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28 Oct 2002 : Column 604—continued

10.36 pm

The Parliamentary Under-Secretary of State for International Development (Ms Sally Keeble): I congratulate the hon. Member for North Norfolk (Norman Lamb) on obtaining an Adjournment debate on the very important subject of HIV/AIDS. I also congratulate him on the way in which he presented it by touching on the wide range of issues involved in dealing with HIV/AIDS in Africa and Asia. I want to consider in particular the effects that it is having on those regions. It is not only a humanitarian catastrophe but a huge disaster for the development of Africa, as he outlined. I shall set out my Department's approach to tackling the problem, dealing with the work that we are doing on prevention and treatment and, as he rightly pointed out, the important work that needs to be done to build up health systems.

HIV/AIDS is one of the biggest threats to the achievement of the goals agreed by all United Nations member states in September 2000. The hon. Gentleman will be aware that the goals cover a range of key issues including poverty, health and education, and they are at the heart of my Department's practice. At the United Nations General Assembly special session in June last year, the world community agreed that a much more intensive effort is needed to prevent HIV/AIDS and to improve the care and support for those infected by it. That poses a huge challenge for health systems in Africa and Asia which at present cannot cope. It also means that all parts of Government and civil society have to play their part. HIV/AIDS has long since ceased to be an issue for the health sector alone.

The hon. Gentleman set out clearly the scale of the disaster in terms of the numbers and I will not go over that again. However, he did not touch on the appalling impact of the epidemic on children, especially in Africa where there are more AIDS orphans than there are children in the United Kingdom. That adds an extra dimension to what we will see in the years to come as a result of the epidemic. As the hon. Gentleman said, it is not just a matter of human suffering; the epidemic also seriously undermines growth and social and political stability. In addition, it threatens security. The epidemic compromises all the work that has been done to reduce poverty and conflict and to improve education and health. As he said, it strips out the economically active people, especially in sub-Saharan Africa. The problem is made worse by the current famine.

Poverty and inequality are two key drivers of HIV/AIDS. Dealing with gender inequality is crucial in any strategy to prevent the transmission of the disease. In many countries women and girls are more likely than men and boys to be infected and to bear the burden of family support and care of those affected. Physiology increases women's vulnerability to infection, but that is made worse also by the lack of power that girls and women in many societies have over their bodies. That is reinforced by social and economic inequality.

Higher rates of AIDS-related deaths will lead to large-scale loss of skills and institutional knowledge in the public sector. Education, health services and police forces are of particular concern because death rates may be so high in those sectors that lost workers will not be replaced simply by increasing training or recruitment programmes. The disease is therefore having an increased effect on the very services needed to tackle some of the other problems that it causes. We are also concerned about the impact of HIV and AIDS on Government revenue and expenditure, and about reduced access by the poor to markets. We are concerned for the human rights of those excluded because of the stigma of HIV and AIDS, and we are focusing attention on those whose security has been undermined by HIV and AIDS, especially orphans.

My Department believes strongly that HIV/AIDS is not simply a health issue, and that care for the victims of AIDS must include support for communities that have been ravaged by the disease. That includes not only help in caring for the sick and dying but support for the livelihoods and food security of communities that have lost a large part of their working population. It is, of course, one of the particular characteristics of AIDS that it strikes down those who carry the greatest responsibility for feeding and maintaining their communities.

My Department is working with other agencies not only to prevent new infections but to ease the impact of AIDS on rural livelihoods and rural development as a whole. We are using a twin-track approach of continuing to fund research so that we can better understand the precise impacts of AIDS on rural livelihoods, while recognising the urgency of funding interventions now in the face of a disaster that is having an appalling effect on so many people. The hon. Gentleman quoted the Secretary of State's concern about that. The extra nutritional needs of HIV/AIDS patients are also having some bearing on the way in which we are dealing with the famine.

It is important to recognise that progress is being made, and we do not simply have to accept the doomsday scenarios that are so often put forward. We are starting to see evidence in Africa and Asia that the tide of HIV can be turned back. Examples include Uganda, which the hon. Gentleman mentioned, and Cambodia, where strong leadership at all levels and effective community-based prevention programmes have been key to controlling the epidemic. Uganda has reduced the rate of infection from over 20 per cent. in the early 1990s to about 5 per cent. now. In Cambodia, the prevalence of the disease has been reduced from 2.8 per cent. in 2000 to 2.6 per cent. today—a smaller decrease, but it goes against the trend that we assume to be typical of all countries. For some time, Thailand, where condom use has increased significantly, and Senegal have also been models of good practice in HIV/AIDS prevention. Progress can be made, but there is an urgent need for other countries to learn from these successes.

Despite those encouraging pockets of success, it is clear that the global response to the epidemic has so far been lacking, as the hon. Gentleman said. A much more intensive effort, which goes beyond the health sector, is needed. African and Asian countries need to learn lessons from each other on how best to tackle the epidemic. My Department will continue to do all that it can to help to facilitate that, and I will outline some of the ways in which we are working to do that.

The hon. Gentleman mentioned debt repayment. I think that he would accept that this country and this Government have led the world in developing a programme of debt repayment. However, he is right to express concerns about the continuing problems of unsustainable debts.

However, I am sure the hon. Gentleman would agree that we cannot see that as the cause of the problems in the provision of the health services needed to counter AIDS.

In response to the epidemic, DFID has committed considerable resources at the international and bilateral levels. We invested more than #200 million in HIV/AIDS programmes last year. We currently support programmes in more than 40 countries, including major new investments to support the implementation of effective national strategies to combat the illness in countries across Africa and Asia. Our overall programme in Africa is set to increase from #640 million to #1 billion by 2006. HIV/AIDS will remain one of our highest priorities for the region. In Asia our focus will continue to be on preventing transmission of HIV from vulnerable groups to the general population. We have committed US$200 million to the Global Fund to fight AIDS, TB and Malaria. Considerable extra funding is also going to institutions such as the World Health Organisation, the United Nations Population Fund and civil society organisations in a coherent effort to combat the disease and support people who are already living with it.

Our strategic response is to tackle HIV/AIDS through both prevention and care interventions, but as the hon. Gentleman pointed out, the strengthening of health systems is a critical issue in the delivery of prevention and care interventions. The ability to deliver community-oriented care and other HIV/AIDS and TB care and support services and anti-retroviral therapy are dependent on properly functioning health systems. Since 1997, my Department has committed more than #1 billion to health systems strengthening, and will continue to support that strongly.

DFID is driving work to promote international commitment on a package of measures that will facilitate widespread, sustainable, predictable differential pricing of essential medicines in order that such medicines are available to the world's poor at affordable prices and become part of a broader international agenda. We are also supporting work on establishing feasible approaches to increase access to highly active anti-retroviral therapy, and help Governments make informed decisions about their use that is specific to local needs and circumstances. In addition, we have committed an additional #40 million for research into HIV vaccines and microbicides. All these initiatives will benefit the poor in Africa and Asia.

While we move forward on developing new technologies, it is worth reminding ourselves that many of the strategies available now can be successful against HIV/AIDS. The key to reducing vulnerability to the epidemic is to create an environment that enables women and men to avoid risky behaviour and to have access to and use appropriate services. This requires strong and sustained political commitment to help those who are most vulnerable to be actively involved in designing strategies to meet their needs. The hon. Gentleman stressed the need for that, particularly in sub-Saharan Africa.

Government and civil society need to open up the public discussion about HIV/AIDS, sex, and gender relations and promote openness and respect for the human rights of all people. Explicit commitment to tackling stigma and discrimination is essential. I recently saw some of DFID's work on that in China, and I was struck by the way in which stigma had been dealt with. People were living openly with AIDS in the community. Tackling the HIV/AIDS epidemic with all its consequences sometimes appears to be daunting. It is important to emphasise that success against the disease can be achieved, but only if we all work together. In my Department we are committed to doing everything we can, in partnership with others, to help poor people across the world who are infected and affected by the disease, and to prevent it becoming a catastrophe not just to people, but to their societies and the future of their communities. Our Department is committed to achieving that goal.

Question put and agreed to.

Adjourned accordingly at eleven minutes to Eleven o'clock.

Correction

Official Report, 23 October 2002: at top of col. 375 replace Division with the following:

XQuestion put:—

The House divided: Ayes 164, Noes 65.


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