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28 Oct 2002 : Column 604—continued


Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6),

Former Yugoslav Republic Of Macedonia

That the draft European Communities (Definition of Treaties) (Stabilisation and Association Agreement between the European Communities and their Member States, and the Former Yugoslav Republic of Macedonia) Order 2002, which was laid before this House on 17th July, be approved.—[Jim Fitzpatrick.]

Question agreed to.


Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Northern Ireland

Question agreed to.





Motion made,

Hon. Members: Object.





Consumers for Health Choice

10.17 pm

Mr. Paul Goodman (Wycombe): I would like to present a petition on behalf of 500 or so of my constituents about the European food supplements directive.

The petition

To lie upon the Table.

Sue Penney

10.19 pm

Shona McIsaac (Cleethorpes): I am honoured to present the petition of Sue Penney and 2,384 others concerning the dangerous, inappropriate use of mobile phones by motorists while driving, a practice that has led to loss of life in this country.

The petitioners therefore

To lie upon the Table.

Consumers for Health Choice

Mr. David Rendel (Newbury): I present a petition similar to that presented by the hon. Member for Wycombe (Mr. Goodman). The petition is signed by more than 1,000 people resident in west Berkshire and the surrounding areas.

The petition states:

To lie upon the Table.

HIV/AIDS (Africa and Asia)

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

10.20 pm

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

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

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

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

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

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

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

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

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

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

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

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

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

She continued:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Those are forceful words, but very necessary.

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

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