[Sir Nicholas Winterton in the Chair] — Children and HIV/AIDS (Developing Countries)

– in Westminster Hall at 12:00 am on 7th May 2009.

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

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development 2:30 pm, 7th May 2009

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 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.

Photo of Sally Keeble Sally Keeble Labour, Northampton North

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?

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

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 the information that my hon. Friend requires and I will, I hope, be able to incorporate it into my closing remarks.

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development

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?

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

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 Ms Keeble often makes.

In response to 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 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 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.

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development

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?

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

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 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.

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.

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development

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?

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

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.

My hon. Friend the Member for Northampton, North will be interested in the fact that this country has been at the forefront in the support of orphans and vulnerable children for a long time. We set a spending target of £150 million for the years 2005-08, but actually spent £180 million. More than 30 countries have developed national action plans for orphans and vulnerable children. Considerable donor funding has been committed, including significant funding from the UK and the United States. The challenge now is to integrate the needs of children affected by AIDS within wider national polices and budgets to ensure long-term domestic funding that reaches vulnerable children.

Photo of Sally Keeble Sally Keeble Labour, Northampton North

I have asked at various times about tracking the £150 million, but an answer has never been forthcoming. Can the Minister give a breakdown of how the £180 million was spent—in which countries and in which years? That would be very helpful, but perhaps he could write to me if the answer is not in his speech.

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

I am grateful to my hon. Friend for that detailed question. I assure her that the answer will be forthcoming, but it is likely to be in writing. I will ensure that she is provided with some detail following the debate.

We seek to achieve progress through our support for country-led programmes that reach the most vulnerable children, and through our work to ensure a robust evidence base to guide global actions and effective global leadership. At country level, we will ensure that children are reflected in health, education and social protection plans. The strategy commits us to spending £200 million on social protection programmes, and to working in at least eight African countries to develop social protection policies and programmes that provide effective, predictable support for the most vulnerable households.

We are focusing on the most affected countries: Zimbabwe, Kenya, Zambia, Malawi, South Africa, Angola, Botswana, Ghana and Rwanda. There has been a major focus in Parliament on the tragedy in Zimbabwe, but there may now be a glimmer of hope with the new Government. We still want to focus on the need for major reform in that country and progress on the economy and human rights, but there is a glimmer of hope.

Funding must reach the most vulnerable communities and children. For example, in Swaziland, the Department for International Development supports through UNICEF 665 neighbourhood care points, which support more than 35,000 vulnerable children living in the community. In Zimbabwe, we have supported more than 200,000 children through a multi-donor programme of support implemented through more than 100 community-based organisations.

We are ensuring that increased spending is supported by good evidence. We have provided funding to the Joint Learning Initiative on Children and HIV/AIDS, and the Inter-Agency Task Team on Children and AIDS, to inform global actions. This work has informed our response on social protection for AIDS-affected households and children. Social protection, including cash transfers, has been shown to be effective in reaching and strengthening families affected by HIV and AIDS. Social protection can vastly increase the number of AIDS-affected households getting predictable assistance. It helps keep families together and protects both children and their vulnerable carers. That is why, in Malawi, DFID is supporting social protection policy development and the design of a national programme and social protection legal framework. DFID is also strengthening the department responsible for poverty and social protection, which is specifically delivering services in that country to vulnerable children.

We need an effective multilateral response and global co-ordination. Our support for UNICEF is crucial in that respect. In 2004, DFID supported the development and implementation of UNICEF's framework for the protection, care and support of orphans and vulnerable children living in a world with HIV and AIDS, which sets out a global action plan specifically for orphans and vulnerable children. We are providing £5 million to UNICEF's Unite for Children, Unite Against AIDS campaign. The biennial global partners forum on children affected by AIDS, which was held in Dublin in October last year, presented the most up-to-date evidence available on how best to meet the needs of orphans and vulnerable children. Based on the information presented at that forum, we are convinced that our policies and programmes are strongly supported by current evidence and emerging global best practice. Over the next seven years, we will continue to measure the impact of our programmes and policies on the lives of the most vulnerable children, and to ensure that global policies for children affected by AIDS continue to be informed by lessons and best practice from DFID-funded programmes and elsewhere at country level.

We accept that the situation remains critical. We believe that all the world's children, wherever they live, deserve access to the services they need, and that we have a moral responsibility to do whatever we can to bring that about. I welcome Parliament's devoting such a significant chunk of time to this debate today, which will not only enable us to reiterate our collective commitment to the fight against AIDS, but will shine a light on this issue in an effort to ensure that the world does not take its eye off an incredibly important goal for the future of the poorest people in the world.

Photo of Sally Keeble Sally Keeble Labour, Northampton North 3:02 pm, 7th May 2009

I am sorry that I have to leave after speaking, as I mentioned in my note to you, Sir Nicholas. I have a long-standing meeting with somebody that I have already had to rearrange once.

I welcome this debate. The United Kingdom Government play an important role in international development. I welcome the fact that the needs of HIV/AIDS orphans have been recognised. However, it is important to be hard-headed in looking at what is happening to the HIV/AIDS orphans on the ground. Since 2004, I have made that the one bit of international development work that I still deal with, so that I can focus some attention on it. I set up a charity to focus specifically on work with HIV/AIDS orphans. I have to say that, although I fully recognise the UK Government's input, the reality for a lot of orphans is dire and the numbers are increasing. In that sense, the position is getting very much worse.

It is important, when looking at what the solutions might be, to recognise the severity of the problems facing those children. It is also important to recognise that the solutions are not just in the area of health policy or development policy, but are to do with children's policy. Those children's needs are as complex and varied as those of children anywhere in the world. If we are going to make it possible for those children to take their place in the adult world in future, we have to ensure that we meet all their needs, not just their health needs—and not just through a development prism.

I want to deal specifically with the needs of the HIV orphans in sub-Saharan Africa, because I have looked at that area in particular. The countries that I have looked closely at, although I am familiar with others, are Zimbabwe, Kenya and Tanzania. I am aware of South Africa, but that is obviously in a slightly different category.

We must recognise that there has always been a problem in relation to orphans in Africa. But it is about working out why the pressures of HIV/AIDS make so much difference. The figures for Kenya show that between 1985 and 2008 the total number of orphans increased from 1,251,878 to 1,852,139. Hon. Members might think that, although that is a substantial increase of over 30 per cent., it is not out of control. But I shall break those figures down and just look at the dual-orphaned, not just at maternal or paternal orphans. The number of AIDS orphans has increased from zero in 1985 to just over 326,000 in 2008 and the number of non-AIDS orphans has decreased dramatically, from just over 240,000 to almost 95,000. So there has been a complete cross-over in children's well-being, in terms of having parents. As we all know from our experience in this country, it is best for a child to have two parents—preferably a mother, I hasten to say, as all colleagues in the Chamber are male. Certainly, the parents are the prime advocates for the child and they are the child's main defence against all life's disasters. In normal times, if it had not been for HIV/AIDS, through the falling off of the number of orphans we would have seen real improvements in the well-being of children in Kenya. Instead, there is more vulnerability, because of the impact of HIV/AIDS on the parents.

Parents' illness is also an issue. The figures for Kenya are just for children who are orphans, but there are, in addition, children who look after sick parents for a long time and, in the process, suffer from poverty and from staying out of school and from all the other things that affect children with a sick parent. I met one little girl in Kenya whose mother, a lone parent, had brought her into an emergency shelter before dying. The little girl, who had been looking after her mother, was stick thin—she was skin and bones—in a country that should at least be able to feed its children. She had not been to school and had no proper clothes. So, although she had a parent and was not a complete orphan until her mother's death, her chances in life were massively compromised by her mother's poor health. Ironically, in purely material terms she was probably better off in the emergency centre than she had been while her mother was alive, because at least she got food and medicine and had a secure roof over her head at night.

Looking at the numbers, we have to accept that the position is, perhaps, more complex than the simple headline figures sometimes warrant, scandalous as the overall number of orphans is. Enormous improvements have been made in the treatment of adults. That is visible in sub-Saharan Africa, where the levels of illness and the obvious signs of HIV/AIDS are not as they were some years ago. None the less, the numbers of orphans continue to increase.

This morning I spoke to a person in Tanzania who runs a big centre for HIV/AIDS care and supports a lot of orphans in the community. It supports a network of children living in foster homes or with parents who are ill. The person I spoke to told me of the dramatic increase that the centre had seen in the number of orphans, which had risen from 5,000 to 7,000 in one year. By this September—just a few months from now—staff expect to be supporting 9,000 orphans. The orphanage is a big organisation, which is run by a British person, but it does not get a penny piece from the UK Government. All its funding comes from the US—it has never been able to access UK funding. There are therefore some real issues about ensuring that people know how, when and where to access UK funding.

We also need to look at the complexity of children's needs. My hon. Friend the Minister was right to spell out the work that has gone into supporting health systems, and he was right about the need to ensure that money was well spent and sustainable. He also mentioned the very real problems of paediatric formulae, and Mr. Clifton-Brown noted the particular problem of requiring a range of such formulae to provide proper care for children. As he said, such things are not always particularly commercially attractive to companies, so we need to give some real thought to how we can tackle the issue. My hon. Friend also noted the problems involved in ensuring that women do not pass the virus on to their children. Baragwanath hospital, in Soweto, has a sophisticated health care system, but things are quite different when women are giving birth in the slums. That is one of the real challenges that we need to tackle.

In addition to such obvious health system issues, a range of other issues affect children, although I will deal with only some of them, because I would be here all afternoon otherwise. One major issue is children's rights. For example, where both parents die, the children may be left in a hut, and the relatives may come for the hut. In one case that I saw, the hut was starting to break down and there was no repair system in place. In another instance, the husband had died, the mother was nearly dead, the granny was looking after the children and some rustlers came and stole the cattle. There are therefore real issues about children's property rights.

There is also an issue about children having all their certification. As my hon. Friend will know, cash transfer payments often depend on the children's having birth certificates. Non-governmental organisations have done some interesting work to ensure that children have the certification that they need to get support and cash transfer payments. Those are all important issues.

Another important issue is children's psychosocial needs. Compared with setting up hospitals and providing medicines, meeting children's psychosocial needs may seem like a secondary issue. As we all know from our experience in the UK, however, it is important to equip children for adulthood and to ensure that they can function as adults and do not carry too much excess baggage of grief from their childhood. I saw some interesting work by faith-based organisations in Zimbabwe, which got children to do memory books about their families and to keep pictures of them. As the children passed from being eight or nine-year-olds into adulthood, they had something to hold on to from happier days when their parents were around, and they could deal with their grief.

The importance of that was brought home to me most as a result of a meeting that I had with a little girl. I will talk about her a bit more at the end. I had previously met her and her family and I had taken a picture of them all to use in things such as leaflets. The following year, I found out that her mother had died, the baby had died, one daughter had been taken away by relatives, the little boy had gone somewhere else and the little girl, who was very ill, had ended up in a shelter. When I met her, I happened still to have the picture of her with her family so I gave it to her. By the end of the day, I had to get a second copy because she had run around with it and worn it out completely. She had nothing to remember her family by except for that picture. That really brought it home to me that we have to meet the psychosocial needs of orphans—whether in Africa or the UK. It is not about giving a child a pill but about putting proper care provisions in place so that the child can grow and develop.

Obviously, changes have taken place over time, and the biggest change that I have seen relates to food. We could transform the lives of quite a lot of children if, after dealing with the health care system, we found money to feed them. There is not much in the way of food in the store cupboards of many of the projects that support children. There are real issues about who does and does not get access to World Food Programme food and what type of food they get. One of the main things that projects that support orphans do is feed them, but those which feed small babies have no infant formula. There are all kinds of debates about infant formula, but it is not very clever to give a little baby powdered skimmed milk. It should not be beyond the wit of some of us to sort out the provision of something appropriately nutritious for babies whose mothers have died or cannot feed them, perhaps for nutritional reasons. We should be able to do something where babies have no one else to breastfeed them and need better quality food, and it is about the number of calories.

One of the things that most struck me the last time I went to the orphanage outside Nairobi was that food had become chronically expensive. For example, the amount of rice that the children were eating had fallen because it was too expensive, so the variety and quality of their diets had been severely curtailed. Similarly, the amount of meat that they were eating was going down. The orphanage spent about £2.10 a week on food per child, and that met only their basic needs. Again, that is in a country that should have a plentiful supply of food.

There are also issues of governance. I know that my hon. Friend the Minister is very concerned about governance, and the Government are doing a great deal of work on it with developing country Governments. However, there are issues relating to services for children in those countries, just as there are problems with such services in this country. The departments that deal with children tend not to be very important in the bureaucratic hierarchy, so they cannot get much done. Often, those who deal with these issues are in a sub-section of a department that is tucked away somewhere at the bottom of the heap. There is a real need to ensure that departments that provide services for children can deliver.

Let me give a simple example. DFID has bought a large number of malaria nets, which are supposed to be supplied free to young children in malarial areas. The orphanage that I mentioned earlier is in a malarial area just outside Nairobi. The couriers responsible for delivering our malaria nets took them to the district commissioner's office. However, no malaria nets reached the orphanage—I was told that they had simply ended up in the local market. It is completely wrong that malaria nets paid for by British taxpayers and intended for orphans should not be delivered to orphanages. If there had been strong advocacy from children's services departments to make sure that the malaria nets did not go off into the general distribution but went to the identified centres where the children were living, perhaps those children would have got the malaria nets that could save their lives. Big issues arise from that incident, as they do in relation to other areas of children's services. If the right kind of attention were given to children's services there would also be more training for social workers. A professor in Nairobi is trying to get that issue raised, and to obtain recognition of the need for more trained social workers to make sure that children's services are delivered properly. I hope that my hon. Friend the Minister will be sympathetic to the idea of supporting that work.

My hon. Friend did not speak about the cash transfers that were being considered to replace the £150 million that was earmarked over three years. There have been experiments with cash transfers and in some places—largely in South Africa, which has more sophisticated financial systems—they have proved quite successful. However, I hope that if the main financial support for HIV/AIDS orphans is to be given through a system of cash transfers, there will be clarity about who gets the money and what they get it for, and careful follow-up. If cash transfers are to be given to a family to look after orphans it is important that the money should subsidise the family income generally, and preferably should help the orphans, rather than that it should go to perhaps more privileged family members who do not need so much support. It is also important that if the money is supposed to go to the poorest 10 per cent. of people, as I think it is in some areas, there should be clarity about that, so that it goes to those poor people intact and to good effect.

I hope that my hon. Friend will carefully consider the very good role of some UK companies and their corporate and social responsibility policies, which have provided community support for some orphans. Business Action for Africa has done a lot of thinking in this area, and has co-ordinated the work of quite a number of companies.

Finally, perhaps I may give an account of the life of one of the children we are concerned about. It is the little girl whom I met with her mother, who was HIV-positive and a single parent. The little girl—Beatrice—had three siblings; there was an older girl, a brother and a baby called Tabitha. The baby was being spoon fed with powdered skimmed milk made up with water that was given by an NGO; her mother chose not to breastfeed because she thought she might pass on HIV to the baby. The mother was on antiretrovirals, so it was thought that it would be possible to stabilise the family, but unfortunately the mother and baby died. The older girl was of reasonable working age and was quickly taken off by family members up-country to work on a farm. The siblings lost touch with her completely. The little boy, who was thought to be HIV-positive, was put in a children's home.

The next time I saw Beatrice she was in an emergency shelter in Nairobi. Apart from being HIV-positive, she had tuberculosis and was very ill. Those caring for her managed to deal with the TB and get her into a reasonable physical state. They fed her up, and once she was a little recovered they got her on to antiretrovirals. The next time I saw her she was in the same children's home as her brother. They had no bed nets or running water and not much food. She was starting to lose weight. The next time I saw her she had lost a considerable amount of weight. The next time I went there, she had been moved up-country. The organisation that had done all that work for her was virtually out of funds. My hon. Friend the Minister knows which organisation I mean, because I have spoken to him about it before. If we are going to provide support and protection for the children, it is desperately important that we support and safeguard the organisations that feed them. In four or five years of going to and fro, the state of some of those organisations has got significantly worse.

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

The Secretary of State has asked me to meet my hon. Friend to talk about the work that she is doing at the moment specifically with a Kenyan non-governmental organisation, and at that meeting—in the next couple of weeks, I hope—there will be an opportunity to discuss further some of the detailed issues that she has mentioned affecting the experience of organisations on the ground.

Photo of Sally Keeble Sally Keeble Labour, Northampton North

I am grateful to my hon. Friend because my perception is that there has been progress in areas such as treatment, and where there has been economic development there have been improvements anyway. However, some of the more vulnerable members of society have been left out of that and, as always, that means children. Everyone says that children are the future and that we must look after them, but children are always at the bottom of the heap when it comes to any form of assistance. The evidence is that if they have parents, and particularly if they have mothers, they have someone to fight for them. A doctor told me that the failure of the mother predicts the failure of the child.

Once the parents have gone, the next line of defence is often the NGOs and community groups, which feed the children and provide them with counselling and personal support, clothe them and advocate for them. It is obviously important to improve the systems and do the cash transfer payments, but we should also make sure that the community-based organisations that provide so much help and support are supported in their turn, so that they can see to it that the next wave of the HIV/AIDS epidemic—that of the orphans—will be resolved, and those children will have a secure future.

Photo of John Barrett John Barrett Shadow Work and Pensions Minister 3:28 pm, 7th May 2009

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 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 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.

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.

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.

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.

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development 3:42 pm, 7th May 2009

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 John Barrett said, it is often the personal examples that stick in one's mind. The speech from 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:

"Britain has almost twice as many new HIV cases diagnosed in a year as any other west European country, new figures show.

There were 7,734 new cases...recorded in 2007".

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, 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

"there are some serious questions to be asked about delivery and also about our interaction with donors, with NGOs and with governments in terms of achieving what we say we want to achieve."

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.

The Select Committee report states that

"the challenge remains for DFID to turn rhetoric into practical implementation and demonstrate much more clearly how it will achieve the targets it has set and the commitments it has made."

Although the £6 billion is admirable, we need to see what effect—what change—it is having. I concur with that assessment; and I would add that my hon. Friend Mr. Mitchell has called for intermediate targets to be set for scaling up implementation to full access, and for detailed yearly—I emphasise, yearly—impact assessments to be made to demonstrate whether the strategy is on track.

Why should the reporting be more regular? Nearly every minute, one child dies from AIDS and two become infected with HIV. If aspects of the strategy do not work, or the goalposts move, a biennial assessment will not pick up the fact that millions of people would have died in the time needed to detect whether the strategy was wrong. I ask the Minister to consider that point.

I move on to policies relating to children that arise from the Select Committee report "Achieving Universal Access". It notes the need for an increased focus on groups that are more affected by HIV. The Minister mentioned some groups, especially women—I would say, more particularly, adolescent women. There are also children, sex workers, men who have sex with men, injecting drug users, prisoners and migrants—the last being a particularly vulnerable group.

The Government's strategy has moved towards expanding social protection programmes. DFID says in its response to the Select Committee report—this is an important aspect, and I ask the Minister to concentrate on it—that it will

"provide effective and predictable support for the most vulnerable households, including those with children affected by AIDS."

The Minister, I am sure, will be aware of the Select Committee's concern that

"many of the most vulnerable children, including orphaned children and street children, do not live in traditional households".

That is self-evident. If they have lost their parents, it is likely that sadly they may become part of the itinerant child population that we see in so many parts of the world. Therefore, they may not benefit from the change in strategy. Will the Minister say how the strategy will work for those vulnerable groups of children?

Children suffering from HIV find their immune systems dramatically weakened. The Select Committee makes the clear recommendation that

"Children living with HIV should not be dying needlessly when a cheap and effective antibiotic is available to mitigate their vulnerability to opportunistic infections."

In his evidence to the Select Committee, Dr. Stuart Kean, the chair of the working group on children affected by AIDS, reported that co-trimoxazole costs just one or two pence a day. As the hon. Member for Northampton, North said, £2.10 could feed an entire family for a week. Such small sums can provide a huge amount of money for the third world.

The hon. Member for Edinburgh, West said that the pound is not going as far as it used to; I calculate that because the pound has devalued over the last year, £334 million of DFID aid is not going where it should. One can imagine how many drugs that money could buy. Furthermore, a World Bank report notes that eight countries now face shortages of antiretroviral drugs or other disruptions to AIDS treatment. Twenty-two countries, home to more than 60 per cent. of people on HIV treatment worldwide, expect to face disruptions over the next year.

I shall now speak about mother-to-child infections. The Minister will be well aware that a mother with HIV has a 30 per cent. chance of passing on the disease to her child; such means of transmission account for 90 per cent. of the disease in children. DFID has launched an ambitious strategy to increase antiretroviral treatments for HIV-infected women from 34 per cent. to 80 per cent. by 2010, to reduce if not eliminate that form of transmission. I hope the Minister will give us an update on whether that target is still attainable.

The picture is bigger than simply providing drugs, as many others have said this afternoon; on their own, they will not lead to a solution. One key fact is awareness of carrying the disease. As I said in an intervention, only 18 per cent. of pregnant women have received an HIV test. We should remember that the diagnostic testing equipment is becoming much smaller and more portable. If we can pick up on more of the pregnant women carrying HIV, the appropriate treatment can be given at an earlier stage, and we might be able to stop some of the maternal transmission and thus save more young children's lives. As well as the equipment needed for testing, it is vital that countries' health care systems be able to deal with such transmission effectively.

The distribution of drugs in many poor countries is important. Some excellent work has been done on the distribution of drugs, particularly by companies involved in corporate social responsibility programmes. For example, Coca-Cola is thinking about delivering drugs to remote rural communities—places that are almost impossible to reach. The company's franchisees operating in those remote areas—it amazes me that Coke is sold in such remote places, but I am sure that it is—are considering distributing drugs with the Coca-Cola.

A proper system of distribution is necessary; once the drugs have reached those communities, someone has to be in charge of getting them to those who need them—and of ensuring that they take the correct amount. One of the tragedies is this. I have heard from more than one source that when a woman is given her drugs, she will go home; but the man will see the drugs and regardless of whether he knows he is an HIV carrier, he will seize all or part of those drugs, and the woman will get none. It is important that the drugs get through to those for whom they are intended.

The Select Committee notes that DFID's strategy

"fails to explain how the high-level funding commitments will be broken down by country or sector, making it difficult to understand how implementation will occur on the ground."

I think that the Minister addressed that point. He said sotto voce that he could give me a country-by-country breakdown or, at least, put one in the Library so that we can all access it. That might be a very good way of communicating the information.

Although this debate focuses on children, as I have remarked already, the death of adults has a huge effect on the lives of children, and as such, although I cannot go over it in detail, a brief comment on the overall strategy remains salient. Regular monitoring of progress has been carried out, which ties in to all the areas of the strategy, because it is the only means by which success will be achieved. We must also address the need for continued growth in education—this is terrifically important—particularly among men, who have a role to play in this whole affair. We must ensure universal access to family planning services. That is most important, as women are disproportionately affected by the disease: two thirds of young sufferers are female. I would also like to hear how DFID has sought to engage more fully with civil society to tackle issues relating to the disease.

I want to raise—again—one discordant but important point relating to DFID staffing. I am not the only one concerned; it is regularly raised by the Select Committee, including in its report, as well as by non-governmental organisations. In her evidence to the Select Committee, DFID's permanent secretary—no less—noted that

"our staff are very pressed, they are working very, very hard...we are coping but we are struggling".

That is a very significant admission from a senior civil servant. It is as close as one could come to saying that there are not enough staff to deliver the programme. Of course, every Department's central office has had its fair share of Government cuts—

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development

Let me conclude my point.

Each Department has been given a Treasury public service agreement target to cut staff numbers, but, at a time when DFID's budget is increasing—thankfully—it seems a little unfortunate if not enough health advisers, for example, are in place to deliver DFID's creditable HIV programme, which is one of the largest in the world. We want to ensure that it is delivered well and is getting results for the money spent. It is important, therefore, that we have the correct—not excessive—number of staff.

Photo of John Barrett John Barrett Shadow Work and Pensions Minister

The hon. Gentleman clarified the point I was about to make: a reduced staffing level, when the budget is increasing, produces a unique problem, because without outsourcing DFID's functions, it will not be as effective as it would otherwise be.

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development

I am very grateful to the hon. Gentleman for reinforcing my point, which DFID Ministers must make to their Treasury counterparts, so that we can have the correct balance. The Minister might assure me that we have that balance, but it would be interesting to know.

I have raised a number of questions for the Minister to respond to today. The purpose is not criticism for criticism's sake, but to probe his Department's performance. Everyone who has contributed to the debate knows only too well the horrific effects of this disease, and we all want to ensure that our contribution to the global fight is as effective as possible. Of significant concern is the scale of the reporting and monitoring of our achievements, because the number of lives lost every day means that we simply cannot permit any weakness in our strategy.

Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

Before I call Mr. Borrow, I want to say that it is unusual that somebody who enters a debate very late is called to speak. It is not something that the Chair often wishes to do, but the hon. Gentleman was courteous enough to drop a note to the Speaker's Office indicating that he had a very important meeting with the Under-Secretary of State with responsibility for disabled people, and I believe that it would be the wish of the Chamber—he has my sanction as well—to allow him to contribute to this debate.

Photo of David Borrow David Borrow Labour, South Ribble 4:04 pm, 7th May 2009

Thank you, Sir Nicholas. I apologise to the Chamber for being late. As you said, I had a meeting with the Under-Secretary of State with responsibility for disabled people and a constituent of mine who runs a charity for the disabled in Lancashire. I travelled down especially for the meeting, and I felt that it was important that I kept it. However, as chair of the all-party AIDS group, it is also important that I make a contribution to this debate.

I shall keep my remarks fairly short. Last year, I made a visit to Malawi, funded by the Commonwealth Parliamentary Association scholarship scheme, in order to investigate AIDS and vulnerable children. Initially, I spent three days in Lilongwe, meeting Government officials and NGO personnel, to learn about the problem in Malawi, which is one of the poorest countries in the world and has an infection rate of about 14 per cent. Furthermore, it has only a handful of doctors and nurses and is really struggling to provide the sort of care needed. Certainly, the three days that I spent in Lilongwe visiting the AIDS centre in the main hospital, meeting Ministers and holding many discussions brought home to me the scale of the problem in Malawi.

The last three days of my visit were spent in Mulanje, in southern Malawi, and I had the privilege to see work being done by a charity called Friends of Mulanje Orphans, which is based in my constituency and was set up by Mary Woodworth, who comes from Mulanje and lives in Walmer Bridge in my patch. She returned to Malawi eight years ago for her father's funeral and saw large numbers of orphans on the streets. That is unusual in Africa, where traditionally if children are orphaned, they are cared for by their extended family. It was probably a sign of the scale of poverty and the number of orphans that extended families could no longer care for them. Mary returned to Lancashire and set up a charity. When I visited, last year, it probably cared for about 5,000 orphans through 12 or 13 centres, but it has since expanded.

The charity does not use the orphanage model. It works with the extended family and provides day centres, so that when children return from school, they get a proper meal and are looked after in the afternoon. Furthermore, it provides clothing and books for them and pays school fees. The charity works with the families, so that at night the children return to their grandparents, siblings or uncles and aunts and live with their family. Very small, pre-school children spend the day at children's nursery-type centres. This seems to work. The charity has also set up everything from mechanics to dress-making centres and a range of other things. Furthermore, it grows much of its own food, although a court case is currently under way—a landowner is arguing that the land used to grow the food belongs to them. That argument is ongoing.

What struck me about that model for supporting orphans in Malawi is that it went with the grain of Malawian society by supporting the extended family. We should follow that model wherever possible. However, sometimes orphanages are the only option. Several years ago, I visited the SOS Children's village in Botswana, which uses a different model arranged around a number of families with a housemother and children of both sexes and a range of ages. It tries to recreate a home environment, with a mother figure and siblings or children of a variety of ages. In each village, there will be a school and various community facilities. It tries to reproduce, as much as possible, what a child would expect in a normal family.

I point to that contrast, because about six or seven years ago, I visited an orphanage in Africa. I shall not say where it was, because it might have improved, and I do not want to criticise the charity, because it was working hard. The most distressing experience that I have ever had was visiting that orphanage, where children of all ages were kept in groups of 20 or 30 in dormitories or rooms with cots. That was before antiretrovirals—ARVs—were generally available. In each group of children, three or four were visibly ill, and they were looked after by carers. When I walked into a room of three-year-olds, all the children wanted was to be picked up and hugged. Food was provided, the place was clean and the workers were doing their best, but it was not a model place in which to bring up orphans. The contrast between that and the SOS orphanage was stark. An important lesson for me was seeing how Malawi supports its extended families. One of the reasons why I am so grateful for being a Member of Parliament is that it has given me the opportunity to learn and see how other countries handle such issues. It has shown me that things can be done well and not so well. When we give support to orphans and vulnerable children, we must consider carefully the model of care that is used. In the discussions that I have had with DFID officials in different countries in Africa, it is clear that that message has been learned.

I should like to pay tribute to FOMO, which is based in my constituency. It has virtually no paid staff, but manages to raise money, mostly from my part of Lancashire, to support 5,000-plus orphans many thousands of miles away. That shows us the type of work that can be done by a small charity.

I know that you do not want me to speak for too long, Sir Nicholas, so I shall be brief. The all-party group is carrying out an inquiry into access to medicines, and its report will be published in a few weeks' time. We recently visited Geneva and had meetings with a range of organisations, including UNAIDS, the World Health Organisation and the World Trade Organisation. We considered some of the issues that have crystallised around access to ARVs. The first range of adult drugs for first-line treatments are now relatively cheap and can probably be delivered to most parts of the world at a reasonable price. However, after people have been on those drugs for a number of years, they need to move on to the second round of drugs, which are expensive and tied in with patents—as a way for the big drug companies to protect themselves. Over the next few years, the real challenge for the developing world will be making available that second round of drugs. There is talk of patent pools, which DFID is promoting.

As for children with AIDS, the problem is the shortage of paediatric formulae. Many children end up having a mixture of drugs in liquid forms. We must encourage companies to produce a range of single tablets with a mixture of drugs in each one for various sizes of children. That is not cost-effective for the rich part of the world because relatively few children have AIDS. However, in the developing world, many, many children are HIV-positive and need such treatment. To get drug companies to develop those small pills will be very difficult. Some of the most efficient producers of pills are in India. They are generic producers rather than producers that work with the traditional first-world pharmaceutical companies. If we can encourage the large companies to make available the patents, and then work through international organisations to ensure that the generic producers use all their efficiencies to produce a range of ARV pills that can be used for children, that would bring things on a great deal.

Mindful of your earlier words to me, Sir Nicholas, I will end my contribution. I have made my two main points, so I will now listen with interest to the Minister.

Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

I thank the hon. Gentleman for his succinct but very relevant contribution to this debate.

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development 4:15 pm, 7th May 2009

The overwhelming lesson of this debate is that behind every statistic lies a human tragedy—a beautiful baby who never gets to dream let alone pursue those dreams, a child who never knows the unique love of a parent, and an infected parent who lives a soulless, numb existence, tormented by the death of their child. Any politician or civil servant engaged in tackling such a problem must remember that those are the very people whom we are trying to help. We want to see far fewer people facing such tragedies on a daily basis. Given the knowledge that we have at the beginning of the 21st century, there can be no excuses for people suffering unnecessarily. We have a collective responsibility to do something about it.

Today is also an example of Parliament at its best. The quality and sensitivity of the contributions from all hon. Members have demonstrated the positive side of a House that often gets very bad publicity. I want to pay tribute to everyone who has contributed, including my hon. Friend Mr. Borrow, who made an extremely focused and important speech.

I want to do justice to the key points that were raised. I shall write to my hon. Friend Ms Keeble on access to treatment in low-income countries. I have the information here, but it will take a long time to read it, and as she is not here, it is probably best that I write.

My hon. Friend also raised the question of how we track the impact of our work on orphans and vulnerable children. We are working with UN agencies such as UNAIDS and UNICEF, and directly with non-governmental organisations to find more effective ways to ensure that we get resources to the most local of levels. An example of that is the work that we are doing with UNICEF to channel resources to community-based organisations in Zimbabwe and Namibia. As I mentioned, we are reaching more than 130 such organisations in Zimbabwe.

My hon. Friend also mentioned the importance of cash transfers. Social protection programmes, including cash transfers, have been shown to be highly effective in reaching OVC and promoting their access to basic services. She also mentioned South Africa, where cash grants have resulted in an increase in height for children under three years, thereby indicating that the impact of AIDS can be mitigated.

My hon. Friend also mentioned baby milk and how we ensure that babies are fed correctly. It is important that we use this debate to highlight the fact that the WHO guidance promotes very strongly that, in such circumstances, breastfeeding exclusively for the first six months of life is the best way forward. I still think that we have a long way to go in explaining why that makes such a difference, particularly in these circumstances.

John Barrett asked how we will monitor progress on delivering the strategy and using public resources. That point is very important given the current economic situation. There has never been a time when we have so needed to be able to demonstrate to the UK population the value for money that they are getting as a result of their taxes and the choices the Government have made to prioritise and focus on our responsibilities to the developing world. Therefore, he is right that we need to talk about impact and outcomes, and not just about interventions, resources and programmes.

In that specific context, we will publish biennial reports over the seven-year lifetime of the strategy, which will ensure transparency and accountability for its implementation. They will present and analyse data from a series of templates, and will focus primarily on efforts being made at country level, but they will also define our work globally. We are also in the process of commissioning inputs from all relevant parts of DFID and Whitehall so that we can produce the baseline report in line with our commitments. There is a very clear process.

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development

I raised the problem of the biennial reports. What if the strategy is not working? A report will be produced every other year, in which time an awful lot could go wrong. Is it not possible, with modern reporting mechanisms, to produce annual reports?

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

I do not think that I will concede that point. Why? The hon. Gentleman is right that it is the responsibility of Ministers and senior officials to monitor the matter on an ongoing basis, not simply biennially. It is also more than legitimate for parliamentarians to ask questions or stimulate debates and to ask for more frequent updates. However, we must be careful—he raises this point frequently in another context—not to bog down our people who work in the countries affected and in DFID with endless reporting mechanisms that stop them doing the job that we ask them to do. I also think that we need a reasonable period so that we can make serious judgments about progress, which is linked to what the hon. Member for Edinburgh, West said about DFID staffing arrangements. We should ensure that we have a smart and effective operation and that we make the best use of our resources, but I do not want our officials or in-country people to be bogged down in unnecessary, undesirable reporting. In the end, that would not help us.

Some 92 per cent. of DFID staff said in the recent capability review that they enjoyed going to work every day. Any Department would celebrate that, as would any organisation in the private sector. It is a remarkable tribute to the leadership of DFID and its senior civil servants. I sometimes think that we do not state such things often enough. It is not only politicians who are attacked; civil servants are frequently attacked too—they are described as "bureaucrats" and so on. I have never worked with such a mission-driven group of people. We are very fortunate and privileged. It is also useful to put on record that in the capability review, DFID was the top performing Department. That is a source of great credit to staff at every level of the Department, of which I am proud to be a Minister.

The hon. Members for Edinburgh, West and for Cotswold (Mr. Clifton-Brown) asked about the United States Administration, who have given us a massive opportunity. They have removed some of the ideological and philosophical constraints that were placed on our approach to HIV/AIDS. Ironically, when we look back, we might find that the resources and investment that President Bush made in HIV/AIDS in Africa was his top achievement. The problem was that some of the constraints and restrictions to which I referred were undesirable in relation to our ability to make significant progress on prevention.

Only this week, the Obama Administration made a significant announcement. They are going to increase further the resources that the previous Administration invested in health generally. For the first time, the American Administration are saying that they believe that we must maintain a level of commitment to vertical funding specifically for HIV/AIDS work and, additionally, that they must play a role as a partner in building health systems in developing countries. In the end, long-term, sustainable change comes as a consequence of building those health systems. Those are massive steps forward.

On South Africa, there was a diabolical period in that country's history, when the President was in denial about what needed to be done on HIV/AIDS. Consequently, public policy reflected that attitude, with unnecessary and tragic consequences. I am delighted that the interim President changed that policy and that a new, progressive and enlightened Health Minister was appointed. I flew to South Africa to support and endorse her new approach to HIV/AIDS, which is a move away from the denial years. We announced specific extra resources to help her with the new strategy. Now that there have been elections, we hope that the new President will retain this strong level of commitment to a new, authentic and serious approach to HIV/AIDS.

The DFID office in South Africa is working on supporting the country's Government, private sector and NGOs so that they can have a new, effective strategy to tackle AIDS. It is not for me to appoint Cabinet Ministers in this country, let alone any other, but we are great advocates and supporters of the current Health Minister and we wait to see who will be in the Cabinet that the new President will assemble during the next few days. We believe that the Health Minister has the vision, credibility and support to lead a tremendous push on HIV/AIDS, which could begin to make a real difference. It is not just about what happens within South Africa's borders: if South Africa adopts a progressive approach to HIV/AIDS, it would be profoundly significant for the continent of Africa.

The hon. Member for Cotswold asked what level of detail DFID can provide on its delivery. I point him to the DFID response to the excellent Select Committee report. However, I should also like to correct something he said, because I do not wish to mislead him. We cannot publish some of the details about the money we will spend and the strategy we will adopt country by country at the moment because we have to be nimble and flexible, and ready to take advantage of opportunities such as the change in the political context in South Africa. More to the point, if there are political obstacles, such as those that existed previously in South Africa, we have to find other ways of getting resources to the front line. We can publish information but, inevitably, we have to retain flexibility and the capacity to respond and to change our interventions.

The hon. Gentleman also asked about targets for preventing mother-to-child transmission. Our position is that we will intensify international efforts to increase to 80 per cent. by 2010 the percentage of HIV-infected pregnant women who receive ARVs, which will reduce the risk of mother-to-child transmission in low-income and high-prevalence countries. Maternal, new born and child health services, including preventing mother-to-child transmission, are important entry points for women and their children and families to access broader health and AIDS services, and there is strong evidence for the effectiveness of PMTCT interventions. We are making significant progress.

Photo of Geoffrey Clifton-Brown Geoffrey Clifton-Brown Shadow Secretary of State for International Development

I used to be chairman of the all-party group on population development and reproductive health. As I said, I am keen that men take more responsibility for the problem. To enable them to do so, they need greater access to family planning services. Will the Minister assure us that that will be part of his strategy to deal with the problem, because it is lacking at the moment?

Photo of Ivan Lewis Ivan Lewis The Parliamentary Under-Secretary of State for International Development

The hon. Gentleman is absolutely right. The idea that it is somehow an issue for women only is, frankly, a mistake. Men have major responsibilities when it comes to preventing and reducing HIV/AIDS. Too often, it is presented as a women's issue, which we understand and recognise. That is why we must send strong messages to men about their individual behaviour. We must also send a strong message to men in political leadership roles and men who are leaders of faith networks, villages and rural communities. They can make a massive difference because they can influence the behaviour of other men and how communities respond to the problem. Our approach must be a combination of empowering women and giving them access to the right support and treatment, with a focus on prevention, and, equally, as we know, the behaviour of men has got to change significantly if we are going to achieve all our objectives.

The hon. Gentleman asked how we will ensure that we reach the most vulnerable people. We are committed to working with UNICEF and NGOs to review the impact of social protection, particularly cash transfers, on vulnerable children. We are carrying out a six-country study, we have committed £200 million for social protection systems in eight countries in Africa that will provide essential support for children affected by AIDS and their families, and I have referred to our specific work in Zimbabwe.

I pay tribute to my hon. Friend the Member for South Ribble for his tremendous work over a long period as chair of the all-party group on AIDS, and to the group for its work. There is no question: without the all-party group on AIDS, the issue would not have as much focus and priority as it does. If he could relay our thanks to the staff and members of that group, I would be grateful.

My hon. Friend focused on the human realities. I, too, have visited orphanages and seen the efforts made to keep families together and give kids continuity in family life experience even when their parents, tragically, have passed away. I think that we all know that only in recent times has our own country begun to care for orphaned children in a positive and progressive way; only in the past 20 years have we started to understand what children in such dreadful and horrendous circumstances need.

I agree entirely with my hon. Friend when he says that we should not satisfy ourselves with the fact that we are offering a basic level of care to children without parents. We should be seeking more than ever to offer such children the best. Part of that involves the technical assistance, learning and expertise that we can make available to developing countries, as well as networking to ensure best practice in influencing change in how children in such circumstances are cared for throughout the developing world.

The charity in my hon. Friend's constituency that he endorsed, FOMO, does an excellent job. It represents the finest in UK traditions of grassroots organisations raising money to benefit the poorest people in the world. We should all be proud of it, remembering that although we can be proud that the Government, the country and the population are passionate about the agenda, there is a limit to what can be achieved by Governments alone. It is important that we recognise the contribution made by exceptional citizens doing remarkable things, often in the developing world, and by voluntary and non-governmental organisations.

Sir Nicholas, thank you for the generous way in which you have chaired these proceedings. This debate has been the House of Commons at its best. We all share a collective determination to be able one day finally to say that we were part of a journey that led us to win the war against HIV and AIDS.

Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

I congratulate the Minister, the Opposition spokesmen and all those who have participated in the debate on the quality of their contributions. It has been interesting and stimulating for me, in the Chair, to listen to them.

Question put and agreed to.

Sitting adjourned.