HIV/AIDS (Africa and Asia)

– in the House of Commons at 10:19 pm on 28th October 2002.

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Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]

Photo of Norman Lamb Norman Lamb Shadow Spokesperson (Treasury), Liberal Democrat Spokesperson (Treasury) 10:20 pm, 28th October 2002

I want to raise one of the biggest and most important development challenges facing the international community: how to tackle the appalling tragedy of HIV/AIDS. On its own, that disease will make it impossible to achieve the millennium target of reducing by two thirds the rate of infant and child mortality by 2015.

HIV/AIDS has already ravaged Africa and continues to take a terrible toll across the whole continent as it is beset by famine—an issue to which I shall turn later. Asia is set to become the next continent to be devastated by the virus unless action is taken urgently.

What is the current situation? Worldwide, an estimated 40 million people are HIV-positive, and 14,000 more individuals are added to that total every day. Of that 40 million, horrifyingly, 28.5 million live in sub-Saharan Africa. UNAIDS—the joint UN programme on HIV/AIDS—confirms that the figure includes 9 per cent. of all those aged between 15 and 49, and equates to 70 per cent. of the world's HIV-positive population, with more women being infected than men.

Last year, of 3 million deaths from AIDS worldwide, 2.2 million were in sub-Saharan Africa. Average life expectancy in the region has decreased from 62 to 47 as a result of the epidemic, and 14 million children aged up to 14 have been orphaned worldwide due to the virus.

In some sub-Saharan countries, the picture is even bleaker: in Zimbabwe, 33.7 per cent. of people aged 15 to 49 are HIV-positive and in Botswana, the figure is 38.8 per cent.

When I visited South Africa in February, I met some very brave HIV-positive women who told of the awful stigma that they face as a result of the disease. They are unable to tell their friends about it because of the impact in the community. They also spoke of the appalling myth in much of southern Africa that if one has sex with a child it cleanses the body of the illness. Those are some of the dreadful human impacts of the disease.

In Asia, things are worsening. The Chinese Government recently confirmed the UN's fears by stating that at least 1 million of its citizens will be HIV-positive by the end of the year. That is widely believed to be an underestimate, as we were told when we were in the area earlier this year.

In the northern province of Henan, infection rates of up to 45 per cent., due to infected blood, have been found in some villages. With almost 4 million HIV sufferers, India has the second highest total number of cases of any country in the world, after South Africa. In Thailand, despite much progress in tackling the disease, the virus affects about 700,000 people. It was spread initially due to the sex trade in that country. The figure is higher than in any other east Asian country and represents the biggest cause of death.

UNAIDS programme development director, Dr. Werasit Sittitrai, summed up the crisis starkly:

XThe HIV/AIDS epidemic in the Asia and Pacific region is at an early stage. This means we have time, but the time is running out. In the next few years, if we cannot contain the epidemic, the size of infected and affected populations in this region will dwarf those of other regions combined. The social and economic development gains that countries have invested in will not be achieved."

That depressing prediction is borne out by the contents of a report published by the US National Intelligence Council on 30 September, in which it is estimated that 10 million to 15 million people in China will be HIV-positive by 2010, with the total in India rising to between 20 million and 25 million. Although those totals might represent small percentages of the populations of those countries, the possible social and economic effects if the epidemic reaches such levels in the next decade certainly cannot be underestimated.

It is estimated that India's gross domestic product could fall by 1 per cent. a year as a direct result of HIV/AIDS. Many firms that operate in South Africa have been suffering from the effects. For example, Standard Chartered bank has calculated that some 10 per cent. of its whole African work force is off work at any one time because of AIDS-related illnesses. Another impact in affected areas is that inward investment, which is essential for economic development, is discouraged.

I want to comment on the impact of HIV/AIDS on the famine that is afflicting much of sub-Saharan Africa. It is clear that HIV/AIDS is exacerbating the famine. Many non-governmental organisations working in the area confirm that, although the drought in recent months has been less serious than that back in 1991–92, the added effect of HIV/AIDS has substantially exacerbated its impact. The most productive age group has been the hardest hit, bringing with it damaging falls in productivity, not least in the all-important agricultural sector.

In answer to a written parliamentary question that I tabled, the Secretary of State for International Development said that

Xin some countries, households and villages are losing from 10-50 per cent. of agricultural productivity due to the disease".

She continued:

XAt a family level, food production has fallen by as much as 80 per cent. when the main producer is affected."—[Hansard, 22 October 2002; Vol. 391, c. 196W.]

According to Save the Children, the epidemic is one of the trigger factors that has helped to tip the balance in many areas between an already very difficult humanitarian situation and a large-scale crisis of hunger and destitution. The shockwaves will continue to be felt in the future due to the loss of so many experienced farm workers to the virus.

Philip Mthobwa and Gemma Brugha, co-founders of the Likulezi project in Malawi, report that some of their 300 unpaid volunteer staff are now HIV-positive. They also confirm that, in Malawi, there is minimal income generation due to the vicious circle of illness, food shortages and the effect that those factors have had on an almost exclusively rural economy.

The African epidemic is not confined to the poor, so professional, managerial people are also being affected.

I want to deal now with the action being taken to address the epidemic. First, the Global Fund to Fight AIDS, TB and Malaria must be welcomed as a means of focusing further attention on the need to fight the epidemic. However, the fear remains not only that it has created an unnecessary additional tier of bureaucracy through which funding is channelled, but that it is also seriously under-resourced. While supporting the principle of the fund, Christian Aid has described it as a case of Xfighting HIV/AIDS with peanuts". Oxfam has said that it is

Xin danger of delivering little more than false hope".

On examining the facts, that pessimism does not appear to be ill founded.

The UN Secretary-General, Kofi Annan, has called on the international community to increase overall spending on HIV/AIDS to $10 billion a year by 2005. However, total pledges to the global fund for the next five years amount to just $2.1 billion, which must of course go towards the fight against not just HIV/AIDS, but TB and malaria—pernicious diseases in themselves. That level of funding is wholly inadequate to tackle the spread of HIV/AIDS.

I welcome the commitment, confirmed by the Secretary of State in a written answer to me earlier this month, to increase the spending of the Department for International Development on HIV/AIDS programmes in Africa by #180 million in this financial year. The Government are also committing $200 million to the global fund.

However, Oxfam has calculated that if the UK were to provide its full share of the estimated $10 billion annual requirement for combating HIV/AIDS, that would be a slightly more than threefold increase in our contribution to the fund. If we are serious about tackling the epidemic and about the continued value of the global fund, and if that is to amount to more than rhetoric, we should consider increasing our contribution to an appropriate level to meet the challenges that lie ahead, and we should persuade other industrialised countries to pay their fair share.

However, the global fund suffers from other practical problems. Its director, Dr. Richard Feacham, has said publicly that the fund imposes a significant administrative burden on countries that must already deal with many different donors. Representatives of the Likulezi project in Malawi, which I mentioned earlier, said that some non-governmental organisations were adding HIV/AIDS elements to their projects simply to obtain resources from the global fund, but were then failing to meet the requirements of work to tackle the disease. Those kinds of difficulties should be addressed if the grand idea is ever to prove truly effective.

Furthermore, there is the danger that the fund seems to circumvent existing health infrastructures by way of grandiose interventions: for instance, the supply of anti-retroviral drugs without any means of administering them or without an infrastructure to ensure that they are administered properly. It is essential that the fund addresses the current inability of basic health and social infrastructures in those countries to cope with the epidemic. Funding must be injected into the provision of vastly improved primary health care services, including investment in human resources, if there is to be any chance of halting the tide of infection.

On debt relief, I want to deal with the unsustainable debt repayments that are such a burden on many HIV/AIDS-affected nations. Oxfam has reported that Zambia, where 1.2 million people are affected, spends 30 per cent. more on debt repayments than on health. That picture is repeated across much of sub-Saharan Africa. That cannot be allowed to continue, and I hope that the Minister and the Secretary of State will be at the forefront of an international effort to reform the enhanced heavily indebted poor countries initiative. Many countries need properly co-ordinated HIV/AIDS strategies if they are to meet the millennium development goals, but they are unable to implement them due to the burden of debt. Clearly, that is unacceptable.

On anti-retroviral drugs, major progress must be made in making good-quality ARVs available in developing countries at cheaper prices. Family incomes are too low to allow the purchase of such drugs. In Uganda, for example, only 0.3 to 0.5 per cent. of the country's HIV sufferers are reported by Oxfam as having access to that life-saving treatment. Prices have fallen as a result of the availability of cheaply produced generic forms of ARVs, and competition between generic drugs can reduce the price further, but it is essential that the commitments made at Doha are honoured so that the trade-related aspects of intellectual property rights rules do not prevent export of generic drugs from countries such as India. There are indications of some backsliding since the commitments were made in Doha.

Education and awareness building constitute perhaps the most important of all the targets for individual countries to make a political commitment, from the top down, to tackling the disease, as they are vital in communicating a clear message about prevention. Many examples of good practice can be found in affected countries: notably, partnerships between national ministries of health and education, and the full engagement of local government. Several imaginative ideas are emerging. I recently attended the launch of BBC World Service Trust's partnership with India's National AIDS Control Organisation and national television network, which is aimed at increasing HIV awareness. Likewise, a version of the children's programme XSesame Street" broadcast in South Africa now includes an HIV-positive character.

Bearing in mind the low level of knowledge about the virus in many infected areas—South Africa is perhaps one of the worst examples because of the failure of the leadership under President Thabo Mbeki to tackle the problem—such projects can be of enormous value.

There has been a steady fall in the overall infection rate in Uganda thanks largely to a national programme with support from many different groups and organisations. That has led to the provision of much more widespread sex education and greater awareness of the need to use condoms. That is not to say, however, that Uganda is an example of perfection. HIV/AIDS is still a national tragedy there and it cannot be fully addressed without also tackling the underlying factors of poverty and economic stagnation. However, Uganda has made an important start.

HIV/AIDS is too great a humanitarian disaster for us to ignore. Working towards a solution is in all our interests. As things stand, the epidemic will not be contained and is bound to spread beyond current boundaries. Its economic and social effects will undoubtedly lead to increased instability in the affected areas and more failed governance. The shockwaves that that could cause across Africa and Asia, and the rest of the world, cannot be underestimated. As always, it is important that the fine rhetoric that we have heard from so many quarters is matched by meaningful and effective action. Indeed, on the occasion of the opening ceremony of this year's international AIDS conference in Barcelona, Kofi Annan said:

XI will join with you and do my utmost to ensure that our reply to this epidemic is urgent, comprehensive and determined."

Those are forceful words, but very necessary.

We cannot allow a situation to develop that would end with the effects of an unchecked AIDS epidemic weighing on the conscience of those who failed to act.

Photo of Sally Keeble Sally Keeble Parliamentary Under-Secretary, Department for International Development 10:36 pm, 28th October 2002

I congratulate Norman Lamb on obtaining an Adjournment debate on the very important subject of HIV/AIDS. I also congratulate him on the way in which he presented it by touching on the wide range of issues involved in dealing with HIV/AIDS in Africa and Asia. I want to consider in particular the effects that it is having on those regions. It is not only a humanitarian catastrophe but a huge disaster for the development of Africa, as he outlined. I shall set out my Department's approach to tackling the problem, dealing with the work that we are doing on prevention and treatment and, as he rightly pointed out, the important work that needs to be done to build up health systems.

HIV/AIDS is one of the biggest threats to the achievement of the goals agreed by all United Nations member states in September 2000. The hon. Gentleman will be aware that the goals cover a range of key issues including poverty, health and education, and they are at the heart of my Department's practice. At the United Nations General Assembly special session in June last year, the world community agreed that a much more intensive effort is needed to prevent HIV/AIDS and to improve the care and support for those infected by it. That poses a huge challenge for health systems in Africa and Asia which at present cannot cope. It also means that all parts of Government and civil society have to play their part. HIV/AIDS has long since ceased to be an issue for the health sector alone.

The hon. Gentleman set out clearly the scale of the disaster in terms of the numbers and I will not go over that again. However, he did not touch on the appalling impact of the epidemic on children, especially in Africa where there are more AIDS orphans than there are children in the United Kingdom. That adds an extra dimension to what we will see in the years to come as a result of the epidemic. As the hon. Gentleman said, it is not just a matter of human suffering; the epidemic also seriously undermines growth and social and political stability. In addition, it threatens security. The epidemic compromises all the work that has been done to reduce poverty and conflict and to improve education and health. As he said, it strips out the economically active people, especially in sub-Saharan Africa. The problem is made worse by the current famine.

Poverty and inequality are two key drivers of HIV/AIDS. Dealing with gender inequality is crucial in any strategy to prevent the transmission of the disease. In many countries women and girls are more likely than men and boys to be infected and to bear the burden of family support and care of those affected. Physiology increases women's vulnerability to infection, but that is made worse also by the lack of power that girls and women in many societies have over their bodies. That is reinforced by social and economic inequality.

Higher rates of AIDS-related deaths will lead to large-scale loss of skills and institutional knowledge in the public sector. Education, health services and police forces are of particular concern because death rates may be so high in those sectors that lost workers will not be replaced simply by increasing training or recruitment programmes. The disease is therefore having an increased effect on the very services needed to tackle some of the other problems that it causes. We are also concerned about the impact of HIV and AIDS on Government revenue and expenditure, and about reduced access by the poor to markets. We are concerned for the human rights of those excluded because of the stigma of HIV and AIDS, and we are focusing attention on those whose security has been undermined by HIV and AIDS, especially orphans.

My Department believes strongly that HIV/AIDS is not simply a health issue, and that care for the victims of AIDS must include support for communities that have been ravaged by the disease. That includes not only help in caring for the sick and dying but support for the livelihoods and food security of communities that have lost a large part of their working population. It is, of course, one of the particular characteristics of AIDS that it strikes down those who carry the greatest responsibility for feeding and maintaining their communities.

My Department is working with other agencies not only to prevent new infections but to ease the impact of AIDS on rural livelihoods and rural development as a whole. We are using a twin-track approach of continuing to fund research so that we can better understand the precise impacts of AIDS on rural livelihoods, while recognising the urgency of funding interventions now in the face of a disaster that is having an appalling effect on so many people. The hon. Gentleman quoted the Secretary of State's concern about that. The extra nutritional needs of HIV/AIDS patients are also having some bearing on the way in which we are dealing with the famine.

It is important to recognise that progress is being made, and we do not simply have to accept the doomsday scenarios that are so often put forward. We are starting to see evidence in Africa and Asia that the tide of HIV can be turned back. Examples include Uganda, which the hon. Gentleman mentioned, and Cambodia, where strong leadership at all levels and effective community-based prevention programmes have been key to controlling the epidemic. Uganda has reduced the rate of infection from over 20 per cent. in the early 1990s to about 5 per cent. now. In Cambodia, the prevalence of the disease has been reduced from 2.8 per cent. in 2000 to 2.6 per cent. today—a smaller decrease, but it goes against the trend that we assume to be typical of all countries. For some time, Thailand, where condom use has increased significantly, and Senegal have also been models of good practice in HIV/AIDS prevention. Progress can be made, but there is an urgent need for other countries to learn from these successes.

Despite those encouraging pockets of success, it is clear that the global response to the epidemic has so far been lacking, as the hon. Gentleman said. A much more intensive effort, which goes beyond the health sector, is needed. African and Asian countries need to learn lessons from each other on how best to tackle the epidemic. My Department will continue to do all that it can to help to facilitate that, and I will outline some of the ways in which we are working to do that.

The hon. Gentleman mentioned debt repayment. I think that he would accept that this country and this Government have led the world in developing a programme of debt repayment. However, he is right to express concerns about the continuing problems of unsustainable debts.

However, I am sure the hon. Gentleman would agree that we cannot see that as the cause of the problems in the provision of the health services needed to counter AIDS.

In response to the epidemic, DFID has committed considerable resources at the international and bilateral levels. We invested more than #200 million in HIV/AIDS programmes last year. We currently support programmes in more than 40 countries, including major new investments to support the implementation of effective national strategies to combat the illness in countries across Africa and Asia. Our overall programme in Africa is set to increase from #640 million to #1 billion by 2006. HIV/AIDS will remain one of our highest priorities for the region. In Asia our focus will continue to be on preventing transmission of HIV from vulnerable groups to the general population. We have committed US$200 million to the Global Fund to fight AIDS, TB and Malaria. Considerable extra funding is also going to institutions such as the World Health Organisation, the United Nations Population Fund and civil society organisations in a coherent effort to combat the disease and support people who are already living with it.

Our strategic response is to tackle HIV/AIDS through both prevention and care interventions, but as the hon. Gentleman pointed out, the strengthening of health systems is a critical issue in the delivery of prevention and care interventions. The ability to deliver community-oriented care and other HIV/AIDS and TB care and support services and anti-retroviral therapy are dependent on properly functioning health systems. Since 1997, my Department has committed more than #1 billion to health systems strengthening, and will continue to support that strongly.

DFID is driving work to promote international commitment on a package of measures that will facilitate widespread, sustainable, predictable differential pricing of essential medicines in order that such medicines are available to the world's poor at affordable prices and become part of a broader international agenda. We are also supporting work on establishing feasible approaches to increase access to highly active anti-retroviral therapy, and help Governments make informed decisions about their use that is specific to local needs and circumstances. In addition, we have committed an additional #40 million for research into HIV vaccines and microbicides. All these initiatives will benefit the poor in Africa and Asia.

While we move forward on developing new technologies, it is worth reminding ourselves that many of the strategies available now can be successful against HIV/AIDS. The key to reducing vulnerability to the epidemic is to create an environment that enables women and men to avoid risky behaviour and to have access to and use appropriate services. This requires strong and sustained political commitment to help those who are most vulnerable to be actively involved in designing strategies to meet their needs. The hon. Gentleman stressed the need for that, particularly in sub-Saharan Africa.

Government and civil society need to open up the public discussion about HIV/AIDS, sex, and gender relations and promote openness and respect for the human rights of all people. Explicit commitment to tackling stigma and discrimination is essential. I recently saw some of DFID's work on that in China, and I was struck by the way in which stigma had been dealt with. People were living openly with AIDS in the community. Tackling the HIV/AIDS epidemic with all its consequences sometimes appears to be daunting. It is important to emphasise that success against the disease can be achieved, but only if we all work together. In my Department we are committed to doing everything we can, in partnership with others, to help poor people across the world who are infected and affected by the disease, and to prevent it becoming a catastrophe not just to people, but to their societies and the future of their communities. Our Department is committed to achieving that goal.

Question put and agreed to.

Adjourned accordingly at eleven minutes to Eleven o'clock.