anti-HIV treatment can, however, greatly, reduce the risk of a woman passing HIV to her baby. Having a caesarean rather than a vaginal delivery can reduce the risks even further. The aim of HIV treatment is to get and keep the viral load below 50. Once the baby is born, it will need to take AZT syrup for four to six weeks. A high viral load and low CD4 cell count will damage the immune system of the mother, who will be vulnerable to infection. They will need a combination of three anti-HIV drugs. The drugs can rapidly pass across the placenta, into the baby, protecting it. With so many mothers being HIV positive across the world, these drugs need to be available to prevent babies from becoming AIDS children.

Children across the world who are at risk of HIV/AIDS, TB and malaria are being helped by the Global Fund, and I am pleased that we are one of the countries taking the lead in supporting that important work. I hope that other countries that have not been as generous will follow this example.

8.06 pm

Lord Rea: My Lords, the noble Baroness, Lady Northover, has, as usual, put the case very concisely and clearly—so clearly in fact that it is not easy to find an area that she and others have not already covered in four minutes.

I shall make some use of the excellent briefings by UNICEF and the UK Consortium on AIDS and International Development. I am sure that my noble friend on the Front Bench and her department are fully aware of the strong case that they make, but I do not have time to develop that in four minutes.

Obviously, prevention is better than cure, particularly when there is not a cure and long-term, continuous treatment of HIV infection is the only option but, as every noble Lord who has spoken so far has pointed out, the treatment of pregnant mothers with anti-retroviral drugs, particularly nevirapine, can successfully prevent transmission to the unborn child in 98 per cent of cases. Unfortunately, that is not as simple as giving one or two injections in an immunisation campaign against diseases such as smallpox, polio or measles. In those cases, a team with the appropriate vaccines can visit a local community and, with suitable planning, immunise a high proportion of the child population before moving on to the next village. However, to prevent mother-to-child transmission of HIV infection, mothers need to have an HIV test, and counselling and health education should be part of the package. That requires the participation of one or more health workers with suitable training. The minimum necessary training, however, can be given to community workers who have not obtained formal professional qualifications. I will say a bit more about that if time permits.



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