– in Westminster Hall at 2:30 pm on 19th December 2012.
It is a particular pleasure to serve under your chairmanship today, Mr Bayley, because this debate is probably of more interest to you than many debates you have to chair, given your membership of the Select Committee on International Development.
I thank Mr Speaker for selecting this important debate on the rights, risks to and health of HIV patients in developing countries. I also thank the Under-Secretary of State for International Development, Lynne Featherstone, for attending, and I hope she has fully recovered from her recent illness. Before I start—as this would not be appropriate at the end—I wish everyone a happy Christmas and a peaceful new year.
The Global Commission on HIV and the Law, chaired by the former President of Brazil, recently published a report the findings of which are the reason why I wanted to secure this debate. If there is just one point that I want everyone to take away with them today, it is this quote from the commission’s chairman:
“The end of the global AIDS epidemic is within our reach.”
We have the unprecedented opportunity of a generation to have a world where no one dies of AIDS-related illnesses or newly acquires HIV. It is now a realistic ambition to imagine an HIV-free generation.
Some three decades ago, the HIV epidemic was first discovered. Since then, 30 million have died of AIDS, and 34 million more have been infected with HIV. The epidemic became one of the greatest public health challenges of our time. However, as the report makes clear, the crisis is also one of law, human rights and social justice. We are now fortunate enough to live in an age where we have all the research and tools to slow radically the rate of new HIV infections and stop HIV-related deaths, but the AIDS epidemic is not over. This time, it is not nature that is getting in our way of achieving success; this time, we are the problem. Bad laws, political obstacles and straightforward discrimination are preventing us from combating one of the greatest challenges ever to face humankind. We, as members of the human race, are standing in the way of ourselves.
Before I go on, it is important to praise United Kingdom Governments over the past 30 years—Conservative, Labour and now the coalition—for their work and for being global leaders in the response to HIV for much of the past 30 years. Tribute should be paid to Lord Fowler, who, as Health Secretary, opened up the discussion about HIV/AIDS at a time when many hesitated to speak its name, and initiated the striking “tombstone” adverts to alert the public to the nature of the new and dangerous disease. That is something the British people should feel proud of and that should continue, as I am sure we all agree. Perhaps we are ready again for a public health awareness campaign.
As many Members present will be aware, I undertake a lot of work on international development, and an issue that almost always arises in developing countries is gender inequality. Women and girls account for half the people living with HIV in the world. In Africa, the rate is even higher. Poverty repeatedly features, as almost all women with HIV—98%—live in developing countries. Why are women so vulnerable to HIV there? Their vulnerability can partly be put down to biological reasons, but the real reason is the gender inequality and discrimination enshrined in the customs and law and sexual and domestic violence that rob women of power. The United Nations special rapporteur on violence against women found that the majority of sexually active girls in developing countries aged 15 to 19 are married, often to much older men, and such married adolescents tend to have higher rates of HIV infection than their peers.
Sexual violence is the accomplice of HIV, depriving women of their ability to control their lives and thereby protect their health. In 2005, a World Health Organisation study found that in a broad range of settings, men who were violent towards their female partners were also more likely to have multiple partners, with both violence and infidelity being expressions of male privilege. I have previously spoken in this Chamber about rape being used as a tool of war. Increasingly, it is a weapon to break the spirits of women and girls, because, as the global commission’s report rightly points out, it destroys what holds people together—a community.
Disclosure of positive HIV status puts women at risk and in fear of more violence. I recently visited Pakistan, and when I returned home, I read about a Pakistani woman who had been gang-raped. She later discovered that she was both pregnant and HIV-positive. Her husband then abandoned her and her children. The commission’s report cites an example that demonstrates that education and class do not necessarily insulate women from such outcomes. It describes how a Tanzanian woman who led a middle-class life and was happily married to a professional man was affected. When she told him of her positive status, he was furious and started blaming her for their sons’ illnesses. He exposed her to stigma and torture, expelling her from the matrimonial home that she had paid for with her own money. The divorce courts did nothing to uphold her rights or to help her children.
We know that many women in the Democratic Republic of the Congo suffer rape, often in front of their husbands and children, who are then murdered in front of them. As a result, the women are frequently victims of HIV/AIDS, and they have few places to go for help. Antiretroviral drugs are much more difficult to obtain, administer and take consistently in such a chaotic place.
I welcome the commitment of the Department for International Development to putting women and girls at the centre of its work in the developing world. However, the Government have to urge other Governments, particularly at the G8 next year, to adopt the same strategic priority in their international development policies.
Another issue is Governments such as Uganda’s wishing to introduce laws making gay sex illegal and punishable by the death penalty. Many Governments in Africa are intolerant of gay sex. If challenged by UK Members of Parliament such as the late David Cairns, their Ministers try to tell us that they are just continuing with the laws we left with them following independence. That is some 50 years ago, so it is absolutely no excuse. We have moved on in the past 50 years and so should they.
There was a debate in Westminster Hall about the brutal murder of Ugandan gay rights activist David Kato. Since then, I have met a number of young gay men from African countries who are frightened for their lives. Such repressive laws must be outlawed, and it is up to our Ministers in the Foreign Office and DFID to stand up to Governments in countries where such laws are a problem.
Not only are the laws frightening gay men; they are a recipe for disaster in the fight against HIV/AIDS. Men will go underground; they will not see their doctor if they suspect they have HIV, because they are terrified they will be labelled as gay. They will not even want to collect drugs from a pharmacy for exactly the same reason.
A Bill has been tabled in Uganda—it is supposed to go through by the end of the year, so it is not long—proposing to expand the scope of criminalised activities and provide harsher punishments upon conviction, including life imprisonment and, unless the clause in question is definitively removed, the death penalty for some offences. The Bill will force anyone who is aware of an offence under the Bill or an offender to report the offender within 24 hours, or be liable to a fine or three years’ imprisonment. There are indications that the clause might be dropped or amended, but if it remains the draconian provisions will punish any parent who does not denounce their lesbian daughter or gay son to the authorities. They will face fines of 2,650 dollars or three years in prison. Any teacher who does not report a lesbian or gay pupil to the authorities within 24 hours will face the same penalties. That must not happen, and I call upon the Minister to try to do something to stop it.
As the global commission’s report states, children and young people have the most to lose from HIV. It also states that such children are far more likely to become poor or homeless, drop out of school, face discrimination and violence, see their opportunities dwindle, or grow ill and die long before their time. The research quoted in the report states that globally, there are 3.4 million children living with HIV, roughly 16.6 million of whom have lost one or both parents to AIDS, and millions more have been affected. Fewer babies are now born with HIV, thanks to an increase in programmes to prevent vertical transmission. However, less than one quarter of children who qualified for the standard antiretroviral therapy actually received it in 2010. Despite that treatment, 2,500 young people still acquire HIV every day.
Young people in developing countries are also affected if their parents become ill or die. That point is in many ways linked to the gender rights issues I raised earlier, as older children, especially girls, are often forced to leave school to care for the family if a parent dies. That becomes a vicious circle for girls, trapping them for life, meaning they cannot have a long enough education to become economically independent, and elevating their risk of being infected by HIV. We must ensure that when parents die, developing states are well enough equipped to provide children with human rights and to make sure that their legal interests are protected, and that they are being cared for by suitable people.
Then, there is the issue of discrimination against families living with HIV. Adults living with HIV may be denied rights to see their children. Agencies prohibit
HIV-positive children from living with their parents in state-sponsored housing, and school and child care administrators shut the door to HIV-positive pupils, believing that they will infect others. For example, in Paraguay,
“People who suffer from chronic contagious disease” are forbidden to marry or adopt. Challenging those legal obstacles is a particularly important role for non-governmental organisations. Gidnist, the Ukrainian legal aid NGO, challenged the Ukrainian court to protect the rights of an HIV-positive child who was denied access to the paternal home. Thanks to that legal action, the child’s access to his paternal home was restored.
Studies cited in the global commission’s report state that age-appropriate, comprehensive sex education, including information on HIV prevention, serves the health of young people. Those studies show that such programmes reduced sexual risk-taking. If we are serious about working towards an HIV-free generation, it is therefore vital that age-appropriate sex education be available in schools worldwide.
As I briefly mentioned, among the things that stand in our way are the laws and political thought in some developing countries. The global commission’s report makes it clear that HIV is not just a health issue. The report makes for sober reading, informed as it is by those at the sharp end of the making and breaking of HIV-related laws in more than 140 countries. The global commission heard from people living with HIV who are deprived of the medicines they need because of intellectual property laws that put the prices out of reach. Men who have sex with men, and female sex workers, told the commission of their harrowing experiences of arbitrary arrest and abuse by police. People who inject drugs spoke of their time in detention, when they were denied clean needles or substitution therapy to help them reduce the harms associated with their habit. The commission heard about the experiences of migrant workers expelled from countries with laws that ban the entry of, or deport, foreigners with HIV, and the experiences of HIV-positive citizens denied health care, schooling, employment or housing because of stigma and discrimination.
Many companies help their own work forces by providing antiretroviral drugs, antimalarial drugs and other drugs that families need, in order to keep a healthy work force. In Uganda, we saw people from Nile Breweries give such drugs not just to their own workers but to the farmers who provide the agriculture for them—I forget which plant they make beer from. However, they also provide condoms for sex workers. There are people out there trying to help, and they are not just from NGOs and Governments, but from companies. That is encouraging to hear.
I am grateful to my hon. Friend for making a very strong case, particularly with regard to the attitudes that must be overcome in order to address this issue. Does she agree that one answer clearly must be further integration of HIV systems—not a separation of HIV systems—within an integrated health systems approach, particularly in circumstances in which TB is the major killer of people with HIV? In view of those circumstances, does she agree that what we can do in this country is to ensure that the UK continues to take a leading role in addressing the replenishment issue with regard to the Global Fund to Fight AIDS, Tuberculosis and Malaria?
I thank my hon. Friend for those comments. I will come on to those points in a moment, but they are very important because we do need an integrated approach. It cannot be a stand-alone approach; it has to work together with other things.
The global commission’s findings clearly demonstrate that the myriad laws, across multiple legal systems, have one thing in common: by punishing those who have HIV or the practices that may leave them vulnerable to infection, they serve simply to drive people further away from disclosure, testing and treatment—fostering, not fighting, the global epidemic.
To quote Dr Shereen El Feki, the representative from Egypt on the global commission,
“It is time to say, ‘No more.’ Just as we need new science to help fight the viral epidemic, we need new thinking to combat an epidemic of bad laws that is undermining the precious gains made in HIV awareness, prevention and treatment over the past thirty years.”
I absolutely support her position. She argues, and I agree, that deliberate and malicious transmission of HIV is best prosecuted through existing laws on assault, homicide or bodily harm, rather than the special HIV criminal statutes that have sprung up in recent years and that sweep up those—pregnant women among them—to whom they should never apply.
In relation to pharmaceuticals, existing intellectual property laws require a complete overhaul to ensure that the interests of public health are balanced against incentives for innovation, and that the best new HIV medicines are available to all. Laws that criminalise sex work, drug use, same-sex relations or transgender identity do little to change behaviour aside from discouraging the people most at risk of infection from taking measures to protect themselves and their communities from HIV. Laws against gender-based violence and towards the economic empowerment of women are badly needed, and need to be enforced, to reduce women’s vulnerability to HIV. To work towards making an HIV-free generation a human reality, the world needs to take a joined-up, 21st-century approach to, as I said, one of the greatest public health challenges of our time.
Let me now discuss what my hon. Friend Andrew George mentioned in his intervention. Since the Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002, it has saved an estimated 7 million lives, disbursed antiretroviral drugs to more than 3 million people, treated 8.6 million cases of TB and distributed 230 million insecticide-treated bed nets.
I thank the hon. Lady for securing this important debate. I must apologise to her and to you, Mr Bayley, because I must leave the debate early to attend the Energy Bill debate in the main Chamber, but I wanted to be here today to listen to the comments being made. The hon. Lady has made important points about children, access to medicines and the pharmaceutical industry. She will be aware that 72% of children living with HIV still lack access to the ARVs that they need. Does she agree that we need to see a greater commitment to treatment, care and support for those children and simpler drug formulations that are more suitable for younger people suffering from HIV? Does she recognise, like me, that without treatment 30% of children living with HIV will die before their first birthday and 50% before they reach the age of two?
I thank the hon. Gentleman for that intervention. We need drugs to be regularly available at an affordable price, but many countries where the problem is rife are chaotic and often in conflict, so the drugs would not necessarily get to where they are needed.
We have a role to play with DFID, because we provide a lot of health strengthening in different countries, but we must ensure that the health strengthening in the Governments is true. Often a Government will take money out of the health system, because we have put it in. We must ensure that the systems we put money into to fight this huge epidemic are absolutely transparent. It is also important that drugs are age-related; a drug for a young child will not be the same as a drug for somebody in their 50s. The hon. Gentleman makes an important point.
The global fund is the largest international financier of the fight against the three diseases. It channels two-thirds of the international financing provided to fight TB and malaria and half of all antiretroviral drugs to people living with HIV and AIDS. It also funds the strengthening of health systems. Inadequate health systems are one of the main obstacles to scaling up interventions to secure better health outcomes for HIV, TB and malaria. In contrast to other multilateral institutions, the global fund has been ranked by DFID as performing very highly on transparency and accountability. However, 2011 was a difficult year for the global fund, as the cancellation of the round 11 funding caused great concern among non-governmental organisations delivering services through the fund in developing countries.
In 2012, the Select Committee on International Development, of which I have been a member since the 2010 general election, held a short inquiry into the global fund. It concluded that the UK Government should release the additional funding promised to the fund without delay. In the Government’s response to the inquiry, DFID unfortunately states that they will wait until after the second multilateral aid review, which is due to be published in spring 2013.
The global fund has gone through a huge transformational process, developing a new strategy and recently appointing a new executive director, Mark Dybul. It now has a new funding model. Due to financial constraints, however, the fund has withdrawn its programme from some middle-income countries, such as Ukraine where the figures on the HIV epidemic are rising. Will the Minister look urgently at that?
On drugs, it is worth noting that approximately 80% of the 8 million people currently taking ARVs are prescribed generic versions. Competition in generic drugs has enabled the cost to be reduced at least tenfold to around $100 a year for first-line treatment. That was only possible due to India’s pre-2005 patent laws and protracted discussions with the pharmaceutical industry in the late 1990s and early 2000s. Since India’s patent laws have become compliant with the agreement on trade-related aspects of intellectual property rights—TRIPS—it is not possible for Indian companies to make generic versions of newer medicines within the 20-year patent period. We are, therefore, reliant on the good will of pharmaceutical companies to reduce prices for poorer countries.
During 2012, it is estimated that about half a million people will need second and third-line treatment, which is patented and at least three times the price of first-line treatment. Third-line treatment is as much as 20 times the price. One initiative to deal with the cost of drugs is the medicines patent pool, which would enable free generic competition on newer patented medicines. Unfortunately, only one company—Gilead Sciences Inc—has signed up and more companies need to join for the system to be viable. Will the Minister comment on what she plans to do to help that happen?
As we move towards 2015, a lot of work is being undertaken to put together a post-millennium development goals framework. One risk we face as the MDGs come to an end is that the global community will turn its back on the gains made in the past decade. It is important to consider the linkages between HIV/AIDS and other diseases. A post-MDG framework must continue to work towards the unmet MDGs. There is an urgent need for continued action on HIV: each day more than 7,000 people are newly infected with HIV; and 7 million people are still in need of HIV treatment—a number set to increase dramatically as all 34 million people living with HIV will ultimately require it.
TB is the leading cause of death among people infected with HIV/AIDS in developing countries, and 1.1 million people were living with HIV-acquired TB in 2010. Because HIV infections attack and weaken the immune system, an HIV-positive person with latent TB is 20 to 40 times more likely to develop active TB than someone who is not infected with HIV. Promoting and implementing the linkages between HIV and other relevant areas—including gender, sexual and reproductive health, maternal and child health, TB, education, and hunger and nutrition—brings wider benefits for development. A post-2015 framework must therefore ensure that goals and targets support synergies between areas. In particular, it must ensure that addressing HIV is part and parcel of a coherent and holistic approach to strengthening overall health, social protection and legal systems. Will the Minister tell us what progress she hopes will be made at the G8 next year?
My hon. Friend has made an extremely important point, which echoes my intervention on the integration of services. Does she agree that it is a serious false economy if developing countries do not ensure that the drugs are delivered on the ground? The cost of treating drug-resistant strains of TB—such strains are an increasing problem—is much greater than the cost of investment on the front line to treat such cases in the first place.
My hon. Friend is right; if we cannot get the drugs out to the people, they will not do well, so systems need to be put in place. It is ironic that many African countries have appalling transport systems and yet organisations such as Nile Breweries, which makes beer, can get drugs to people, no matter how difficult it may be, because beer gets everywhere, whereas Governments do not always think it important to ensure that pharmacies and health clinics do not have stockouts. All African countries need to ensure that there is blanket coverage of such drugs and that there is never a shortage, because, as my hon. Friend mentioned, to do otherwise is a false economy. They need to work hard to move forward on prevention, because so many people are living with, and still dying from, HIV/AIDS.
I started by saying that the key point I wanted everyone to take away today is that the end of the global AIDS epidemic is within our reach. Working towards an HIV-free generation is now a possibility, but it will become a reality only if we have the will to make it a reality. I shall repeat what I said earlier: nature is not standing in our way; we, as members of the human race, are standing in our way. We must urge the Governments of the world to take a joined-up approach to combating HIV/AIDS.
I also started by praising the work of UK Governments over the past three decades. The UK has provided excellent political and financial support. It is clearly an example of best practice and has set the standard for others to follow. The UK Government will review their HIV programmes in 2013. I agree with the Stop AIDS Campaign, which urges that the 2013 review becomes a blueprint or strategy for the future of the UK’s global HIV work. It is a chance to demonstrate the UK’s continued leadership in the field.
The strategy would map the UK’s contribution to delivering the combination of game-changing interventions necessary to ensure that we reach the tipping point and have a generation in which no one dies of an AIDS-related illness or newly acquires HIV and in which the rights of all those living with or affected by HIV are upheld. I also agree with the Stop AIDS Campaign that the blueprint should include three key themes: first, commit to maintaining the UK’s investment in HIV/AIDS; secondly, commit to putting all people living with and affected by HIV at the centre of the response, regardless of where they live; and thirdly, commit to leading the way in the UK and globally.
It was a privilege to secure this debate and speak on this important issue. I thank you for your chairmanship, Mr Bayley. I thank everyone who has attended and the various organisations that provided me with briefings ahead of the debate. I look forward to hearing other Members’ contributions and particularly the Minister’s response.
Order. Three colleagues are trying to catch my eye. I will call the first Front-Bench speaker at 3.40 pm, so we have plenty of time for speeches of about 10 minutes each.
I congratulate Pauline Latham on bringing this important issue before the House. Some people know about it and others have acquired knowledge of it, as I have through my office and the organisations that I deal with.
The topic is worthy. Many of us cannot fail to be touched by the scenes on television from Africa and other parts of the world, and we often think, “If only the children had more food.” However, looking more deeply at the issues, they need not only more food, but more medication and, in many cases, HIV medication. The hon. Lady referred to the statistics. Some 1.7 million people died of AIDS in the past year, and there have been 2.5 million new infections this year, so there has been an increase to about 38 million people with HIV infections across the whole world. Those figures put the issue into perspective, and bring into focus where we are on this.
Every year, one of the girls in my office takes a two-week summer holiday in a small country called Swaziland. I will speak specifically about that country, because I have some knowledge of the area. She does it through the Elim Church’s international missions; the headquarters are in Newtownards in my constituency. The missions do marvellous work in Swaziland, in schools, education, and health, and in trying to build lives and give people more quality of life and opportunity. Two years ago, we had the youth choir over from Swaziland. What put the issue into perspective for me, perhaps for the first time, was meeting some of those young people, who were in their teens or early 20s. I did not know this until they had returned home, but the girl in my office said, “Jim, many of those people you met have AIDS—not by choice, but from birth.” That puts the issue into perspective; it certainly did for me.
In Swaziland, the people are very similar to those in Northern Ireland—they have the same friendliness that we have, and that the Scots also have, and which we are renowned for—and it is also about the same size as Northern Ireland, but there is one big difference: 40% of Swaziland’s population has HIV/AIDS. The perspective is that nearly half the population has it, and the difficulty is that no one talks about it. I agree with what the hon. Lady said about educating people better to address the key issues that affect them.
When someone goes into an overcrowded hospital in Swaziland, they find two people on each bed and another lying beneath each bed. That is the nature of their hospitalisation. They are probably there for tuberculosis, cancer or some other problem, but they will never admit that the underlying issue is HIV/AIDS, and we must address that. Those lovely young people from Swaziland whom I met had what I would call heavenly voices, but that belied the undercurrent of their health issues.
In Swaziland, to use that country as an example, people do not protect themselves against HIV. They do not use the condoms that are given out for free, because that would be an acknowledgment that they were already ill or could become ill. We have to get past the barrier that seems to exist. In Swaziland, as in many other African countries, male circumcision is also available as a method of trying to reduce the number of people with HIV/AIDS. Will the Minister give us details, if she has them—if not, I am happy for her to reply in writing—on how much the use of condoms and male circumcision has reduced HIV/AIDS in Swaziland, in which I am particularly interested, and across the world? For every one starting treatment, two become infected, which gives us an idea of the massive mountain that we have to climb.
My office sponsors a child in Africa. It is not big money; every week £1 goes into a box to sponsor a young orphan in Swaziland. Through the Elim missions, that money gives orphans clothing, school fees, school books, food and, most importantly, the HIV medication that they need to allow them to live a full, normal life—small moneys, but big dividends and big returns. The kids live on a farm and are sponsored by people from all over the world who understand their illness and how to treat it. The orphanage has a hospice, with a nurse who picks up the first signs of infection. They have hope and a future, but unfortunately the same cannot be said of most people with AIDS in Swaziland, not because of ignorance, but because they just do not want to face the key issues.
An entire generation is missing due to this disease. Grandmothers look after toddlers because the parents have died of AIDS. The grandparents who concentrate on the children perhaps do not want to talk about it. They do not talk about it to their grandchildren, because they do not want them to know that their mums and dads died from it. Again, we can see the dangers for that third generation. A middle generation is missing because of the epidemic, and the older generation is keeping that from their grandchildren, so another generation is being raised not to talk about this unspoken illness.
The scenario is replicated across Africa and the whole world; we have statistics and information relating to places such as Indonesia. Will the Minister respond about the educational drive that we need? It has to be an educational drive that people will respond to, not one that sounds good on a piece of paper that can be sent off without our knowing how the drive works or whether it will be successful. We need to know that it will ensure that we can put an end to losing entire generations. I have looked through the statistics on India. It has had an AIDS campaign since 2001, and it has reduced new infections by 50% in 10 years. The statistics illustrate that; there were 270,000 infections in 2001, and 120,000 in 2012. However, there are still 2.1 million people in India with AIDS, which gives us an idea of the magnitude of the problem.
There have been many pharmaceutical developments, and some of the costs are fantastically different. In America, one dose of medication would cost $12,000, but the same medication can be produced in India, where there are pharmaceutical companies, for $300. Again, we must focus on that. With the wonders of modern medicine, HIV/AIDS no longer has to be a death sentence; medication and care can allow people to have a long life. That life will not be as long as ours in this Chamber, because the disease reduces people’s length of life and their time on this earth, but it will be longer than if they were under the threat of the disease without any medication.
Medication is not always readily available, and given the cost implications, it is clear to many that change must come from stopping the spread by educating people and changing their mindset. If that needs the help and support of those of us in the western world, I believe that we should give it.
Does the hon. Gentleman agree that, in many African countries, for education to be successful, it needs political leadership behind it? Without that, we will struggle.
I thank the hon. Gentleman for his intervention. I absolutely agree that we need leadership at the very top in all countries, and that we need to make the necessary commitment.
The pupils who came over here as part of the choir from Swaziland were young, and although they were AIDS carriers, they were clearly focused on what they had to do for the future. If we can keep young girls at school, or give them an improved livelihood, so that their focus is on the good things of life, we can reduce the number who can be infected by AIDS. I support the efforts of the hon. Member for Mid Derbyshire to highlight this issue in the hope of securing attention and help for people who are so much in need, in Swaziland and many other countries across the world.
I congratulate my hon. Friend Pauline Latham on securing the debate and on drawing attention to the continuing importance of these issues. [Interruption.]
Order. I must interrupt the right hon. Gentleman early in his speech, because there is a Division in the House. I suspend the sitting, and I ask Members to get back as quickly as possible. We will resume as soon as those who are here have returned to their places.
Sitting suspended for a Division in the House.
On resuming —
As I was saying before I was interrupted, I am grateful to my hon. Friend the Member for Mid Derbyshire for securing the debate and for raising the issue of tuberculosis. It is often the orphan disease, in terms of public attention and understanding in this country. Nowadays it is possible to hear people say that they believe TB is resurgent, and that betrays a certain attitude—that somehow the disease is relevant only when it occurs in this country, where we believed we had it beaten, whereas there continue to be 1.5 million unnecessary deaths a year globally, because of a disease that is, essentially, easily and cheaply treatable. That is relevant to this debate in the context of TB and HIV co-infection, which is a particular problem.
At least one third of the 34 million people living with HIV worldwide are infected with latent TB, and TB is the leading cause of death among people living with HIV. It accounts for one in four HIV-related deaths. In fact, last year, some 430,000 people died of HIV-associated TB. In 2005, when I was first elected, I joined a party that included my hon. Friend Andrew George, who is now the chair of the all-party group on global tuberculosis, on a visit to Kenya, indirectly sponsored by the Bill and Melinda Gates Foundation, to go and see the problem. The success of the visit was that it drew the importance of TB to the attention of a few of us. Afterwards, we founded the all-party group, and since then we have continued to try to raise the profile of the need to deal with that disease. I had to step down as co-chair of the group when I became a Minister, but I am pleased to have resumed my interest since stepping down from the Government.
There are things that we still need to draw attention to, in connection with the problem, and I want to raise a couple of them. First, anyone who doubts the importance of focusing on HIV and TB together, and ensuring diagnosis of both diseases, need look no further than sub-Saharan Africa. There were more than 1 million HIV-positive new TB cases globally in 2011, but around 79% of those patients live in sub-Saharan Africa. That is the only World Health Organisation region that is not on track to meet the millennium development goal for TB, which is to halve the 1990 prevalence and mortality rates by 2015. We need attention on that region and on that incidence of co-infection. It is highly unlikely that the target will be met, because of the negative impact of the HIV epidemic. For the world as a whole, reaching the 2015 prevalence and mortality rate targets will be possible only if TB control efforts, and funding for those efforts, are sustained.
The Government have a clear understanding of the importance of an approach based on the possibility of co-infection, and the need for integrated programmes of diagnosis and treatment. Their position paper on HIV, published in May last year, recognised that, which is welcome. The Government’s major contribution, in particular through multinational channels such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, is also welcome. A considerable portion of it is invested in TB interventions.
There are two things that I want to draw to the attention of my hon. Friend the Minister. The first relates to diagnosis. It is striking that the diagnostic ability and treatment for HIV are much further ahead than they are for TB, yet TB is a more easily and cheaply treatable disease. Why is that? It is straightforwardly because HIV is a disease that affected the west, and TB was a disease that the west believed had gone. Its attention was therefore not on it. The resources and money that were invested in necessarily trying to deal with the terrible and growing problem of HIV were not directed in the same way at TB. Therefore, the diagnosis of TB is not as quick as it should be, and the treatments go on for an extended period, with old-fashioned drugs that must be taken on a continuous basis; if they are not taken in that way, the problem of drug-resistant TB arises—and that is a killer and particularly difficult to deal with.
When people living in poverty are far from the facilities that they need to travel to repeatedly for diagnosis and to get drugs, there are no incentives to get the diagnosis and continue to take the drugs for an extended time. Something that should be cheaply and easily dealt with is not, and that accounts for the numbers of deaths. That is why programmes that improve diagnosis are welcome.
I want to draw the Minister’s attention to the TB REACH programme, which is a WHO initiative that gives small grants of up to $1 million to find and treat those who have no access to TB diagnosis or treatment. It is an incubator for innovation. It pushes the frontiers of mobile phone technology in health, and the deployment worldwide of rapid diagnostics. Even if my hon. Friend cannot answer today—I know she has a lot to get into her response—perhaps she would just consider the power of the TB REACH programme, and the support that the Government might be willing to give it in future.
The second issue that I wanted to raise was diagnosis and vaccination. The first thing that people in the west tend to say about TB is “Surely there is a vaccination available for it.” People know about vaccinating children in this country. However, the vaccination is not available for adults; if a vaccination were available, in developing countries, there would not be such a problem, and there would not be deaths on such a scale. Research and development of a vaccination is therefore as important as R and D of improved diagnostics. It is particularly important for the growing threat of drug-resistant TB, which is not so easily and cheaply dealt with, and can indeed be a killer, evading all medical treatment, including what might be available in the west. My second question to the Minister is therefore this: what support are the Government giving to TB vaccine development, which would be so important in heading off the incidence of the disease and save a large number of lives every year?
On the wider debate about why it is necessary to maintain public spending on international development and aid, there are few better examples than the successful spending of money, through the global fund and directly, on programmes doing very simple things—providing the diagnostics for TB and securing treatment. The intelligent organisation of those programmes to address TB and HIV co-infection is particularly important. We should hold TB up as an example of a disease that we in the west believed we had conquered, but that we are now concerned about, because it is coming back. We can treat it relatively easily, but we have ignored the fact that every year it killed 1.5 million in the rest of the world. We should be concerned about that, too.
It is a pleasure to serve under your chairmanship, Mr Bayley. I congratulate Pauline Latham on securing this debate and on making a thoughtful opening speech that covered a number of topics that I, too, want to explore. I should also like to congratulate UK organisations, and the agencies that they support overseas, on their fight to combat the HIV/AIDS epidemic. They include the International HIV/AIDS Alliance, Save the Children, Oxfam, Christian Aid, and Voluntary Service Overseas; I could go on with the list for the rest of the afternoon. I shall concentrate first on VSO, as I was lucky enough to do volunteer work with it in Kenya during the last recess. It became clear to me that civil society plays a key role in Kenya when it comes to the response to HIV/AIDS.
I want to focus on three main points. The first is the issue of the rights of men who have sex with men. I very much appreciate the fact that the Minister, in her short time in office, has made it clear that she is committed to tackling this issue, and that appreciation goes right across the board. I am sure that she shares the grave concern felt by the hon. Member for Mid Derbyshire and me about the Anti-Homosexuality Bill that has appeared on the Order Paper in Uganda. The Bill had been promised as a Christmas present to the people of Uganda. Although its Parliament is now closed for the holidays, I am pretty sure that the Bill will be firmly back on the agenda in 2013.
One of the most shocking sections of the Bill states that any member of the Ugandan public can be obliged to tell the authorities about homosexual people that they know. Failure to do so could lead to prosecution. The Parliament, therefore, is not only outlawing practising homosexuality, but criminalising those who do not inform on homosexual friends, family members and colleagues. Criminalising a section of the population that is most at risk from HIV and denying them access to basic services not only undermines their human rights but poses a devastating threat to public health in a country where over 7% of the population lives with HIV.
Even those who are inherently against the practice of homosexuality must see that the legislation would pose a health risk, not just to the community, but to the entire population. This is a matter of human rights, and must be of interest to people across the world and to leaders in Africa. Will the Minister confirm whether she or other Government Ministers have raised this matter with African leaders, in the hope that they might raise it with both the Speaker of Uganda and President Museveni?
Following the recent announcement by the UK Government that they are withdrawing direct budget support from the Ugandan Government, I was concerned that the Department for International Development did not appear to offer a route back for the funding to be reinstated. None the less, I do support the reasons for the funding being withdrawn at this time. I worry, though, that there is little incentive for the Ugandan Government to address the corruption issues that led to that withdrawal of funds, and to engage with us and other countries on human rights abuses, such as those we are about to see if the Anti-Homosexuality Bill is passed.
Part of the reason why the Bill is back in the headlines is to distract people from the problems caused by corruption, and to keep out of the headlines the fact that the UK Government have withdrawn direct budget support from the Ugandan Government. Will the Minister confirm whether there is a possibility of Uganda again receiving direct budget support, and what obligations it will have to fulfil to achieve that?
Moreover, what support is our Government providing to organisations that are fighting for lesbian, gay, bisexual, transgender and intersex people in Uganda, such as Sexual Minorities Uganda, for which many of my colleagues on the all-party parliamentary group on HIV and AIDS have shown support? Finally, what provisions have been put in place to support the health needs of all people in Uganda following the suspension of direct budget support to the country?
My second point relates to access to HIV medicines. In my role as chair of the all-party parliamentary group, I have been honoured to meet many inspirational people who are living with and affected by the virus. One of them is Angelina Namiba, who I believe the Minister met in her constituency last week. Angelina has been brave enough to share her story in the national press this week, and I congratulate her on her courage in doing so. She has also participated in many events here in Parliament and has shared her story, allowing us further to understand what it is like to be a young woman living with HIV in the UK today.
Women such as Angelina live healthy, happy and productive lives because they are lucky enough to receive the treatment that they need. Sadly, 7 million people around the world are not receiving that treatment. The Minister may be aware that the majority of antiretroviral drugs are produced in India, which has been able to take advantage of the flexibilities in laws on the trade-related aspects of intellectual property rights set by the World Trade Organisation. Some 80% of the drugs used in
Africa and purchased by multilateral organisations, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, come from India.
The United Nations Development Programme’s Global Commission on HIV and the Law recently highlighted the fact that many of those flexibilities are currently under threat from a series of trade agreements. Clauses relating to data exclusivity, which would require generic companies to redo clinical trials and would therefore significantly delay generic versions of medicines, have hopefully been dropped from the EU-India free trade agreement, but there are other treaties, including the EU-Thailand free trade agreement, that may contain equally harmful provisions. Has the Minister had any conversations with colleagues in the Department for Business, Innovation and Skills about the impact of such trade agreements on the availability and affordability of HIV medicines? Although price is not the only barrier to accessing HIV medicines, it is an important one.
When I was in Kenya with VSO in September, I witnessed the difficulty that people have in rural areas—they were very rural areas, as I know from my 10-hour trip there in the back of a car. People have to travel for many hours every week on poor roads to access clinics and the medication that they so desperately need. Poor health systems and infrastructure hinder people’s ability to access HIV treatment. Next year, the all-party parliamentary group will be looking in more detail at the barriers to accessing medication, and I look forward to working with colleagues and, hopefully, the Minister on that matter.
My final point is about the importance of the UK as a global leader in fighting HIV and AIDS. I am delighted that other Members have already raised that point today. The Department for International Development is the second largest bilateral donor on HIV, and has given tremendous political and financial support to the Global Fund to Fight AIDS, Tuberculosis and Malaria. I was delighted to hear, from the Secretary of State at the all-party parliamentary group’s world AIDS day event, that DFID is “absolutely committed” to getting to zero: zero infections, zero discrimination and zero deaths. A new strategy for HIV that maps out how to achieve that goal would illustrate DFID’s clear commitment to tackling HIV.
Last year, the Government focused on family planning, and I was pleased that a side event at this summit highlighted the links between HIV and sexual and reproductive health rights. We cannot tackle any major development issue, be it food security, hunger or violence against women, without also addressing HIV. Moreover, as we go into discussions about the post-2015 development agenda, we must not lose sight of the incredible challenges that lie ahead. As campaigners from the Stop AIDS Campaign asked parliamentarians just three weeks ago, why stop now? We cannot afford to ignore this disease, which still takes almost 2 million lives each year. An AIDS-free generation is within our grasp, but AIDS is certainly not over. We have the tools, the science and the knowledge to turn the tide on this epidemic. We just need to sustain the political will.
Thank you, Mr Bayley, for calling me to speak. It is a pleasure to take part in a debate under your chairmanship. I begin by thanking Pauline Latham for securing this vital debate, and I pay tribute to the work that she does on the issue.
As I was reminded when I met campaigners from Why Stop Now? on world AIDS day recently, impressive progress has been made in the fight against HIV/AIDS, but as other speakers have already said, there is still much more work to be done. Millennium development goal 6, which is to combat HIV/AIDS, malaria and other diseases, galvanised international attention to the fight against HIV, and created political momentum that has played a substantial role in the success of the HIV response.
Since 2005, 25 countries have seen a 50% drop in new HIV infections. In 2011, a record 8 million people living with HIV had access to antiretroviral therapy, which is more than half of those in need of such treatment. Globally, there were more than 500,000 fewer AIDS-related deaths in 2011 than there were in 2005. As a result of the mobilisation effects of the MDGs, people living with HIV are living longer, healthier and more productive lives. A tipping point—where more people living with HIV are initiated into treatment than there are people newly acquiring HIV—is now within reach.
However, global action and shared responsibility is necessary to sustain investment in AIDS programmes. Consequently, although we have all welcomed the progress made to date, we must also acknowledge the challenges that lie ahead and make a concerted effort to maintain political momentum. I was particularly disappointed—I put it no more strongly than that—that the UK failed to send a Government Minister to the international AIDS conference in Washington in July.
I just want to highlight that an ex-Government Minister attended that conference on behalf of Parliament: Lord Fowler. There was also representation at the conference from the all-party group on HIV and AIDS, and from the all-party group on global tuberculosis. We were able to meet parliamentarians from across the world and discuss a lot of the important issues that we have discussed today.
And vital work it is. That gives me the opportunity to pay tribute to my hon. Friend for her personal commitment in this area, and to the all-party group on HIV and AIDS, which does incredibly valuable work. We must ensure that the UK and the EU maintain their commitment to financing efforts to combat this epidemic, and make strategic plans to capitalise on the opportunity that we have all said is within reach.
Let me move on to some of the challenges that we face. First, progress on HIV has been uneven across countries and certain populations. Although many countries have seen impressive declines in the rates of new HIV infections, since 2001 the number of people newly infected in the middle east and north Africa has increased by more than 35%. HIV prevalence is also consistently higher among sex workers, intravenous drug users and men who have sex with men. In sub-Saharan Africa, as has already been said, women have a 60% higher risk of HIV infection than men. These groups often face legal and social barriers, including discrimination and criminalisation, which impede their access to services.
Secondly, as the majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding, there is a need for greater integration of sexual and reproductive health responses, and HIV responses. I think that the Liberal Democrat Member, Andrew George, mentioned how important that is.
In 2011, one in five maternal deaths was directly related to HIV, but when women living with HIV receive antiretroviral treatment during pregnancy, the risk of transmission is reduced to less than 5%. This progress on mother-to-child transmission has been hailed as a hugely significant factor, and it provides a real opportunity to take control of the problem.
Finally, we need to acknowledge the importance of middle-income countries, which are often forgotten. Three of the top five countries with the highest HIV burden but the lowest coverage of antiretroviral treatment are middle-income countries. We need to focus on tackling this inequality within and between countries, and ensure that human rights are integral to the global response to the HIV epidemic. Will the Minister tell us what steps her Department is taking to tackle discrimination and to ensure that there is access to HIV treatment for the poorest, most vulnerable communities? There is also a need for urgent action to ensure that we can continue to reduce transmission and expand access to treatment to those who need it.
As a number of speakers, particularly the hon. Member for Mid Derbyshire, mentioned, the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was created in 2001 to increase funding to tackle three of the world’s most devastating diseases, has approved $22.9 billion for more than 1,000 programmes in 151 countries and provided AIDS treatment for 4.2 million people. That is incredible. The fund channels half of all antiretroviral drugs to those living with HIV/AIDS. The UK has been the fund’s third biggest donor since its creation, and the second largest bilateral HIV donor, which reflects our impressive leadership on this issue. I was pleased that the hon. Member for Mid Derbyshire talked about a period of 30 years; this work is not party political, but will go on across decades and across political parties.
However, in May 2012, the International Development Committee’s inquiry into DFID’s contribution to the global health fund urged the Government to honour their promise to increase their contribution to the fund significantly, over and above the current pledge of £384 million for 2012 to 2015. The Government have cited a desire to see reforms to the fund as the reason for the delay, so will the Minister tell us more about the fund’s new funding model and strategy? The IDC specifically stated that
“DFID is a key partner whose increased contribution to the Global Fund could unlock funds from other donors. It should do all possible to commit additional funds earlier than 2013 by prioritising its assessment of the Global Fund ahead of, and separately from, the broader update of the Multilateral Aid Review.”
Given that next year will be a replenishment year for the fund, will the Minister use her G8 discussions to leverage additional funding from other countries and announce further UK funding for the fund? Does she agree that announcing funding for the fund would help to increase certainty and encourage other donors to make a commitment of additional resources?
The UK Government should be doing everything they can to ensure that the global health fund is able to operate at the height of its ability, tackling these horrific diseases and saving lives, so I ask the Minister: can she say when we can expect to see the “increased contribution” to the fund from the UK that was announced by the previous Secretary of State for International Development, Mr Mitchell, earlier this year? Also, what steps are the UK Government taking to galvanise support from other donors for the global health fund? Although the fund is not the only institution involved in the fight against AIDS, TB and malaria, it is by far the single biggest actor in the fight against these diseases. It was a British Government who spearheaded the drive to establish the global health fund, and it is the current British Government who should pick up the mantle at this important moment, showing the leadership to get the fund back into full operation.
In conclusion, it is clear that progress is being made on HIV. The number of new infections is declining, and the number of treatments is increasing, but we must not lose sight of those who are still in desperate need. Rather than focusing on single programmes or issues such as family planning or drug availability, the overall approach must be one of cohesion. Health systems and the integration of HIV/AIDS responses with wider programmes of reproductive health must be considered. Commitments to address the global AIDS pandemic must not take a back seat as other issues take the political stage in the UK. As significant advances are made and global leaders in the United States and elsewhere begin to state openly that an AIDS-free generation is within reach, the UK must continue its leadership on this issue.
The significance of what we face must not be forgotten, and as 50% of people eligible for HIV treatment do not receive it, it is essential to support those most at risk, to help them to access the help that they desperately need without fear of discriminatory laws or prejudices. The UK’s impressive record on this issue must be maintained and, as such, we need continued and renewed leadership. Will the Minister tell us what steps the Government are taking to increase access to medicines for the 7 million people who are still waiting for HIV treatment? Will the Government commit to a blueprint that will lay out the UK’s contribution to the attempt to gain control of the HIV pandemic internationally? Much has been done; much is still to be done. However, as the hon. Member for Mid Derbyshire said so eloquently, success is within our reach.
Thank you, Mr Bayley, for calling me to speak. It is a pleasure to serve under your chairmanship this afternoon.
First, I thank Pauline Latham for calling a debate on such an important topic so soon after world AIDS day. I also thank hon. Members from all parties for their thoughtful and important contributions to this debate on what I still regard as one of the priorities for all of us in this day and age. I sometimes feel that, with the advent of drugs that mean people can live with AIDS rather than it being a death sentence, a complacency has begun that somehow the situation is not as bad as it was. With the tantalising prospect of zero infections and zero transmissions just out of reach, we know that success can be achieved, but if any of us let up on our commitment to tackling the disease it will not happen. We must translate our commitment in Westminster Hall today to those around the world who have the power to take the fight forward, and we must keep going in that regard.
As many Members have said, there is much to celebrate. The latest UNAIDS report shows an unprecedented pace of progress in the global AIDS response, with 700,000 fewer new HIV infections each year across the world than a decade ago, especially among newborn children. The work to eliminate HIV transmission from mother to child is clearly delivering results. More than 8 million people now have access to treatment and, for the first time, countries are investing more money in HIV than is received from global giving, which shows that we are moving forward to a sustainable response. That is really good news.
Many people, including me just now, have raised the possibility of seeing an end to transmission—zero infections—but so much is still to be done, and there are risks that could seriously jeopardise the incredible progress we have made. Too many people are still getting infected, with 2.5 million new infections last year. Women remain disproportionately affected, accounting for 58% of people living with HIV in Africa, and I will come on to specific points raised about that in a moment. Some 7 million people still do not receive the treatment they need, and in low and middle-income countries work to address HIV in key populations—sex workers, men who have sex with men, injecting drug users and prisoners—is still almost entirely funded by international sources, which is an inadequate human rights response and is not sustainable. I will come on to some of the issues relating to human rights and homosexuality.
The context in which we work is changing; the dynamics of the HIV epidemic are changing and the patterns of resources are shifting. We must continue to adapt our ways of working to overcome those challenges, and we need a global HIV response that is fit for purpose. DFID supports, therefore, the strategic investment approach, which allows countries to make decisions about how to allocate resources most effectively and efficiently on the basis of national evidence. I am pleased that through the approach DFID and other members of the HIV community are embedding the principles of effectiveness, efficiency and equity. The focus will help to drive more and better results and improve value for money.
The decisions taken at the recent board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria demonstrate that efforts are being made to find new and more efficient approaches. The new funding model should better align with country processes, reduce transaction costs, and make a greater impact with investments. DFID is closely following its implementation to ensure that it achieves those aims.
Many Members have mentioned the issue of the global fund. We have committed £1 billion between 2008 and 2015, and that time scale has not been delayed but rather brought forward by one year. Regarding increasing our funding, we have stated that future funding increases are contingent on the global fund’s progress with reforms. I hear the exasperated, “But hasn’t it done enough?” We have committed to reviewing our position paper, and we will have the multilateral aid review update, which is due in the first half of next year. That will provide us with the evidence, but the intention is to make the increase. The global fund has moved a long way from the days when there were issues in round 11 and we had to suspend payments to the fund. With the fund’s replenishment planned for September 2013, the UK is committed to working with others to ensure that reforms succeed and, as has been mentioned, to using our influence with other donors to draw in more overall financing to raise the final total.
One of the deepest ironies of the HIV epidemic is that the people most in need of prevention and services are from communities that are most neglected and discriminated against. A human rights approach is, therefore, essential, and through our bilateral aid review process DFID’s country offices have been updating their HIV programmes, based on the latest evidence and on national responses. In Zimbabwe and other parts of southern Africa, where there is evidence of growing epidemics in key populations, we are exploring how we can pilot innovative approaches to prevention with sex workers, adolescents and prisoners. We have also given new funding for the Robert Carr Civil Society Networks Fund to support global and regional networks to improve HIV responses for key populations.
We also recognise that addressing gender inequality and ensuring women’s rights is also essential to achieve universal access. The Prime Minister appointed me as international champion for tackling violence against women and girls across the world, and that issue is a key part of my agenda. Violence against women and girls is one of the most systematic and widespread human rights violations in the world, and it materially and significantly increases the risks of maternal death and vulnerability to HIV and AIDS.
The issue of sex education has been raised. I recently returned from Zambia, and I was shocked to find that no one talks about sex there. Not only is sex education not taught in school, sex is simply not spoken about. One of DFID’s programmes there is about girls’ empowerment, and I went to visit the girls and asked them which of their life lessons—that is almost what they are—they liked the most. They had had only three lessons so they did not have many to choose from, but it was heartbreaking that they said that what they most liked was finding out about their own bodies. They had absolutely no idea about the changes that were happening to them.
I want to reassure the Minister that I witnessed a similar DFID-funded programme in Rwanda that was much further forward than the three lessons. I witnessed young girls being fantastically confident in talking about their own health issues. They had much stronger and brighter futures as a result of the programme.
That is the key point: education is vital. The girls were saying that the boys were already very jealous because they were not allowed to go to the girls’ meetings. The initiative was empowering them to feel confidence in their bodies and about their rights over their bodies, and the boys were beginning to be a bit more wary of them. It is a long process, and negotiating such relationships, even in this country, is not always easy.
Having said that about boys, there is also a lot of work to do with boys and men. I went to a gender-based violence clinic—a one-stop shop—where remarkable work was being done with bringing the men along. Where there had been violence, the men had to come in for counselling. They were invited in, and if they did not come they were invited again, by the police. If they still did not come the police went and got them—quite extraordinary. Of the 10 survivor women I talked to, five said that they were still with their husbands, who had changed. One of the men had joined a men’s network. Men who have multiple partners are a real threat, where the spread of HIV is concerned.
Many Members raised issues about Uganda and the homosexuality Bill. I went to Uganda before I moved to DFID, in my violence against women role. Where women are oppressed, there are often hideous homosexuality laws. I raised the issue with the Speaker of the House in Uganda. I would not say that what I said was taken in the best way, but I raised the issue politely, but firmly. It is important to be able to discuss matters, even when people disagree. The discussion was private and appropriate. The issue is a really serious one, and it is not uncommon in many countries across Africa and Asia. I am looking closely at what is possible and at how we move forward on the agenda. One thing we do is to support civil society and Ugandan groups. I met with groups when I was in the country, and there is a lot of fear of a backlash, so how we move forward is a delicate matter.
The Minister mentioned Uganda. Has she had any discussions with any of her Foreign and Commonwealth Office colleagues about making the case in other Commonwealth countries about more legal reform, so that people are not persecuted? I firmly believe we should be doing that.
The hon. Gentleman raises an important point. He may be aware that the Prime Minister raised the issue at the Commonwealth Heads of Government meeting. I have spoken to Foreign and Commonwealth Office Ministers about the issue, and in my international champion role I have developed key messages. Three of those messages are on women, and they address: leadership; rights and laws; and impunity, access, justice and enforcement. There are two messages on homosexuality, and it has been agreed that all travelling Ministers will raise the issue when appropriate. That must be done appropriately as it is easy to raise feelings that the issue is a western construct. The issue, therefore, has to be worked out with the countries not in a preaching way, but in a way in which we can discuss our differences and move the agenda forwards. Human rights are a priority, and we have all made that clear on many occasions. Nevertheless, we work across many countries that come from a different place from us.
In parallel, the UK Government complement grass-roots demand for change through our diplomacy on human rights overseas. We are committed to ending religious intolerance and persecution and discrimination against individuals on the basis of their sexuality. We regularly review the commitment to and respect for all human rights in other countries, including the likely direction of travel over the coming years. Where we have specific concerns about a Government’s failure to protect their citizens’ rights, we raise those concerns directly at the highest levels of the Government concerned.
I will now answer some of the other points that were raised by Members and try to finish ahead of time—we are running over because of the Division.
Pamela Nash asked about direct budget support payments to Uganda and the condition of renewed payments. Aid to the Government of Uganda is predicated on fundamental commitments and agreed principles, so any renewal of general budget support depends on those conditions being met. The route is always open, and there is nothing we would wish more than for countries to want to come back to the same table as us. I am hopeful that that will be the case one day, but it is very early days as we try to address the diplomacy and geopolitics on the Democratic Republic of the Congo, Rwanda and Uganda.
We support Ugandan civil society groups, including the Civil Society Coalition on Human Rights and Constitutional Law, which trains in advocacy and covers the costs of legal cases to protect LGBT communities. That is just one example. Where we cannot give directly to Governments, we find other ways to help people in countries where possible.
My hon. Friend the Member for Mid Derbyshire specifically raised a number of points. Under the global fund’s new funding model, there will be a targeted band for countries, such as Ukraine, with higher incomes and a lower disease burden that remain at risk from rising epidemics. That allocation band includes countries that should focus resources on most-at-risk populations, which are the groups that we have discussed. The UK has consistently argued that such groups should be prioritised in that context. That was the argument I used in Ethiopia when then Prime Minister Meles and I discussed public health, transmission and other such issues.
My hon. Friend is right that Gilead has shown leadership in joining the medicines patent pool, which we strongly support. We are encouraging other companies with patents for new first-line treatments for HIV/AIDS to consider beginning formal negotiations to enter that pool.
On the G8 and the post-millennium development goals, we will use our influence with the international system to deliver our global commitments. As part of our G8 presidency, we will be reporting on progress against existing commitments and holding members to account. There is definitely a view that we need to finish the job. As exciting as it is to think about post-2015 MDGs, there is still much work to be done on the goals we are in the middle of right now.
Several Members raised the issue of the Why Stop Now? UK blueprint, which is where we slightly part company. Our review of progress on the UK’s position paper will happen in the early part of next year, and it is there that we will make our next decisions based on evidence. We think that just spending a lot of our resources to create another blueprint will be just that—using a lot of our resources—when we basically know what we need to do. We want to get on with working with international partners on implementation, rather than having to stop and bring all our resources back to create another plan. We want to work with stakeholders to ensure a robust and accountable analysis of DFID’s HIV results. We are still discussing the time frame because our review of our position paper needs to align with a number of other international processes. I am aware of the call for a blueprint, but I do not think it is necessarily the way we want to go. I apologise if that disappoints anyone. Indeed, I see the AIDS Consortium sitting in the Public Gallery, and I think I have shown my commitment. My first speech as a Minister was an address to the annual general meeting of the AIDS Consortium, which I have since met to discuss all the issues.
I must be quick, but a number of Members raised the issue of the relationship between HIV and tuberculosis. My right hon. Friend Nick Herbert, whom I used to work with at the Home Office, specifically raised that issue. TB is the leading cause of death for people living with HIV. DFID supports leadership among countries on integrated responses rooted in knowledge of local epidemics, with donor support harmonised in line with national plans to deliver quality integrated HIV, TB and reproductive health services, which was a call across the Chamber.
I acknowledge the two issues raised by my right hon. Friend on the TB REACH programme and on vaccination, both of which I will consider further. At the moment, DFID’s support for TB research includes £205 million to the Global Alliance for TB Drug Development and £14 million to the tropical disease research programme.
Jim Shannon mentioned how condom use and circumcision have helped HIV prevention work in Swaziland and the rest of the world. I thank him for highlighting the challenges in Swaziland, and DFID agrees that a combination prevention approach, including condoms, male circumcision and education, is essential to an effective response.
I also mentioned how pharmaceutical companies in India are able to produce the same anti-HIV drugs more cheaply than companies in America. Without promoting any company over any other, does the Minister agree that, if cheap medication is available in India that is every bit as effective as other medication, we should be sourcing medication from India, given our DFID contribution to countries across the world?
I thank the hon. Gentleman. We have heard the point that he has made so well.
I thank all hon. Members who have spoken, particularly my hon. Friend the Member for Mid Derbyshire, who secured this important debate. It is heartening to see so many Members who genuinely hold HIV as a priority and will pursue the wonderful goal of zero infections.