The Parliamentary Under-Secretary of State for International Development (Ms Sally Keeble): Botswana is one of Africa's economic success stories, with a per capita gross domestic product of US$3,070. However, it is also the country most badly affected by HIV in the world, with 38.8 per cent. of adults infected. The Government have launched a national anti-retroviral programme with $100 million assistance from Merck and the Gates Foundation. My Department is supporting the national response as part of a regional HIV/AIDS programme. It includes support for the management of sexually transmitted infections, access to condoms, promoting behaviour change, and supporting non- governmental organisations including the Soul City media programme.
Mr. Prentice: That is encouraging news. When I was in Botswana last year, the Health Minister showed me sex education material that was being provided for schools. It was incredibly explicitreally "in your face" stuff. Yet, as my hon. Friend said, nearly 40 per cent. of the adult population are infected and life expectancy is now below 40. If that is happening in Botswana, which is a well-run, well-governed, relatively rich country, what is the prognosis for other countries in southern Africa where an AIDS pandemic is wiping out whole populations?
Mrs. Caroline Spelman (Meriden): I am sure that the Minister, like me, was shocked to note the collapse in life expectancy tounless I am much mistaken27.9 years in Botswana. A United Nations report predicts that up to 70 million people may die of the disease. Does she agree that at a time like this it is morally suspect that Britain recruits thousands of African nurses, including 100 from Botswana last year?
Of course the recruitment of professionals is a problem if there is a drain and they all come here, but there is also a much bigger issue. HIV/AIDS is affecting professionals disproportionately in Africa, including both teachers and health workers.
A recent conference considered the way in which HIV/AIDS affects teachers. Teachers in southern Africa said that while there were problems over recruitment, they did not want their freedom of movement to be curtailed because they come from countries with a high incidence of HIV.
Chris McCafferty (Calder Valley): Will my hon. Friend join me in congratulating the United Nations Fund for Population Activities on its excellent work on HIV/AIDS prevention and reproductive rights throughout the world? Should we not regret President Bush's disgraceful decision yesterday to end its funding?
My hon. Friend is well aware of the report of the recent visit of Members of Parliament to China to observe the UNFPA's work there. Is she also aware of the subsequent visit and report of a Bush Administration team? Is she aware that both reports conclude
Mrs. Spelman: As the Minister has said, it is a hard fact that the levels of replacement of training for the professional classes are not keeping pace with the pandemic. It is also a hard fact that a teacher in a country such as Botswana would have to spend most of his or her salary to purchase anti-retroviral drugs, even at the subsidised rate. Does the Secretary of State support our call for the global health fund to be focused on the provision of free anti-retrovirals, especially for pregnant women to prevent maternal transmission?
Ms Keeble: Botswana has made the decision to provide access to anti-retroviral drugs, but it can do so for two reasons: it has the money and it has the health system. Some countries do not. The Government support
The Secretary of State for International Development (Clare Short): HIV/AIDS is deepening poverty in Africa and undermining development. It causes great human suffering and loss of life but also has deeply destructive economic effects due to loss of life and skills among the economically active generation and leaving elders and children unsupported.
My Department committed £180 million in HIV and sexual health programmes in Africa last year. We also made significant contributions to the global health fund, which provides commodities for the treatment of HIV, tuberculosis and Malaria. We are supporting programmes to develop a vaccine and microbicide. Our work focuses on prevention, treatment and care.
Dr. Lewis: The Secretary of State's record in trying to combat this catastrophe is second to none. Does she agree that even if there were unlimited quantities of anti-retroviral drugs, all the problems of expense were solved and they could be supplied free of charge in unlimited quantities, the main problem that Africa would still face would be distribution to the people who need them? What practical steps is she proposing to take to engage non-governmental organisations, international organisations and any other agencies in building an effective distribution system for those vital drugs?
Clare Short: I agree with the hon. Gentleman, except on one pointI do not agree that the provision of anti-retrovirals is the most important thingthe most important thing is prevention. Uganda needs to happen across Africa; its prevalence rate decreased from 35 per cent. to 5 per cent. That is a great achievement. Every country in Africa and, indeed, China and India need to achieve what has been achieved in Uganda.
On the availability of anti-retrovirals, obviously people are morally entitled to them, but even at cost price they are very expensive. As the hon. Gentleman says, distribution systems are not in place so even if the drugs were free most people in Africa would not get them. They would need regular treatment, good food and a good quality of life because they are very toxic drugs.
UNAIDS has a system whereby reduced price anti-retrovirals provided by the drug companies can be made available to countries. UNAIDS helps countries to make use of that provision; 13 have done so. We are busy trying to build basic health care systems for the immunisation of children and for other purposes across Africa. We must do that, but prevention, care and anti-retrovirals should be our order of priorities.
Clare Short: I agree with my hon. Friend, except that the decision of the courts in South Africa that testing of pregnant women across the country to prevent mother- to-child transmission must be provided has solved the big row in South Africa, I am happy to say. It can now get on with rolling out an appropriate programme.
We must all remember that the speed of the increase in infection is fastest in Russia. It is spreading quite rapidly in India and in China, although China is now taking action. It is a serious problem in the Caribbean. Africa's crisis is bad and more advanced than elsewhere, but there is a danger throughout the world. The Ugandan lessons need to be learned throughout the world. Infection rates must be brought down as rapidly as possible. This crisis goes beyond Africa, although it is hitting Africa hardest at the moment.
Dr. Jenny Tonge (Richmond Park): One source of funding for the HIV/AIDS programmes in Africa is the World Bank's International Development Association loans. However, under the 13th replenishment, all loans for HIV programmes will be turned into grants. Is the Secretary of State not concerned that, in six months' time, the shortfall in the resources available for HIV/AIDS programmes, and for grants in particular, will be significant? Can she tell the House how that shortfall will be accounted for?
Clare Short: The hon. Lady is half right. The IDA loansthe most concessional arm of the World Banklast for 40 years, and nothing is paid back in the first 10 years anyway. The big argument against turning part of the loans into grant was somewhat theoretical, and many who advanced itmost of whom were in the USAdid not understand how IDA worked. None the less, we have had to compromise, as one does. The grant element in the new programme has not been funded; it will bear down in years to come, not in six months. We pointed out in the mid-term review that we must cover that; otherwise, over time, the value of IDA will go down and down. However, it will take more than six months to have an effect.