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As all the noble Lords who have spoken have pointed out, the unacceptable fact is that, although the knowledge and ability to prevent mother-to-child infection exists, only 9 per cent of pregnant women with HIV in low-to-middle-income countries with a high prevalence of HIV received the necessary care in 2005. UNICEF found that, of 81 million pregnant women, only 8.4 million, about 10 per cent, were told about the prevention of mother-to-child transmission of the HIV virus, and only 9.5 per cent opted to be tested. Those disturbing findings represent starkly the inadequacy of the health infrastructure in much of the developing world, and plans to boost that in many developing countries are seriously handicapped by a chronic shortage of health workers, particularly doctors and nurses.

On a recent visit to Malawi and Ethiopia, sponsored by UNICEF, to look at how malaria—the other major African scourge—is being tackled, we were told that around 60 per cent of established posts for medical officers and nurses were vacant. The major reason for that was not inadequate output from nursing or medical schools but the loss of personnel through emigration to the first world, where conditions of work were much better and salaries considerably higher. In Malawi, the problem, as my noble friend Lady Whitaker said, was being tackled by a series of incentives to retain would-be emigrants through the provision of housing and salary bonuses. Whether that will stem the flow or attract emigrants back remains to be seen.

I would like to ask my noble friend how far the Government are responding to this difficult situation. When the NHS needs nurses, it is difficult to stop recruiting from some countries and not others. Can we assist by improving salaries for health staff when and if they return to their own countries? I recognise that this is a difficult area, but I would be interested in the thoughts of my noble friend and DfID on this subject.

A more down-to-earth policy is to train health workers to a level that would be helpful in a local context but not to the level of an internationally recognised qualification. I saw this in action in Kenya when I observed the work of a small faith-based NGO, ICROSS, led by an energetic Irish priest, Mike Megan, who has lived in Kenya for many years. He has trained a team of dedicated community-based health workers who are trusted by their neighbours and care at home for many AIDS patients, thus saving beds in hard-pressed hospitals. I will not be able to develop that theme because I see that my time has run out. However, I think DfID should follow that model because it is economical and effective and popular in local communities.

8.11 pm

The Earl of Listowel: My Lords, I declare an interest. I have visited Angola twice: first with the assistance of UNICEF and then with the assistance of Tearfund and Save the Children.

Angola has the lowest prevalence of HIV/AIDS of any sub-Saharan nation. I would like now to consider how that state might be maintained and Angolan children protected from infection, from becoming orphaned and from losing their teachers, doctors and

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nurses to HIV/AIDS. Angola has experienced 40 years of an armed conflict, including a 24-year civil war that was resolved in 2002. It has great wealth, yet needs assistance now as it recovers from its long trauma. It is the conflict that has broken communications within and without the country and has stemmed the spread of HIV/AIDS. But as displaced people return from without and within, the risk of the spread of HIV rises steeply. While statistics are somewhat unreliable, it appears that the rate of HIV in the capital, Luanda, is about 3.8 per cent, while in the region bordering Namibia it stands at about 9 per cent.

The risk of spread is great. Children represent around 60 per cent of the population in Angola. The country has the second highest fertility rate in the world. When surveyed, only 55 per cent of men admitted to using condoms with their last casual partners. The 40 years of conflict have damaged families and communities, leaving many young men without experience of stable family relationships. Lack of female autonomy and low levels of education are also significant risk factors. I hope that the Minister will be able to say that every opportunity is taken to recognise the Angolan Government’s positive efforts in this area and that encouragement is given to the president and senior political leadership to dispel any stigma attached to HIV/AIDS status.

The Department for International Development has most helpfully provided UNICEF with £3 million of unearmarked money for work in Angola. This is making a huge difference, I am told, mostly spent at local community level in training for staff in health centres and in support for mothers. As the noble Lord, Lord Rea, said, this is not high-level training and they are not going to be poached. Building HIV/AIDS awareness must be an important means of protecting children from its fallout. The national football team played its part during the World Cup. Recently, all schools took part in a national competition to compose and perform an AIDS song, and within schools there are AIDS clubs.

The quantity of provision has rapidly increased. For instance, antenatal testing was available only in two areas in 2004; in 2007 it is available in 27. Now there needs to be greater emphasis in developing the quality of provision, and here attention to capacity-building by the Department for International Development could make a significant improvement in children’s lives. The noble Lord, Lord Fowler, referred to the importance of preventing mother-to-child transmission. It is a complex task and people need to be trained to do the job effectively. We have the quantity of care and now we need the quality. What role might the Minister’s department play in developing capacity for these interventions with parents and children?

To conclude, HIV/AIDS might be the main barrier to Angola’s successful recovery from the trauma of conflict. UNICEF certainly holds it to be so. DfID already plays an important role in capacity development. If the Minister’s department can build on this, we will play an important part in preventing at least one sub-Saharan state from succumbing to the full scourge

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of HIV/AIDS and thus protect many children from the experience of being orphaned.

Are Her Majesty's Government carefully monitoring the situation in Angola with regard to AIDS? I look forward to the Minister’s response and understand that she may prefer to write to me in answer to those questions.

8.15 pm

The Earl of Sandwich: My Lords, last week we briefly debated Zimbabwe, where progressive droughts and food shortages, combined with political failure, have led to destitution, hunger and the vulnerability of ill health. These are the conditions in which the body’s resistance breaks down. Zimbabwe’s HIV/AIDS epidemic, although prevalence may have fallen below 20 per cent, remains one of the worst in the world. Some 3,500 die every week from HIV and the vast majority live beyond proper care and treatment. There are 1.3 million orphans and an estimated 350,000 child-headed households due to HIV. DfID has quite rightly made AIDS a top priority and we are told that it is having a significant impact. I want to ask our Government whether their strategy favours the national and international at the expense of the local. Why, for example, are they spending as much as £20 million on one vast US-based programme in Zimbabwe, Population Services International, which already has USAID funding?

Here I declare an interest as a former board member of Christian Aid and a patron of Trust for Africa’s Orphans. I saw the holistic work of both organisations in Uganda and was especially impressed by the community’s participation in each project. One partner organisation of Christian Aid, while active in AIDS prevention, also excelled in community education and awareness-building, ensuring that there was not stigma attached to its work. While it was church-based, there was no question of evangelical work and it was obviously highly successful, as many church projects have been in Uganda, spreading the ABC messages and combating the HIV virus. The Trust for Africa’s Orphans programme, founded by Mrs Janet Museveni, helps AIDS orphans and is supported by a range of agricultural projects: goat and pig farming, bee-keeping, savings and credit schemes, the provision of seeds,; and other forms of poverty alleviation.

The message for me was that the best healthcare goes hand in hand with community development and the participation of local people. Dependence on traditional healing and cultural and sexual patterns that encourage epidemics such as AIDS will change only when people understand and take part in that change. All this is in contrast to the work of many larger aid agencies in Africa, including some UN agencies and global public/private partnerships. I am not saying that larger organisations are incapable of a holistic approach, but they often assume that they can impose external solutions in spite of the cultural differences between them and the local communities. These agencies, most of which we are supporting as taxpayers, spend considerable sums of money, much of which goes to their own overblown organisations and lifestyles. It is an example of corruption that can be very well disguised by moral superiority.

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I have questions, of which I have already advised the Minister, broadly on whether DfID will reconsider its approach to smaller community-based NGOs that are tackling HIV/AIDS in Africa. For example, I wonder whether DfID is biased towards national strategies in the name of better governance. Zimbabwe is obviously one country where this doctrine does not apply, but we still have to work with its Government. Generally in Africa, DfID has tried to provide budget support to ministries of health, thereby perhaps neglecting some very good small NGO programmes. I suggest that when it comes to defeating the AIDS virus, good practice makes a lot more sense than good governance.

At the same time, I recognise that countries such as Uganda and Mozambique have made huge strides in eradicating poverty and ill health. Perhaps DfID is too concerned with good impact assessments and statistics. Would it like to see more data collection to ensure faster progress towards the MDGs? Where Governments are corrupt and ineffective, what is DfID doing to shift its emphasis away from Governments and towards the community? Christian Aid is supporting some 250 such partners working on HIV/AIDS worldwide. Save the Children has had great success in Malawi and is extending its work across Africa and the Caribbean, benefiting hundreds of thousands of children. In my experience, smaller organisations pay at least as much attention to data collection—sometimes their funding depends upon it—and they are ready to share research with UNAIDS and the national networks. Being more familiar with the areas and the people where they work, with few exceptions, they provide much better value for money and still achieve the necessary results.

8.20 pm

Lord Roberts of Llandudno: My Lords, I appreciate the opportunity to take part in this short debate, and thank my noble friend Lady Northover for keeping our minds concentrated on this problem consistently and in depth over many months.

I was told a true story about a pastor in the Kampala region of Uganda. He was taken to a village about 100 kilometres north of Kampala and, after his service, he was taken to see an old lady of 79. She had given birth to seven children. Six had already died of AIDS and the seventh was dying of AIDS. She said that she had sole care of 23 grandchildren. She was trying to care for them all by herself out of her own resources. She said, “I am an old woman, and I can no longer dig. One day soon I too will die, and then who will look after my grandchildren?”. That story can be repeated so many times. It is not only the disease itself, but the stress and anxiety for those who are in that situation. We hear of children who, when their parents die, lose not only their carers but also the homes in which they were brought up. Children are abandoned on the streets; babies have been saved from rubbish tips in parts of Africa. We all know that the situation for millions of children, women and men is a nightmare. Imagine the lost potential of the people who could be contributing to the future of their countries in that part of the world.

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We must appreciate the vast amount of work that has been carried out by voluntary organisations that care and rescue. I know of the Christian Watoto Child Care Ministries. North of Kampala, they have now set up a village that already cares for 1,500 orphans of AIDS victims and about 17 of them are already going to university. It is a tremendous success story. There is already a new babies’ home. They have undertaken water projects. The work is carried out by volunteers. They have been visited by 60 short-term teams to assist with building and development. People have been moved by compassion to do something themselves. We must appreciate the work of the voluntary organisations. It does not cost us a penny; it is just encouraging.

The Government propose to bring forth some immigration regulations. I ask that there will be no restrictions to impede the work and the visits of people from here to the needy areas of Africa and other parts of the world, and that nothing will stop people from those places coming here to take advantage of any education or training opportunities we might be able to offer them. I ask the Minister for an assurance that any new immigration regulations will not impede that. These are simple requests, but they mean that we would be seen as a caring and compassionate country.

However, that is only treating the victims of AIDS and not attacking the disease itself. I am told, and this is where I begin to fantasise, that £12 billion would be a massive step forward to eradicate AIDS in the whole of the world—not £12 billion from ourselves, but globally. Is that not possible? It is just the amount that we are possibly going to spend on the Olympic Games—although I am a great supporter of the Olympic Games of 2012.

Finally, the World Health Organisation was able to announce some years ago that smallpox had been eradicated. Could we not now, as the United Kingdom, make it our main aim to be able to say that AIDS also, if it has not been eradicated, is at least only a fraction of what it is at present?

8.25 pm

Baroness Rawlings: My Lords, I add my thanks to the noble Baroness, Lady Northover, for tabling this important Question. All the speakers today have made clear that there are no illusions about the severity of the AIDS crisis that affects so many children across the world.

Unfortunately, we have seen over the past few decades that knowledge of this crisis does not necessarily translate into effective action. Without constant efforts to keep the issue in the public eye, it is far too easy to continue with projects of uncertain efficacy merely because of inertia. We need, instead, to re-evaluate continually our approaches in the light of new evidence, new technology and new research.

Currently, the huge majority of retroviral research and provision of medication is based on adult patients; current donor methods and priorities are completely failing to help children in developing countries.

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In researching this topic, I came upon the terrifying statistic that there are more AIDS orphans in Africa than there are children in the United Kingdom. Yet only one in 20 children in a developing country is receiving treatment. When 90 per cent of these children have been infected because of a lack of treatment to their infected pregnant mothers, it is clear their health must be moved further up the public agenda, as we have heard from my noble friend Lord Fowler.

As other speakers have made clear, recent reports have highlighted funding targets and, while they have been effective at improving donor countries’ commitment, they are not the measure we need to use. My honourable friend Andrew Mitchell has so rightly stressed that the emphasis should be on the number of patients treated, not the number of pounds donated.

With these new targets, I hope it is possible that significant attention will finally be given to reducing the cost of these treatments.

Patent law of course needs to be studied, but the considerable reduction in the cost of patented treatments, from $12,000 to $700 a year, due to certain pressures shows what advances can be made in this area. What are the Government doing to increase the supply of cheap, legal and reliable drugs to developing countries? The Government could look carefully at the example of Dr Yusef Hamied, nominated for the Nobel prize for peace for his efforts to eradicate AIDS. His Indian pharmaceutical company, Cipla, has been a major incentive for the recent fall in the price of AIDS medication by producing generic drugs that were legal under Indian patent laws, and sell far cheaper in developing countries. He said:

Obviously, care must be taken to respect patent laws in the countries where the drugs are produced and delivered; but can the Government explain what they are doing to enforce the WTO rules which allow generic medicines to be used in a health crisis? The Government’s target for universal access to anti-retroviral treatment by 2010 is extremely ambitious, but we are unfortunately not on track to meet it.

I hope the Minister will reassure us that the Government are continuing to look at new ways of targeting aid effectively and making sure that much needed money is not being wasted.

8.30 pm

Baroness Royall of Blaisdon: My Lords, I, too, congratulate the noble Baroness, Lady Northover, on securing this timely debate and on re-focusing our minds. It is such an important global issue, and we have had a truly well informed exchange of views. A mixture of despair and hope has been expressed. Like the noble Lord, Lord Fowler, who has such a long and proud record in this area, I wish that more time could be spent in this House on this issue.

The AIDS epidemic is having a devastating effect on communities throughout the world. UNAIDS’s latest estimates show that 40 million people worldwide were living with HIV or AIDS at the end of 2006, and

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that 4 million people became newly infected with HIV—40 per cent of them young people between the ages of 15 and 24. The challenge is enormous, and this Government are responding, although we have no illusions about the efforts that need to be made. Strengthening health services is, of course, the most sustainable way to improve poor people’s health and to address the health aspects of HIV and AIDS, including for children.

Developing countries need to demonstrate their commitment by increasing their own health budgets and investing in the health of their own citizens. The UK has been working actively with Governments and the international community to support such a scaling-up. As my noble friend Lady Whitaker said, we are helping Malawi with a £100 million emergency programme over six years, part of which aims to double the number of nurses and triple the number of doctors, and to retain them through better pay and conditions, with a salary increase of 50 per cent. Early signs suggest that this support is helping to stop the outflow of health workers, and recruitment has dramatically improved.

We also provided Malawi with £20 million in 2005-06 to fund AIDS-specific projects. In response to my noble friend Lord Rea, our investment in Malawi is clearly one answer to doctors and nurses coming out of the country when they are needed in that country, but we also implement a code of conduct on recruiting health workers from other countries to work in the NHS. We are currently in the early stages of designing a new long-term health programme for Sierra Leone that is similar to the one that we have in Malawi.

We have quite rightly heard this evening that children are among those most affected by the epidemic, and I assure the noble Baroness, Lady Northover, that young children will continue to be the main focus of our new strategy. In Africa, 15 million children have lost at least one parent to AIDS. Without the guidance and protection of their primary care givers, these children are particularly at risk of abuse, exploitation, trafficking, discrimination and other abuses. Other members of the community and the family, especially grandparents, and grandmothers in particular, are hugely overburdened. The Government are working to help to ensure that support is provided where it is most urgently needed. That is why Taking Action, the UK Strategy for Tackling HIV and AIDS in the Developing World, gives a high priority to the rights of children and orphans. Between 2005 and 2008, DfID will spend £150 million, from an overall commitment of £1.5 billion, to meet the needs of children affected by AIDS, including street children. Expenditure on street children will be part of this commitment. The UK also supports programmes and organisations that work directly with street children. In Burma, for example, DfID is contributing £450,000 to the street and working children programme. One element of the programme is HIV and AIDS education.

Of course, additional funding is vital for a sustained response to HIV and AIDS, but political leadership is also crucial, and I take this opportunity to pay tribute to my right honourable friend Hilary Benn and his Parliamentary Under-Secretary of State for International

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Development for the leadership that they have shown in tackling these epidemics. In February 2006, the UK hosted, with UNICEF, the Global Partners Forum on Children Affected by HIV and AIDS to identify concrete actions to improve access to the prevention, treatment, care and support for children affected by HIV and AIDS. I spoke at this conference, and I assure noble Lords that it was truly action-focused. The forum made several recommendations, including long-term financial support for community action, integrated HIV and AIDS prevention and treatment services for children, the elimination of school fees and regular, predictable cash transfers to reduce the impact of AIDS. These recommendations fed into the UN General Assembly High Level Meeting on HIV/AIDS in June 2006 and were reflected in the General Assembly’s political declaration for achieving universal access to HIV prevention, treatment, care and support by 2010.

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