World AIDS Day 2017

– in Westminster Hall at 4:30 pm on 5th December 2017.

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Photo of Stephen Doughty Stephen Doughty Labour/Co-operative, Cardiff South and Penarth 4:30 pm, 5th December 2017

I beg to move,

That this House
has considered World AIDS Day 2017.

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to see attendance by Members from across the House. I am thankful for the fact that this important debate has been granted because, as we all know, on Friday—1 December—it was World AIDS Day. This World AIDS Day was particularly important to me because it was my first as chair of the all-party parliamentary group on HIV and AIDS. I personally thank, on behalf of the all-party group officers, Mike Freer, who unfortunately cannot be with us today, for all his hard work while he was chair of the group. I also thank those officers who have been able to join us today, and I draw attention to our relevant declarations in the APPG register.

This World AIDS Day was one of many anniversaries. It was the anniversary of Positively UK and the 30th anniversary of the National AIDS Trust. It also marked 30 years since the first UK Government public health campaign on HIV—“Don’t Die of Ignorance”—the famous tombstones adverts for which we must pay credit to the Lords Speaker. He has made an enormous contribution to the HIV cause, both then and over the years since. It was a delight to join him and the Commons Speaker in Westminster Hall last week at the exhibition of the iconic AIDS memorial quilts, which have been placed out for the 30th anniversary. The AIDS Memorial Quilt Conservation Partnership organised the exhibition, and I am sure that many Members have seen it. It was moving to see such a visual display of a deep and personal part of our social history and to meet with family and friends who lost loved ones to AIDS in the 1980s and 1990s. It was also a reminder of how far we have come in tackling the HIV epidemic, in the UK and abroad but, perhaps more importantly, it highlighted that there is still so much further to go. Given that it is a Department for International Development Minister who is responding to the debate, I will focus the majority of my remarks on the international aspect, but I will also touch on a number of issues to do with the UK domestic situation.

Last week, as well as joining with the Terrence Higgins Trust, Positively UK and the memorial quilts organisation, I met some absolutely incredible young people—Davi, Horcelie and Masedi—at the incredibly powerful and personal World AIDS Day event that Youth Stop AIDS held in Parliament. The young people spoke about their experiences in Indonesia, the Congo and southern Africa, and the challenges so many people around the world still face. Hearing their personal stories of how HIV and AIDS have affected their lives and those of their families was very moving and, I am sure Members will agree, it is important for us as parliamentarians to understand how our international policies can directly affect people’s lives. We are truly grateful for their courage to speak out about their status and their experiences.

Before we begin to look at the areas in which more work must be done, I want to highlight some of the excellent progress that has been made to date. Here in the UK, as Public Health England data have shown, this year marks the first time since the epidemic began that new HIV diagnoses have decreased among men who have sex with men—by 18%. That is a real achievement and is testimony to the hard work of Governments of many different types over the years, the HIV sector—including non-governmental organisations and all those who work in our health service—and many other stakeholders who have dedicated their expertise to improving HIV prevention and treatment. Clearly, something is working.

Internationally, huge strides have been made since the beginning of the epidemic, with a 48% decline in deaths from AIDS-related causes, from a peak of 1.9 million in 2005 to 1 million in 2016, thanks largely to the global scale-up of antiretroviral therapy. Having worked with a number of NGOs that work on the epidemic, including World Vision—which the Minister knows well—and Oxfam, and latterly in my time at the Department for International Development and then with Oxfam International, I have seen the epidemic and some of the efforts around it changing over the years, along with some very positive impacts. However, there are still 36.7 million people worldwide living with HIV, 14.5 million of whom do not know their HIV status.

Stigma is still a major barrier to accessing treatment. Even here in the UK, the Terrence Higgins Trust is working hard to get the message through that undetectable equals untransmittable—the U=U campaign—and that is also vital globally. Later in the debate we will talk a little about pre-exposure prophylaxis. PrEP is a game-changing drug that could reverse aspects of the epidemic, but access is a problem, particularly in low and middle-income countries—we have only just seen major trials and major availability in this country. Some 17 million people, or 46% of people living with HIV, are now on antiretroviral treatment and 38% of people are virally suppressed. That means that we are therefore still a long way from reaching the UNAIDS 90-90-90 targets, which are that, by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. UNAIDS has reported that progress on the decline in new infections has, unfortunately, slowed down and that we are now off track for achieving those internationally agreed targets. In 2016, there were 1.8 million new infections worldwide; the target is to reach just 500,000 by 2020.

Although overall new infections among adults have declined since 2010, progress has varied according to region. For example, in eastern and central Europe new infection rates have increased by an alarming 60%, and we have heard very worrying news from Russia this week, where there have been soaring infection and death rates from HIV/AIDS in recent years, as the epidemic has spread from intravenous drug users to the broader population. Russian and global health experts say that that is the result of the authorities’ long-running refusal first to acknowledge the problem and then to back internationally recognised policies to combat it, such as health education, drug substitution programmes and large-scale antiretroviral treatment programmes. That is alongside the suppression we see of the LGBT+ community in Russia and many parts of the former Soviet Union. Figures are merely statistics, however, and unless we look more closely at what they mean for people living in the poorest countries, and some middle-income countries, we do not see the real impact on lives and the devastating effect that HIV and AIDS can still have.

Although here in the UK AIDS-related deaths have been significantly reduced since the terrible days of the 1980s and early-1990s, worldwide, millions of people are still dying from AIDS-related causes. I would like to praise the leadership that DFID has shown on HIV over many years, under many Governments, particularly its recent contribution to the Global Fund. I was delighted to meet the fund’s interim executive director a few weeks ago here in Parliament, with members of relevant APPGs, and I congratulate Peter Sands on his recent appointment to that role.

HIV is treatable and should not result in death, but there are a number of reasons why it still does, and I will try to cover them. HIV is still the leading cause of death for women of reproductive age. According to UNAIDS data, young women aged between 15 and 24 are at particularly high risk of HIV infection, accounting for 20% of new HIV infections among adults globally in 2015. Although the UK Government are clearly committed to improving women’s rights and opportunities there is some concern that HIV is being overlooked in that area, given that there is, for example, no mention of HIV in the recent update of the strategic vision for girls and women. Will the Minister comment on that, and agree that, given the importance of HIV as the leading cause of death for women of reproductive age, he will consider adding in a specific reference to HIV when the strategy is next updated?

The all-party parliamentary group on HIV and AIDS is currently conducting an inquiry into the withdrawal of aid from middle-income countries and its impact on women and girls living with HIV, which we hope will shine some light on this crucial issue. Multilateral aid, such as that given through the Global Fund, is vital, but it is not the only answer. The UK has shown a very significant presence, both in its personnel and its ministerial involvement at international conferences and, crucially, at country level. A presence on the ground through bilateral aid is also crucial, and that is something we have recently discussed with the Global Fund and other organisations. Those bodies require partners on the ground with whom they can work, and we have a proud track record on that, which we do not want to see decline.

Young people are also particularly vulnerable, because they are often denied the information and freedom to make decisions about their sexual health and do not know how to protect themselves from HIV. Therefore, along with women we need to ensure that young people are at the heart of the UK Government’s HIV prevention and treatment strategies globally. Will the Minister tell us what steps he is taking to ensure that young people are at the heart of the agenda? Will he look at DFID’s youth agenda and include specific reference to young people living with HIV and AIDS?

I mentioned earlier that there has been an alarming increase in new HIV infections in eastern and central Europe. One of the key problems—aside from those issues I mentioned about stigma and the lack of commitment to education and treatment—is that some of the middle-income countries, particularly in eastern Europe and the former Soviet Union, are falling through funding gaps. As international aid is pulled out, their Governments are unable or unwilling to provide funding for HIV prevention and treatment services.

DFID’s support of the Robert Carr civil society Networks Fund is crucial in providing the necessary funding for civil society groups in those harder-to-reach places with harder-to-reach populations. We heard about the importance of the work funded by that network in the event with STOPAIDS last week. UNAIDS’s latest report, which was released on World AIDS Day, highlights that outside of eastern and southern Africa, HIV prevalence is highest among men, particularly within key populations, and that they are the least likely to seek treatment. UNAIDS warns that that is a blind spot within the current HIV response. DFID has given £5 million over the past three years to the RCNF. Will the Minister tell the House whether his Department plans to increase that amount to make further progress towards the 90-90-90 target?

While we have seen a significant increase for multilateral funding and the global fund, others are not doing their bit. What discussions has the Minister had with other donors about their responsibilities and their funding for the global fund and bilateral funding? STOPAIDS released an important report looking at UK bilateral funding, which had some worrying statistics. While I absolutely welcome the funding we have seen for the global fund, the RCNF and other things, we have worries in the sector that some of our bilateral funding is perhaps not what it should be. Will the Minister say a little about that and the steps we can take to increase the transparency of DFID’s funding in this area?

DFID is currently using a policy marker to estimate its HIV spend, which essentially means that a programme identified as having a significant HIV outcome is able to automatically attribute 50% of its budget to HIV tracking. The problem with that is that it risks overestimating our contribution in those areas. That might seem like a technical issue, but I am sure the Minister will agree that we need to know how our money is getting results and where it is being used. Currently, there is no way of accurately telling. Will he look at that issue and how we can improve our transparency on that spending?

Another crucial area is access to medicines. In our 2014 report, we highlighted some of the barriers to accessing HIV medicines. Sadly, three years later we are still grappling with some of the same concerns. While the cost of first-line treatment has come down from a high of £7,500 to £75 a person a year, thanks to generic competition and huge civil society pressure, third-line treatment remains prohibitively expensive for people living in low and middle-income countries, and there are still too few paediatric formulations available. Unfortunately, that is one of the downsides of the current system. We have close, frank and regular dialogue with those in the pharmaceutical industry, but we have to find ways of working with the sector to improve access issues.

While many great initiatives already exist—the International Partnership for Microbicides, the International AIDS Vaccine Initiative and various other public-private partnerships, the Medicines Patent Pool, multilaterals such as Unitaid and the Clinton Health Access Initiative and others—there is still more we could be doing to improve the situation. For example, we should ensure that where public funds are used, there are sufficient conditions in place to safeguard public return on research and development investment. Will the Minister say a little about the work his Department is doing to ensure that we have access to medicines for all those who need it? It is important that we continue to invest in vaccines. We need to invest in the prevention technologies that will ultimately be the way to secure a sustainable end to the epidemic.

Those are some of the challenges we face with HIV internationally, but before I conclude I want to reflect briefly on some of the domestic issues. The issues of stigma, discrimination and access to treatment for vulnerable groups apply across the board. I was astounded to read the other day that a YouGov survey found that one in five Britons would be uncomfortable wearing the red ribbon for World AIDS Day because people might think that they have HIV. There should be absolutely no stigma surrounding HIV status. We all need to do our part to ensure that we stamp out that stigma for once and all. I publicly had an HIV test at the Terrence Higgins Trust centre in Cardiff last week. I was proud to share that on social media and encourage others to take a test during national testing week. I thank all Members, including those here today, who have worn their ribbons in the past few weeks and who have been along to take tests.

I pay particular tribute to His Royal Highness Prince Harry and his new fiancée Meghan Markle for the part they have played by making one of their first public engagements going along to a THT centre. His Royal Highness took a test last year, and I understand that that increased testing rates significantly. As an all-party group, we were delighted to meet him recently and discuss his passion for and commitment to the cause. I am sure we all applaud that work.

Photo of Catherine McKinnell Catherine McKinnell Labour, Newcastle upon Tyne North

Before my hon. Friend finishes his excellent and timely speech, I commend him on securing the debate and apologise that I am not wearing my red ribbon, although I am wearing my sustainable development goal badge. “This ain’t over”—those are the words of the pledge we have all made to recommit our energies to ending AIDS/HIV by 2030, but we will not achieve that goal unless we are committed politically and financially to ensuring that it becomes a reality.

Photo of Stephen Doughty Stephen Doughty Labour/Co-operative, Cardiff South and Penarth

I absolutely agree with my hon. Friend. “It ain’t over” was the central message from STOPAIDS when we met last week. We need to get that message out there loud and clear. The challenge has not gone away, although we have seen much progress.

On the domestic front, I want to mention two issues. I would be grateful if the Minister reflected on them and perhaps discussed them with his colleagues in the Department of Health. First, we have seen the fragmentation of services. The all-party group published a report last year called “The HIV Puzzle”. It looked at some of the fragmentation of services in England since the Health and Social Care Act 2012 and some of the resulting challenges for people in accessing treatment and prevention services locally. Some worrying statistics are coming out about treatment availability in some areas. Secondly, while we welcome the trial of pre-exposure prophylaxis in England and the announcement in Wales and Scotland, in England PrEP will be available to only 10,000 people over three years. What will happen when we reach 10,000? Will we suddenly stop making PrEP available? Surely that cannot be the case. The many organisations that campaign for PrEP want to see it available to all those who need it.

I conclude by thanking all the Members who have come here today to support the debate on World AIDS Day 2017. We will never forget the millions of lives lost to AIDS, and we will continue to fight in their name for HIV and AIDS to become a thing of the past.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

This is an hour-long debate that will finish at 5.30 pm. Six Members are seeking to speak. I am obliged to call the first of the Front-Bench spokesmen at seven minutes past 5. There are guideline limits of five minutes for the Scottish National party, five minutes for Her Majesty’s Opposition and 10 minutes for the Minister, with three minutes for Mr Doughty to sum up the debate at the end. [Interruption.] Mr Doughty is generously declining to have the full three minutes, but he will perhaps take a minute or so. I am afraid there will have to be a time limit of three minutes so that everyone has a chance to contribute. The next speaker will be Ross Thomson.

Photo of Ross Thomson Ross Thomson Conservative, Aberdeen South 4:47 pm, 5th December 2017

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank Stephen Doughty for securing this important debate. Last Friday was World AIDS Day, and I was pleased that the day was commemorated by MPs across the House donning the red ribbon. It is a symbol of solidarity with the almost 37 million people globally living with HIV/AIDS and the millions who die every single year from HIV-related illnesses. It is one of the most destructive pandemics that has not yet been eradicated.

Since the 1980s we have come a long way in tackling HIV and AIDS, as well as the stigma surrounding the issue. We are so close to getting to zero new infections, an achievement of which we would all be proud. However, stigma still stands in the way of reaching that target. We must tackle discrimination around HIV wherever it occurs—ignorance and isolation limit the opportunities for those with a diagnosis.

Across Scotland and the United Kingdom, buildings were lit up in red to mark World AIDS Day. In Aberdeen, the granite from Marischal College to King’s College glowed red to remind us of the work that is still left to do. In Scotland, more than 5,000 people are living with HIV. That figure has doubled since 2001. The figure is far too high and is growing far too fast. Knowledge is a powerful tool, and information liberates us from our current ignorance. Education is vital to progress and is key to tackling the growing figure. Some 79% of young people believe that pupils should have access to up-to-date and effective sexual health education, yet three in five pupils in Scotland do not remember receiving any HIV information in school. With two young people diagnosed with HIV every month, that is not acceptable.

Globally, we are moving in the right direction, as in 2016 there were 300,000 fewer cases than in 2015. Breakthroughs in scientific research have meant that an HIV diagnosis is not a death sentence, and that it does not have to be passed on. Those with a diagnosis are our colleagues, friends, partners, children and neighbours. They lead lives that in the 1980s would not have been thought possible. Such people are a living testament to how far we have come.

We all have a part to play in eliminating HIV-related stigma. Eliminating AIDS and having an AIDS-free generation is within our grasp, if we continue to reach for the goals that we have set. We have fought AIDS and now must work to eradicate the pandemic.

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall 4:50 pm, 5th December 2017

I am grateful for the opportunity to speak in this important debate, and congratulate my hon. Friend Stephen Doughty on securing it. Earlier this year, on 20 April, I led a debate in the Chamber on tackling infectious diseases. It was a wide-ranging and well-attended debate, with interest from across the House. A lot has happened since then, however—not least the snap election, and the appointment of a new Minister covering health at the Department for International Development and a new Secretary of State.

In three minutes, I will try to cover two or three areas very quickly. I am the co-chair of the all-party parliamentary group on global tuberculosis. Hon. Members may not be aware of this, but in recent years TB overtook AIDS as the world’s leading infectious killer. What is worse is that TB is the leading killer of people living with HIV/AIDS. Together the diseases form a lethal combination, each speeding the other’s progress. In 2016, TB was responsible for almost 40% of all AIDS-related deaths.

Next year, the UN will convene its first ever high-level meeting on TB. I urge the Minister to ensure that DFID engages fully in that process, and presses for global agreement and investments to end the deadly duo. Last year, I welcomed the Government’s increased commitment to the global fund. Its investments do great things; it has been at the forefront of tackling co-infection and is on course to save another 8 million lives over the next couple of years.

When DFID’s HIV strategy lapsed in 2015, it was not renewed. Without a strategy to guide DFID’s work, it is little wonder that there are gaps in its financial and programmatic commitments. Ministers have dismissed calls to renew DFID’s strategy, but I urge the new Minister to reconsider, so that we can have a strategy in operation in the coming years.

Will the Minister outline what his Department is doing to ensure that we develop the tools we need to end the epidemic? On balance, much progress has been made, but as the STOPAIDS campaign says, “It ain’t over” yet. There are many challenges, but there are also opportunities, and we must seize them.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 4:53 pm, 5th December 2017

I congratulate Stephen Doughty on such a great presentation of the issues.

Every year, I run a dinner for my association and invite an MP from this place to come across for it. It is an occasion to raise a bit of money, but the great thing is that half of the monies raised through that dinner go to Eden Mission, which has a charitable orphanage in Swaziland. Swaziland is a little country with about the same population as Northern Ireland. The people, like my constituents, are warm, friendly and ever so helpful, but unlike my constituents, almost one in every two of them has AIDS. The epidemic has resulted in a lost generation, with grandparents raising their grandchildren on a massive scale, as the middle generation is dying of AIDS. Every year, the Eden church in my constituency brings over a choir of children, and this year managed to raise some £50,000 for that orphanage and for other projects that Eden Mission has in Africa as well. Those children are still children, but some of them, through no fault of their own, are ill with AIDS. With a healthy diet and medication, AIDS is no longer the death sentence it once was, as the hon. Gentleman said very clearly when introducing the debate.

It is always nice for the children to come and sing in my office, in return for the small part I play in fundraising to allow them access to life-saving drugs. I am proud to wear a red ribbon today as a homage to that lovely choir and the many people throughout the globe who have AIDS. I am very proud to wear that ribbon, like other hon. Members here today. However, looking at home, more people are now diagnosed with AIDS in Northern Ireland than ever before. The figures came out just last week—more than 1,050 people. We are above the norm in the United Kingdom, and that is just the over 50s. Again, just to put a marker down, we look across to Swaziland, other African countries and elsewhere, but perhaps we also have to look at what is happening a wee bit closer to home.

We also have to look at how we deal with this matter in schools. We probably all had to go through an uncomfortable sex education class at some stage; it has to be done. Let us understand it better, and do it better in schools. We should preach the importance of safe sex.

Furthermore, as all of us in this Chamber know, the spread of HIV/AIDS is not simply down to unsafe sex. It can happen through blood transfusions or something as simple but deadly as someone not knowing that they have AIDS and therefore not being careful about the spread of bloods from cuts. It has been transmitted to those who are hooked on drugs and share needles. Babies are at risk of getting it from their parent, yet there are measures that can be taken during delivery to help mitigate the risks if the condition is known about, so there have been massive advances.

It is always very hard for us fit all the things we want to say into just three minutes, but I conclude with this: we cannot and must not pigeon-hole this disease, but equally we cannot and must not ignore the uncomfortable truths that may prevent more people from unknowingly getting HIV. We must address the issue head on, and do what we can to stop the spread and to educate people of all ages, races and genders.

Photo of Stuart McDonald Stuart McDonald Shadow SNP Spokesperson (Immigration, Asylum and Border Control) 4:56 pm, 5th December 2017

It is a pleasure to see you in the Chair, Mr Hollobone. I congratulate Stephen Doughty not only on introducing the debate, but on his speech and his ongoing work with the all-party parliamentary group.

It is extraordinary to believe that with political will we could achieve the sustainable development goal of ending the AIDS epidemic, to all intents and purposes, by 2030. As others have said, however, and as the recent campaign has highlighted, “It ain’t over”. Success is a long way from being a certainty. Indeed, to get close we will all need to up our game, as it seems that the 2020 interim target is likely to be missed. As the statistics cited by the hon. Gentleman illustrate, the scale of the progress gives us grounds for optimism, but the scale of the remaining challenge is formidable.

Some key obstacles are pretty predictable in the context of international development. One is, of course, money, with the Joint United Nations Programme on HIV/AIDS predicting that a $7 billion annual funding gap needs to be filled by 2020 if we are to get back on course. In fact, we seem to be going in the wrong direction. A second obstacle, which other hon. Members have highlighted, is attitudes. Epidemics will flourish where fear and prejudice stop people receiving the services that they need to live healthy and productive lives. Horrifyingly, there remain HIV criminalisation laws in no fewer than 72 countries.

Now more than ever we need a detailed strategy, and careful and generous funding—so where is the UK in all this? Undoubtedly, the UK has an immensely strong track record, and has been a world leader, particularly through its founding role and contributions to the global fund. However, there are genuine concerns that it has been losing its relentless focus and leadership role, so it is welcome that this debate has provided an opportunity to air those concerns.

There have been concerns about a decline in funding for certain HIV and AIDS projects, including cuts to direct funding for civil society organisations, which are so important in overcoming stigma and prejudice. There has been an overall shift away from bilateral programmes and HIV-specific projects. I accept that the Government will offer justification for that, which does have some reason behind it. Moving disease-specific programmes into wider sexual health or health and development programmes can, if done well, be more effective and sustainable. However, done badly it can undermine the work towards the goal. For example, among the clear challenges of such an approach is the problem of assessing exactly how much we are spending and what impact it is having. The hon. Member for Cardiff South and Penarth highlighted the example of the HIV policy marker, which seems rather opaque.

Over the last couple of years, as other Members have said, we have been without specific position papers or strategies to help assess priorities and the UK’s impact. Finally, there is a concern about a lack of ministerial presence and leadership at international meetings and summits.

There is no doubt that what DFID seeks to do is good and welcome—supporting country-led and integrated responses that meet the holistic needs of target populations—so why not say that loudly and boldly with a strategy? At the very least, be more explicit about HIV and AIDS policy goals in frameworks. Why not make funding more transparent, and the assessment of progress towards clear goals more robust? Why not once again play a robust, outspoken leadership role? The opportunity is there to meet the 2030 goal, and for the UK to be pivotal to that achievement. Let us grasp that opportunity.

Photo of Paul Williams Paul Williams Labour, Stockton South 4:59 pm, 5th December 2017

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend Stephen Doughty on securing this debate.

Ten years ago on World AIDS Day, I was leading an HIV/AIDS programme on the edge of the Bwindi Impenetrable Forest on the border of Uganda and the Democratic Republic of the Congo. I started the clinic out of a shipping container, supported by a team of local health workers. It was baking hot and packed full of people desperate for care, in a place where all most people knew about HIV was encapsulated by the name that they used—akakoko ka silimu, translated as “the little insects that make you lose weight”. I saw too many people who did not know what was happening to them until they started coughing up blood from HIV or gave birth to a child who mysteriously died a few months later.

Within a couple of years, more than 2,000 people were getting treatment. Mother-to-child transmission had dropped from 30% to 1%. Every school child understood the basics about HIV and stigma was lifted by brave people, who were proudly positive. Yes, it was the drugs, and huge credit must go to President George Bush and the President’s Emergency Plan for AIDS Relief for making massive financial contributions at the right time to HIV/AIDS care but, more importantly, it was about the health system and the people delivering care.

In a part of the world where, on any given day, half of all health workers in Government facilities are absent, and where drug supplies rarely find their way to the front line, it is a huge leadership challenge to have happy, paid and competent health workers in the same place as needy patients, and with the drugs they need to help them.

I contacted a friend working in the field in Africa over the weekend. She told me that we are still a long way off where we need to be. She said that men are still not coming forward to test, that

“we don’t have enough drugs for everyone and are challenged by low stocks of ARVs” and that adherence to treatment regimes is still a challenge. With the end of the HIV epidemic within our sights, now is not the time to disinvest—but disinvestment is exactly what we are starting to see, with a decline in funding between 2012 and 2015, from £416 million a year to £324 million a year, and a massive drop in funding for civil society organisations through the Robert Carr civil society Networks Fund.

I have two asks of the Minister. First, it would be really helpful to understand what the Department for International Development’s HIV/AIDS strategy is. We are currently investing more than £300 million a year of public money into HIV/AIDS, but without seeing that strategy, it is hard to communicate priorities or measure impact.

My second request is for reconsideration of the amount of financial investment. In many ways, the 20 million people currently on treatment, who were referred to by my hon. Friend the Member for Cardiff South and Penarth, are the easiest-to-reach people. In health care, we need to spend more, not less, to reach the most disadvantaged. There are still 15 million people who either do not know their status or are not on treatment. In order to reach them, we need to invest more to engage them. If we do reach them, we have the potential for an amazing prize—the end of HIV as a global public health problem.

Photo of Martin Whitfield Martin Whitfield Labour, East Lothian 5:02 pm, 5th December 2017

It is an honour to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend Stephen Doughty on securing this debate.

Members will be aware of the importance of the global fund, and I want to pay tribute to the important work the fund does in the diagnosis and treatment of HIV. It is clear today that without a supply of new medical tools, we are not going to meet our global goals promise to give young people the opportunity of a future free from AIDS.

In 2009 a trial showed for the first time that the risk of HIV infection can be reduced by a vaccine, and improved vaccine concepts are now entering new efficacy trials. There is no doubt that vaccine development is a long process, but vaccines are proven to be one of the most effective and cost-effective public health tools. With that in mind, I wish to pose two questions to the Minister about UK scientific innovation.

The Government recently published their industrial strategy, which placed life sciences at its centre. Will the Minister make representations to his counterparts in the Department for Business, Energy and Industrial Strategy about the need for research and development for new HIV prevention tools to be part of that?

There has been little, if any, discussion about how the industrial strategy will offset the uncertainties for UK science created by Brexit. In recent years, the European Commission has overtaken the UK to become the second-largest funder of global health research and development after the US, with many UK scientists benefiting from the pooled funding and collaboration. Will the Minister reassure UK scientists about what the future will hold?

I asked the Minister a question last week. I was grateful for his answer and for the correction yesterday to that answer for accuracy. HIV is still the greatest health challenge of our time. Although it does not quite command front-page attention any more, it must not be put to the back of the Government’s and people’s minds. Investment in research and development will keep the fight against this challenge alive.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

We now come to the Front-Bench speeches, the first of which will be Chris Law from the Scottish National party.

Photo of Chris Law Chris Law Shadow SNP Spokesperson (International Development), Shadow SNP Spokesperson (Climate Justice) 5:05 pm, 5th December 2017

It is a pleasure to speak under your chairmanship, Mr Hollobone. I thank Stephen Doughty for bringing this important and timely debate and for his continuing work with the all-party parliamentary group.

This debate is an opportunity to reflect on the estimated 35 million people who have died from AIDS-related illnesses and to show solidarity with the millions of people living with HIV worldwide today. It is an honour to wear a red ribbon in solidarity with all of those people. However, for many of them, stigma remains a problem. Stigma leaves people feeling ostracised and experiencing poor mental health and social outcomes. Stigma is also one of the biggest barriers to testing and treatment, and fear of a HIV-positive diagnosis discourages individuals from getting tested and engaging with health services. For some, stigma means living in perpetual fear of their HIV status being revealed to those with whom they live, work and spend time.

As my hon. Friend Stuart C. McDonald said earlier, in Scotland last week the First Minister took an HIV test, which gives instant results, as part of efforts to reduce the stigma surrounding the disease. Not only that but voluntary sector bodies, along with people living with the condition, joined together to unveil a new action plan in Scotland ahead of World AIDS Day. The anti-stigma strategy “Road Map to Zero” set out how organisations such as the National AIDS Trust, the Terence Higgins Trust, HIV Scotland and others will continue to work with the Scottish Government and others to end HIV-related stigma.

We should all take pride in the fact that Scotland is a leader in HIV policy. It was the first nation in the UK to make PrEP available on the NHS and I pay tribute today to the campaigners who worked tirelessly for that to happen. PrEP is making a huge difference to the lives of many people in Scotland and I hope the UK will follow in Scotland’s footsteps.

At an international level, incredible achievements have been made in the global response to HIV. Some may argue that the worst is behind us, but sadly HIV is still a death sentence for many people across the globe. Sub-Saharan Africa remains most severely affected, with nearly one in every 25 adults living with HIV.

One of the UN’s sustainable development goals is to end AIDS by 2030. To reach that target, significant work still needs to be done. There are signs that the HIV response is beginning to stall. Key challenges remain. One is that the level of new infections each year is still too high. Only last week, the World Health Organisation highlighted the fact that the number of new infections in Europe is growing at an “alarming rate”. In central Asia, infections have increased by more than half since 2010. Key populations, for example, men who have sex with men, transgender people, people who use drugs and sex workers, are disproportionately affected by HIV. A further challenge is the high price of intellectual property and drug prices, which remain a barrier for HIV patients’ access to medicine. UNAIDS predicts we would need an additional $7 billion annually to respond to the global HIV challenge. However, total DFID HIV funding decreased by 22% between 2012 and 2015, and the Department’s last strategy on HIV expired more than two years ago. It has no plans to renew it.

Without a strategy, DFID has no way to set and communicate priorities or measure impact. I would therefore urge the Minister to increase overall levels of UK funding for the global HIV response, in line with UNAIDS recommendations, and to formalise and make public its approach to HIV. With current tools, we can hope to control the epidemic, but as the Gates Foundation has highlighted, to make headway towards ending it, we must bring down the number of new infections at a much faster rate. That will require new and better prevention technologies, such as an effective vaccine.

The Minister noted during last week’s DFID questions that the UK has been a long-standing supporter of the International AIDS Vaccine Initiative. We all agree about that, but it now needs action. The Government must increase research and development so that we have the necessary tools for the future.

We want to live in communities that have positive and non-stigmatising attitudes towards people who are affected by HIV. World AIDS Day and debates in Parliament help us to share that goal. Ultimately, World AIDS Day reminds the public, and MPs, that HIV has not gone away. Great scientific and medical progress has been made. As others have mentioned, treatment is dramatically more effective, and many more people are living long and healthy lives. At least that is the case in wealthy countries; it is not everywhere. The UK must show leadership in the global response to HIV and AIDS.

Photo of Roberta Blackman-Woods Roberta Blackman-Woods Shadow Minister (International Development) 5:09 pm, 5th December 2017

It is a pleasure to serve under your chairmanship again, Mr Hollobone. I pay tribute to my hon. Friend Stephen Doughty for securing this important debate. As we all know, World AIDS Day was last Friday. I am glad that this debate has given Parliament an opportunity to reaffirm its commitment to tackling HIV and AIDS, both at home and abroad, which was evidenced by the large number of parliamentarians and others wearing red ribbons last week. I hope that that demonstrates our solidarity with those suffering from AIDS and our determination to bring it to an end. It was good to see town halls and other buildings around the country lit up in red last week—that was certainly the case for the town hall in my constituency. Again, that was evidence of our desire to do something about AIDS.

There has been progress on this issue globally. For the first time ever, more than half of the people living with HIV are receiving life-saving treatment. New HIV infections in 2013 were 38% lower than in 2001, and new HIV infections among children have declined by 58% since 2001. We should welcome that decline. Nevertheless, in 2016, there were 1.8 million new HIV infections worldwide, which is 1.8 million too many. That represents more than 2,700 deaths from HIV every day.

As my hon. Friend said, 36.7 million people live with AIDS globally, 69% of whom live in sub-Saharan Africa. Sustainable development goal 3, on good health and wellbeing, has a target of ending the AIDS epidemic by 2030. Despite some progress towards that goal, however, STOPAIDS has estimated that there is a funding gap of $7 billion, which needs to be filled to reach that target by 2030, and the US’s global gag rule will lead to a further decline in HIV funding.

I will ask the Minister later about what he intends to do about the funding gap, but in passing I note that women remain more vulnerable than men. In sub-Saharan Africa, which has the highest rates of HIV infections in the world, there are three new infections among adolescent girls for every one among adolescent boys. Of course, HIV has a disproportionate impact on marginalised groups, especially in middle-income countries. That is further evidence of the systemic inequality that underpins our societies globally, which plays out particularly in terms of health services, information, education and economic opportunities, which are simply not attainable for many people.

I recognise that the Government have made much progress, but there are some issues I would like the Minister to address. Although the UK remains the second-largest donor to the global HIV response, it is concerning that total DFID funding for HIV/AIDS declined by 22% between 2012 and 2015. Although the UK has increased funding through multilateral institutions such as the global fund, that has not made up for the sharp decline in funding for DFID country office programmes, which fell from £221 million in 2009 to £23 million in 2015. There has been a decline in DFID funding for civil society organisations, which do such important work on the ground to tackle AIDS and HIV. We should pay tribute to them and ensure that their work is funded properly. Does the Minister intend to stop that reduction in funding and to fund those organisations properly?

Other hon. Members said that HIV and AIDS work is absent from the UK AIDS strategy. Does the Minister have plans to rectify that and bring forward a new strategy? Political leadership is important. DFID has not always been represented at international AIDS conferences. Does the Minister plan to ensure that we have a young representative attending those conferences? I want to finish by thanking my hon. Friends for their excellent contributions to this debate.

Photo of Alistair Burt Alistair Burt Minister of State (Department for International Development) (Jointly with the Foreign and Commonwealth Office), Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development) 5:15 pm, 5th December 2017

It is, as always, a pleasure to serve under your chairmanship, Mr Hollobone. I thank Stephen Doughty for securing this important debate to commemorate World AIDS Day. I thank all hon. Members who contributed; this subject unites everyone in the House, including my hon. Friend Ross Thomson, the hon. Members for Ealing, Southall (Mr Sharma), for Strangford (Jim Shannon), for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), for Stockton South (Dr Williams) and for East Lothian (Martin Whitfield), and the two Front-Bench spokesmen, the hon. Members for Dundee West (Chris Law) and for City of Durham (Dr Blackman-Woods). They asked a range of questions. In the time available to me, I will not be able to cover them all, but in the time-honoured way, my Parliamentary Private Secretary has very kindly got a note of everyone who is here, so I will cover the questions I do not answer by way of letter. I will make sure the answers get out there.

This is an opportunity for colleagues to reflect on where we have got to. I am grateful to the hon. Member for Cardiff South and Penarth for mentioning the Lord Speaker, who did so much when he had the opportunity to do so, and the haunting quilt. It was particularly noticeable when there was the odd square of anonymity because somebody still did not want to reveal something. I think of the pain behind that expression, of what people have been through in the past, and of what some people still go through. The fact that they are unable to talk about it, when for many of us it has become much easier to deal with and talk about, is a measure of the pain behind some of those issues.

None of us has the experience of the hon. Member for Stockton South. We all noted his work in Uganda, where he used his commendable skills in the best possible way. I still remember visiting AIDS orphans in South Africa with my daughter at a time when it was very clear that the babies could not be kept at home because of the shame and stigma attached to the disease, so they were just dispatched. I remember thinking that the nurses looking after them were making an extraordinary contribution. The afternoon that we saw them, my daughter and I said we did not know what we could do in life that would possibly be as valuable as the love that those people demonstrated towards those children. That was 20-odd years ago. Time has moved on and we are doing so much more.

Let me reflect a little on the progress that has been made, which colleagues mentioned, and then answer some of the tougher questions that come the way of a Minister. It is all part of the day job, even for an issue on which we are all broadly moving in the same direction. I commend the hon. Member for Cardiff South and Penarth for his speech, and the work of the all-party parliamentary group on HIV and AIDS, which has achieved so much over the years. I thank him for advance sight of the questions in his speech. It was much appreciated.

We have come a long way since the first ever World AIDS day in 1988. We now have 20 million people with access to potentially life-saving HIV treatment—a big improvement on the year 2000, when less than 1% of those in need had access. We can be very proud that the number of new infections in children has also dramatically declined. It is important to put on the record the UK’s contribution to those achievements. Colleagues have been generous about that, and of course it covers Governments of all persuasions. The UK continues to play its role. We are proud to be the second-largest international funder of HIV prevention treatment and care. That work is impossible without our partners, through which we invest. Our contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria helped to provide more than 11 million people with antiretroviral therapy by the end of 2016. Our significant pledge of £1.1 billion to the fifth replenishment of the global fund will now help provide enough life-saving antiretroviral therapy for 1.3 million people living with HIV.

Our investments in research and support to Unitaid help improve access to medicines, diagnostics and prevention for those affected by HIV in low-income countries by bringing promising new health technologies to scale faster and more cheaply. The hon. Member for East Lothian was right to raise the importance of carrying on with such research. We must also recognise UNAIDS for its continued leadership of the global HIV response, for pushing for ambitious global targets to stop new infections and to ensure everyone living with HIV has access to treatment, for protecting and promoting human rights, and for producing the data we need for decision making.

Civil society with its links to communities and people living with HIV also has a critical role to play in leading the social movement for prevention, championing the rights of the most at-risk populations and those living with HIV, providing care and support services to communities that others are simply unable to provide, and—vitally—holding Governments to account.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

In our contributions, some of us have recognised the good work of Churches and missions across the seas and at home. For the record, does the Minister too recognise the importance of their input physically, financially and emotionally into making the changes?

Photo of Alistair Burt Alistair Burt Minister of State (Department for International Development) (Jointly with the Foreign and Commonwealth Office), Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development)

I do. The hon. Gentleman’s connections with Churches and Church movements not only in this country but worldwide are well known. Absolutely, that is an important point to put on the record because to some extent it sets the record straight about the commitment of the Church and Christian communities to this particular sort of work, which is important. In some parts of the world, only the Church network is there to provide social care across the board. We would all be the poorer without being able to support that.

Mention was made of the Robert Carr civil society Networks Fund, of which we are proud to be a founding member. I cannot give a further commitment at this stage—we are yet to announce it—but I recognise the issue and we will come back to say what the future funding position will be in due course. I have noted what colleagues have said.

There is also greater shared responsibility from low and middle-income countries. Domestic resources constituted 57% of the total resources for HIV in low and middle-income countries, which is a step in the right direction, but more needs to happen to build a sustained response. As good as that is, as all colleagues have said, there is much more to do, so let me deal with some of the questions I was asked.

In terms of the broad strategy, the UK’s ongoing HIV commitment is that we want to see AIDS ended as a public health threat by 2030. That is an important priority for us. We are proud to be the second-largest international funder of HIV prevention, treatment and care, as I have said, and as a leading donor we will use our influence to ensure that we collectively deliver on the global commitment—to end the AIDS epidemic as a public health threat by 2030—and that no one is left behind.

In relation to the gag, we will continue to show global health leadership by promoting and supporting comprehensive, evidence-based sexual and reproductive health and rights. We are the second largest donor for family planning assistance and we are the largest donor to UNFPA, the United Nations Population Fund, so we will skirt around issues raised by the gag.

On a new HIV strategy, the note I have states that the 2013 review of the UK position paper on zero infections identified the integration of HIV as the key strategic priority. We intend to continue that approach, rather than to develop a stand-alone strategy or conduct a further review. However, I have heard what the House has said, so let me reflect a little on that, as I will on the Youth Agenda point—whether HIV is included. It is not currently. Clearly, the Youth Agenda is a very important part of our strategy and we recognise, as all in the Chamber do, the significance of adolescent girls in particular and the related issues. Again, let me have a look at that to see whether we can say anything further about it. I will come back to colleagues in due course.

For women and girls generally, it was right to recognise the heightened risk. Empowerment of women and girls lies at the heart of our development agenda. DFID is supporting the generation of new evidence to improve outcomes for women and girls, including the development of female-initiated HIV prevention technologies, research into how gender inequality drives epidemics, and a particular focus on improving what works for adolescent girls in southern Africa.

The UK is also working with the global fund to increase its focus on girls and women, which I think is in accordance with the House’s wishes. Giving greater attention to women and girls is a shared priority for us and the global fund. With UK support, the global fund has embraced gender equality as being central to accomplishing its mission of ending the three diseases as epidemics, including it as one of its four strategic objectives in the 2017 to 2022 strategy. Between 55% and 60% of global fund spending directly benefits women and girls. That includes programmes to prevent gender-based violence and to provide post-violence services. The number of HIV-positive women since 2002 who have received services to prevent transmission of HIV to unborn children has reached 3.6 million, and we will continue to press on that.

Photo of Stephen Doughty Stephen Doughty Labour/Co-operative, Cardiff South and Penarth

I welcome what the Minister has said about looking again at the issue of a strategy and, in particular, the situation with young people and women and girls. We have obviously got the Commonwealth Heads of Government meeting here next year. I suggest gently to the Minister that it would be very helpful to have a strong statement setting out the UK’s views on HIV and AIDS in those communities while we have the Commonwealth Heads in this country.

Photo of Alistair Burt Alistair Burt Minister of State (Department for International Development) (Jointly with the Foreign and Commonwealth Office), Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development)

It is a competitive field to get things on the agenda for the Commonwealth Heads of Government summit. I know that health will play a leading part, but the details have not yet been sorted. As would be expected, concerns about HIV/AIDS are certainly well up there and an announcement will be made in due course.

The UK Government will, however, be represented at the international AIDS conference in Amsterdam in July. Precise attendance is still to be finalised, but that depends on my diary and whether we can fit it in. I would really like to go because I think that is what colleagues would wish.

Turning to finance—on which I will write further—there are two issues. On the STOPAIDS suggestion of a 22% cut, our response is that the report gives a snapshot of the figures in a given year and does not always reflect everything that is going on as programmes come to an end and others start. It also does not reflect our huge multi-year global fund contribution. The timing of disbursements partly accounts for the difference in spend between years, but committing £2.4 billion since 2010 to multilateral funds is substantial.

The other issue was integrating the funds and the tracking. DFID uses an HIV policy objective marker to track spending on HIV within broader programming. The system ensures that programmes address a range of developmental priorities, such as health-systems strengthening, governance, social protection and sexual, reproductive and health rights. I take the point that it is difficult to track, but it is important that we put the funds into integrated services, as well as spending them directly.

There are the technical challenges of tracking, so let me take that away as well—not necessarily to change it, but to see what might be done better to give more transparency. We will keep the process of integrating the funds going. It is right and proper to do so, along with the other commitments that we make. With that, let me sit down to allow the hon. Member for Cardiff South a couple of minutes to sum up.

Photo of Stephen Doughty Stephen Doughty Labour/Co-operative, Cardiff South and Penarth 5:28 pm, 5th December 2017

I thank all the Members who have taken part today, and in particular the Minister for his encouraging response on a series of issues. I am delighted to hear that he is thinking of attending the international AIDS conference in Amsterdam. The signal sent out by ministerial and official attendance at such forums is crucial, particularly given the very strong leadership role that the UK has played over many years. When people do not see us at those conferences and events, they wonder what is going on, so what the Minister said is really heartening.

I also welcome the Minister’s willingness to go away and look at some of the issues we have raised on strategy and on funding and its tracking. I know that those things are sometimes not easy, but given the nature of HIV and AIDS, and other issues such as TB, for example, it is important to understand what funding is going towards those epidemics and how it is being spent, so that we can all hold the Government to account. In some cases, it is also important for the Government to show how they are providing leadership to other countries and international organisations.

Clearly, there is much unity across the House on the importance of keeping this issue on the agenda and of us all continuing to play our part in ensuring that we tackle the HIV/AIDS epidemic in this country and globally. The message is very clear that this is not over. We need to keep the issue on the agenda, and we will all our play our part in doing so.

Question put and agreed to.

Resolved,

That this House
has considered World AIDS Day 2017.

Sitting adjourned.