Children and HIV/AIDS (Developing Countries)

Geoffrey Clifton-Brown welcomes the Government’s commitments to children affected by HIV/AIDS in developing countries but, as targets such as universal access to treatment for HIV/AIDS by 2010 look likely to fail, he raises concerns about the implementation of the programme and calls for closer monitoring to see what effect the programme is having.

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): I am pleased to serve under your chairmanship, Sir Nicholas. I am also delighted to have heard the excellent contribution from the Minister. It was a very heartening exposition. As the hon. Member for Edinburgh, West (John Barrett) said, it is often the personal examples that stick in one’s mind. The speech from the hon. Member for Northampton, North (Ms Keeble), who explained that she could not stay for the final part of the debate, was particularly heartening. It is amazing how one suddenly finds that a colleague in the House has a huge amount of knowledge and has done a great deal of work on a subject that one never knew they were involved in. It was a delight to hear her speech. The hon. Member for Edinburgh, West also dealt with the subject comprehensively. Inevitably, therefore, my speech will cover some ground that has already been covered.

The problem that we are debating is a dreadful one. Before I launch into my speech on children in the developing world, I shall just mention that I happened to pick up a free newspaper on the tube today and one of its articles stated:

“Britain has almost twice as many new HIV cases diagnosed in a year as any other west European country, new figures show.

There were 7,734 new cases...recorded in 2007”.

So although in this debate we have been dealing exclusively with the developing world, we must not forget what is going on in our own backyard, as well.

Of course, the focus of this debate is the effects of HIV and AIDS on children, and the statistics are particularly heart-rending. They have been cited before, but I make no apology for citing them again. They are in the relevant DFID report. There are 33 million people living with HIV. As the hon. Member for Edinburgh, West said, 7,000 more are infected every day, 40 per cent. of whom are young people aged between 15 and 25. What a tragic waste. There are 1.8 million children in sub-Saharan Africa suffering from the disease. They account for 6 per cent. of the infected population but, tragically, 14 per cent. of the deaths. Each day, nearly 6,000 people die from AIDS. It is estimated that 15.2 million children have been orphaned as a result of AIDS. Those are tragic and mind-boggling figures, to which we should all pay very close attention.

However, the effects of this dreadful disease cannot be fully expressed by the statistics, as anyone who has witnessed its effects in countries where HIV/AIDS is endemic can report. Last summer, I was in Rwanda, teaching English teachers how to teach and write English. I had a class of 55 people. On the last day, this nice young girl came up to me. She had made quite a good contribution in the class throughout the fortnight and she said, “I want you to know I have AIDS.” I said, “I am desperately sorry to hear that. Are you getting any treatment?” She said, “No. My diet is too poor; the drugs that are supplied are too toxic.” I would not mind betting that she had just a month or two to live. So the millennium development goal of universal access to treatment by 2010, even if we do not get there—the Minister realistically outlined today that we might not fully achieve it; we might get only to 80 per cent.—is still hugely important.

As many others have said, HIV does not discriminate in whom it affects, but it will consistently devastate. It tears families apart and communities are decimated. A person’s chance of pulling themselves and their family out of desperate poverty is quashed, a nation’s economic growth is hindered and the cycle of decline continues. However, the children suffer worst, because they are the innocent victims. As the Minister said, their bodies are least able to resist the ravages of the disease. Even if they do not have the disease, they will suffer if their provider dies. I mentioned in an intervention on the Minister the problem of paediatric formulations of the existing drugs. Drug companies need to pay much closer attention to the problem affecting children.

There have been a number of welcome improvements. If I may say so to the Minister, DFID’s employees must be congratulated on their work, as must their colleagues in similar Departments in other countries, along with charities and health workers, who have worked so hard in this fight. The future of our country’s involvement in combating HIV is shown in the DFID publication “Achieving Universal Access—the UK’s strategy for halting and reversing the spread of HIV in the developing world”. However, that plan must be held up to scrutiny and I hope that we hear from the Minister today a response to some of the issues that I will raise.

Before turning to specifics, I want to raise the issue that was noted by the Minister and remarked on by the International Development Committee. It stated that

“there are some serious questions to be asked about delivery and also about our interaction with donors, with NGOs and with governments in terms of achieving what we say we want to achieve.”

It would be interesting to hear the Minister’s reply to that. The Government’s strategy paper was released in June 2008, almost a year ago. I hope that he will tell us exactly what steps have been taken towards providing answers to those questions, and what the answers are. They are, after all, questions relating to a programme committing a huge amount of funding. We were all very heartened to hear that DFID was committing that funding—£6 billion directly and another £1 billion through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

There are a number of excellent multilateral agencies—for example, UNICEF, which the Minister mentioned, and the World Bank. There are very good and knowledgeable NGOs doing excellent work, such as Save the Children. There is the charity of the hon. Member for Northampton, North. Many charities and NGOs are working in the field of HIV. However, as the Minister said, some companies are becoming involved with providing patent pools. I met representatives of an excellent company yesterday called Abbott Pharmaceuticals, which is one of the biggest pharmaceutical companies in the United States. It does not yet have a high profile here. In 2006, it provided more than $170 million of free HIV drugs, and it is participating in the patent pool arrangements to which the Minister referred. Indeed, an increasing number of multinational companies are taking part in excellent corporate social responsibility programmes, some of which are involved in the HIV field.

The Minister may have mentioned this, but I put it to him that one of the key players in the fight against HIV must be the US Government. Given the recent change of Administration, it is important that we interact with them. Indeed, the recent announcement by President Obama that Dr. Eric Goosby, a man with more than 25 years’ experience in this field, will be the next US global AIDS co-ordinator, has been welcomed by the Joint UN Programme on HIV/AIDS. As I say, the US is bound to be a key player, and it would be of great interest to hear what interaction the Minister has had with the US.

One country that has not been mentioned is one of the most seriously affected: South Africa. One in six of the world’s HIV sufferers live there. Thabo Mbeki, the previous President, had a chequered history in tackling HIV/AIDS, and the newly inaugurated president Jacob Zuma has already caused controversy on the matter. I hope that the Minister will enlighten us on his perception of the effect of the change of leadership in South Africa.

I turn to the important matter of monitoring the processes being brought about by DFID’s many policies. In an intervention on the Minister, I cited the terms of millennium development goal 6, which are well known. They are to have halted and reversed the spread of HIV/AIDS by 2015, and to have achieved universal access to treatment for HIV/AIDS by 2010. Given that 2010 is fast approaching, it seems that we will run short of the latter target. Nevertheless, it is important that we continue to concentrate on those targets.

I was heartened to hear from the Minister something that I did not know—that the UK has a worldwide role in co-ordinating the efforts of NGOs and multilateral agencies in other countries in the fight against HIV in sub-Saharan Africa. That is of great credit to the Government.

The Select Committee report states that

“the challenge remains for DFID to turn rhetoric into practical implementation and demonstrate much more clearly how it will achieve the targets it has set and the commitments it has made.”

Although the £6 billion is admirable, we need to see what effect—what change—it is having. I concur with that assessment; and I would add that my hon. Friend the Member for Sutton Coldfield (Mr. Mitchell) has called for intermediate targets to be set for scaling up implementation to full access, and for detailed yearly—I emphasise, yearly—impact assessments to be made to demonstrate whether the strategy is on track.

Why should the reporting be more regular? Nearly every minute, one child dies from AIDS and two become infected with HIV. If aspects of the strategy do not work, or the goalposts move, a biennial assessment will not pick up the fact that millions of people would have died in the time needed to detect whether the strategy was wrong. I ask the Minister to consider that point.

I move on to policies relating to children that arise from the Select Committee report “Achieving Universal Access”. It notes the need for an increased focus on groups that are more affected by HIV. The Minister mentioned some groups, especially women—I would say, more particularly, adolescent women. There are also children, sex workers, men who have sex with men, injecting drug users, prisoners and migrants—the last being a particularly vulnerable group.

The Government’s strategy has moved towards expanding social protection programmes. DFID says in its response to the Select Committee report—this is an important aspect, and I ask the Minister to concentrate on it—that it will

“provide effective and predictable support for the most vulnerable households, including those with children affected by AIDS.”

The Minister, I am sure, will be aware of the Select Committee’s concern that

“many of the most vulnerable children, including orphaned children and street children, do not live in traditional households”.

That is self-evident. If they have lost their parents, it is sad but still likely that they may become part of the itinerant child population that we see in so many parts of the world. Therefore, they may not benefit from the change in strategy. Will the Minister say how the strategy will work for those vulnerable groups of children?

Children suffering from HIV find their immune systems dramatically weakened. The Select Committee makes the clear recommendation that

“Children living with HIV should not be dying needlessly when a cheap and effective antibiotic is available to mitigate their vulnerability to opportunistic infections.”

In his evidence to the Select Committee, Dr. Stuart Kean, the chair of the working group on children affected by AIDS, reported that co-trimoxazole costs just one or two pence a day. As the hon. Member for Northampton, North said, £2.10 could feed an entire family for a week. Such small sums can provide a huge amount of money for the third world.

The hon. Member for Edinburgh, West said that the pound is not going as far as it used to; I calculate that, because the pound has devalued over the last year, £334 million of DFID aid is not going where it should. One can imagine how many drugs that money could buy. Furthermore, a World Bank report notes that eight countries now face shortages of antiretroviral drugs or other disruptions to AIDS treatment. Twenty-two countries, home to more than 60 per cent. of people on HIV treatment worldwide, expect to face disruptions over the next year.

I shall now speak about mother-to-child infections. The Minister will be well aware that a mother with HIV has a 30 per cent. chance of passing on the disease to her child; such means of transmission account for 90 per cent. of the disease in children. DFID has launched an ambitious strategy to increase antiretroviral treatments for HIV-infected women from 34 per cent. to 80 per cent. by 2010, to reduce if not eliminate that form of transmission. I hope the Minister will give us an update on whether that target is still attainable.

The picture is bigger than simply providing drugs, as many others have said this afternoon; on their own, they will not lead to a solution. One key fact is awareness of carrying the disease. As I said in an intervention, only 18 per cent. of pregnant women have received an HIV test. We should remember that the diagnostic testing equipment is becoming much smaller and more portable. If we can pick up on more of the pregnant women carrying HIV, the appropriate treatment can be given at an earlier stage, and we might be able to stop some of the maternal transmission and thus save more young children’s lives. As well as the equipment needed for testing, it is vital that countries’ health care systems be able to deal with such transmission effectively.

The distribution of drugs in many poor countries is important. Some excellent work has been done on the distribution of drugs, particularly by companies involved in CSR programmes. For example, Coca-Cola is thinking about delivering drugs to remote rural communities—places that are almost impossible to reach. The company’s franchisees operating in those remote areas—it amazes me that Coke is sold in such remote places, but I am sure that it is—are considering distributing drugs with the Coca-Cola.

A proper system of distribution is necessary; once the drugs have reached those communities, someone has to be in charge of getting them to those who need them—and of ensuring that they take the correct amount. One of the tragedies is this. I have heard from more than one source that when a woman is given her drugs, she will go home; but the man will see the drugs and regardless of whether he knows he is an HIV carrier, he will seize all or part of those drugs, and the woman will get none. It is important that the drugs get through to those for whom they are intended.

The Select Committee notes that DFID’s strategy

“fails to explain how the high-level funding commitments will be broken down by country or sector, making it difficult to understand how implementation will occur on the ground.”

I think that the Minister addressed that point. He said sotto voce that he could give me a country-by-country breakdown or, at least, put one in the Library so that we can all access it. That might be a very good way of communicating the information.

Although this debate focuses on children, as I have remarked already, the death of adults has a huge effect on the lives of children, and as such, although I cannot go over it in detail, a brief comment on the overall strategy remains salient. Regular monitoring of progress has been carried out, which ties in to all the areas of the strategy, because it is the only means by which success will be achieved. We must also address the need for continued growth in education—this is terrifically important—particularly among men, who have a role to play in this whole affair. We must ensure universal access to family planning services. That is most important, as women are disproportionately affected by the disease: two thirds of young sufferers are female. I would also like to hear how DFID has sought to engage more fully with civil society to tackle issues relating to the disease.

I want to raise—again—one discordant but important point relating to DFID staffing. I am not the only one concerned; it is regularly raised by the Select Committee, including in its report, as well as by non-governmental organisations. In her evidence to the Select Committee, DFID’s permanent secretary—no less—noted that

“our staff are very pressed, they are working very, very hard...we are coping but we are struggling”.

That is a very significant admission from a senior civil servant. It is as close as one could come to saying that there are not enough staff to deliver the programme. Of course, every Department’s central office has had its fair share of Government cuts—

John Barrett: Will the hon. Gentleman give way?

Mr. Clifton-Brown: Let me conclude my point.

Each Department has been given a Treasury public service agreement target to cut staff numbers, but, at a time when DFID’s budget is increasing—thankfully—it seems a little unfortunate if not enough health advisers, for example, are in place to deliver DFID’s creditable HIV programme, which is one of the largest in the world. We want to ensure that it is delivered well and is getting results for the money spent. It is important, therefore, that we have the correct—not excessive—number of staff.

John Barrett: The hon. Gentleman clarified the point I was about to make: a reduced staffing level, when the budget is increasing, produces a unique problem, because without outsourcing DFID’s functions, it will not be as effective as it would otherwise be.

Mr. Clifton-Brown: I am very grateful to the hon. Gentleman for reinforcing my point, which DFID Ministers must make to their Treasury counterparts, so that we can have the correct balance. The Minister might assure me that we have that balance, but it would be interesting to know.

I have raised a number of questions for the Minister to respond to today. The purpose is not criticism for criticism’s sake, but to probe his Department’s performance. Everyone who has contributed to the debate knows only too well the horrific effects of this disease, and we all want to ensure that our contribution to the global fight is as effective as possible. Of significant concern is the scale of the reporting and monitoring of our achievements, because the number of lives lost every day means that we simply cannot permit any weakness in our strategy.

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