HIV/AIDS (Developing World)

HC Deb 16 September 2004 vol 424 cc1488-519

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

2.19 pm

The Secretary of State for International Development (Hilary Benn)

First, may I say how glad I am—I am sure that this will go for other hon. Members—to have this opportunity to debate the impact that AIDS is having on the prospects for development around the world? May I take this opportunity in our first such debate to welcome the hon. Member for Rutland and Melton (Mr. Duncan) to the Front Bench? We look forward very much to hearing what he has to say on this extremely important issue.

Very simply, AIDS presents an unprecedented challenge to the developing world. It is one of the greatest threats that we currently face to the eradication of poverty and therefore to the achievement of the millennium development goals. I say that because, if one looks back on the history of the past two generations, we have seen in developing countries real improvements in life expectancy. Since the mid-1960s, average life expectancy in developing countries has increased by 18 years, but HIV/AIDS is now in the process of wiping out all that gain in life expectancy in some countries—in other words, reversing four decades of progress. The massive cost in terms of human life and the enormous economic burden on families and communities should not be underestimated.

The first AIDS cases were identified in the 1980s, and the number of people affected by HIV has risen rapidly since then. Today, about 58 million people—no one knows for sure—around the globe are HIV-positive. So far, 20 million people have lost their lives to the disease. Women and young children, including the rising number of children orphaned by AIDS, are particularly vulnerable. Six million young people are living with HIV in sub-Saharan Africa, three quarters of them female.

Twelve million children have lost one or both of their parents to AIDS. Perhaps the House would just pause for a moment to contemplate losing the most important source of support that we rely on, certainly when we are young—our parents, one or both. Think of all those children who are growing up without the care of a mother or father. To make matters worse, that number is estimated to become a staggering 18 million children by 2010. One of the consequences is that an entire generation of grandparents now have to look after an entire generation of their grandchildren, because the generation in between—their children's generation—is in the process of dying. If there is one thing that we as parents fear more than anything else it is that our children will die before we do, because that is not how it is meant to be; it is not in the natural order of things.

In June, the all-party group on Africa published its report "Averting Catastrophe: AIDS in the 21st century", which said: Sub-Saharan Africa is home to between 25.0 and 28.2 million people infected with HIV. UNAIDS estimate that, in 2003 alone, 2.3 million Africans died of AIDS. Despite high death rates, the number of people infected continues to rise as new infections outstrip the number of deaths. In 2002, seven countries saw infection levels surpass 30 per cent. in the age band 15-49 years. I want to take the opportunity of the debate to congratulate my hon. Friend the Member for City of York (Hugh Bayley), who chairs the all-party group on Africa, and all his colleagues—some of whom are in the Chamber today—on that outstanding piece of work, which is a real beacon to all-party groups in demonstrating what they can do when applying their minds and expertise to a subject of such importance.

Last week, I was in Nigeria, which is home to one in 10 of the world's HIV-positive population. The number of infected people in that country is estimated to reach 15 million by 2010. Those figures will outstrip the current number of people who are HIV-positive in southern Africa, where many people would agree that crisis point has already been reached. Yet it is still possible that, if we collectively do the right things now, we could avert the catastrophically high levels of infection that have been predicted, thereby reducing the subsequent death rates. It is important for the House to acknowledge that this is not just about Africa, although that is where we see the scale of the epidemic manifested most clearly. Asia and eastern Europe also face rapid increases, and there is a real danger of a generalised epidemic unless we take action now.

The UK Government are committed to doing what we can to help to halt AIDS and to reverse the spread of HIV globally. Hon. Members will have seen the "Call for Action" document that we published in December last year and the document "Taking Action: the UK's strategy for tackling HIV and AIDS in the developing world", which was launched by the Prime Minister on 20 July. In that document, we sought to set out the practical steps that we are trying to take in working towards all the internationally agreed targets to fight AIDS—in particular, the millennium development goals, the UN General Assembly declaration of commitment and the UN International Conference on Population and Development action plan.

We have pledged to work with others to try to prevent infections—the international target is to reduce the rates among young people by 25 per cent.—to increase access to sexual and reproductive health services; to support the World Health Organisation to get 3 million people into treatment by 2005; to meet the needs of orphans and vulnerable children; to put in place the three "ones"; to increase research; and to meet the millennium development goal target of being

on track to slow the progress of HIV and AIDS by 2015". Given the expertise on this subject that there is in the Chamber, hon. Members will recognise that those targets are extremely ambitious, and we are not currently on track to meet many of them. That is especially true of some of the 2005 targets, and in particular the WHO target. Although we recognise that it is likely that some of them will not be met, it is important that we hold on to ambition and aspiration in trying to tackle this terrible epidemic.

UNAIDS calculates that £6.6 billion is needed to tackle AIDS next year. Although a significant funding gap remains, we have seen in the past few years a significant increase in the international attention given to AIDS and the amount of money that countries are committing to fight AIDS. The US President's initiative on AIDS has committed $15 billion over five years. The UK, too, is seeking to play its part in meeting that need. We are the world's second largest bilateral donor, according to UNAIDS.

We have committed ourselves to spend at least £1.5 billion over the next three years. That is a consequence of the outcome of the comprehensive spending review, which will involve further significant increases in the international development budget, including at least £150 million for orphans and other vulnerable children, especially in Africa. We made that commitment because when we consulted on our call for action, which we published in December last year, one of the messages that came back very strongly was that people did not think that the world or, indeed, the UK were doing enough for orphans and vulnerable children, and we reflected that in the strategy that we published in July.

In July, I also announced that, over the next four years, the UK will give £36 million to UNAIDS, which plays such an important role in co-ordinating the global fight, and £80 million to UNFPA—the UN Population Fund—to support its hugely important work in HIV prevention and its sexual and reproductive health work, particularly with women. We also announced that we would double our support for the global fund, which fights AIDS, tuberculosis and malaria, to £150 million over the next three years. We have therefore pledged £250 million to the global fund to support its work until 2008. To date, we have pledged the third highest amount of any G8 country and the fourth most of any donor to support the fund. I am proud of that record of support for that very important fund.

Bob Spink (Castle Point) (Con)

I congratulate the Government on all that they are doing; they are certainly moving apace, as they should. However, will the Secretary of State pay tribute to the part that the private sector in this country plays? In particular, will he pay tribute to Merck Sharp and Dohme and the Gates Foundation, which have each pledged £33.3 million to the African comprehensive AIDS partnership? Merck is also providing free medicines in some cases.

Hilary Benn

I readily pay tribute to the work that a number of trusts, funds, voluntary organisations and, indeed, the pharmaceutical companies themselves are doing, including the work that has been done to reduce the price of anti-retrovirals—a point that I shall return to later. In this fight, we need all the help that we can get. I genuinely pay tribute to the contribution that the hon. Gentleman has described.

Money, however, is not the only answer, as I think everybody recognises. We also need stronger political leadership. I congratulate my hon. Friend the Member for Walthamstow (Mr. Gerrard) on his outstanding leadership of the all-party group on AIDS. I think that it is one of the world's foremost cross-party responses to the crisis. He, together with colleagues right across the House, has done outstanding work to make sure that we debate the issue and that the Government are kept to task in ensuring that we take the right steps to make a difference.

We need such global leadership, because as we move to 2005—the UK will have the presidencies of the G8 and the European Union—we need to encourage everyone, including other leaders and other countries. All the evidence shows that when there is strong political leadership, we can halt and reduce the spread of HIV.

Let us take the example of Uganda, where there has been courageous political leadership. By that, I mean that it has been open and honest about the disease, how one gets it and what one can do to protect oneself. It has been fighting stigma and discrimination, and politicians and others, including community leaders, have been open and honest about the issue. All that work has helped to turn the tide of infection. Despite the fact that Uganda once had one of the world's highest infection rates, year on year the number of new infections continues to fall.

In Senegal, HIV never really took off. That was not good luck; once again, there was strong political commitment. People were brave and they spoke out. A free media provided information and a determined effort was seen to make things happen and to change people's behaviour. In Thailand, HIV raged at very high levels among the most stigmatised in society—sex workers and drug users—and then it turned around. There, the Government, working alongside others, helped to take the steps that were needed to save people's lives. They have succeeded in that country.

The truth is that we need a continued concerted effort on the part of the whole international community while recognising, however, that the people who face the biggest burden are the Governments and health ministries of the developing countries that are most severely afflicted by the AIDS crisis. To be honest, they are struggling with the task. It would be enough to make any Government struggle. However, we also have a practical as well as a moral responsibility to make sure that this increased international effort, the increasing resources that we are making available, and the desire to help are used in a way to help hard-pressed Ministers and officials in health Departments, doctors and others to deal with the disease.

In that context, I have talked about the successes in Uganda, but I also point out that, in 2003, 25 separate AIDS donor planning missions went to that country. The honest truth is that we can all turn up in succession, knock on the door and say, "We have come from the United Kingdom, you have a terrible AIDS crisis and we want to help. Here's our programme. Can we discuss how we are going to work together and how you will report to us on how you are using the money that we will make available?" That is very well meaning, but if there are another 24 people in the queue outside, we take up the time of Health Ministers and officials and that means that we are not pooling our resources, effort and desire to help in a way that will make the biggest difference.

For that reason, support for the three "ones" is important and that is why the UK Government have played their role in arguing that we should all sign up to them. The principles are very simple. They are not terribly profound but, boy, do we need them. They are that, in every country, we should have one plan for tackling AIDS; one body with responsibility for doing it; and one way of monitoring the progress that is being made. In other words, we should pool the effort, the energy, the money, the good will and support around one plan, one body and one way of reporting. When I was at the World Bank spring meeting in April this year, we organised an event to get major donors to sign up to these principles.

Mr. Julian Brazier (Canterbury) (Con)

The Secretary of State is making a number of important points. However, in making the point about the three "ones", will he also acknowledge that part of the reason why Uganda was so successful was that the effort was not only politically led? Uganda brought in many other outside bodies—the Churches, communities, non-governmental organisations and so on.

Hilary Benn

Indeed, I acknowledge that. The hon. Gentleman is absolutely right. Leadership is required from everyone. When I used the phrase "political leadership", I did not mean just party political leadership or leadership from politicians. As the hon. Gentleman said, the role of NGOs, Churches and others is to provide leadership in this debate. Without that support, there would not have been the progress made in Uganda.

I was about to say that the principles are good, but the question is: how do we turn those principles into practice on the ground? If countries want donor funds to be provided through a pooled funding mechanism, we are happy to do that. We will ensure that, by replacing any lost funding, the measures do not reduce the resources that are available. We will also continue to work very closely with UNAIDS, the World Bank, the World Health Organisation, UNICEF, the UNFPA, the European Community and the global fund to ensure that all the countries that are affected by AIDS are able to tackle the crisis effectively and not just those where the UK happens to have a country programme. Of course, we do not have programmes everywhere, and the World Bank, the European Community and the global fund are major funders of AIDS programme and we support them, too, through our financial support.

The other truth is that success will depend on action by developing countries themselves. The first point to make is that prevention is the fundamental building block. If we can prevent people from becoming HIV positive in the first place and going on to develop AIDS, we deal with many of the problems with which we would otherwise have to cope. Therefore the UK's funding is used to support many innovative programmes throughout the world.

When I was in Nigeria in December last year, I went to the local market in Abuja and saw a creative performance taking place on the back of a converted lorry in the market square. It was funny, engaging and made the point about prevention and openness. Afterwards, the performers—we are supporting this project—went out into the crowd to distribute leaflets and answer questions. That is one small example of a practical approach to get information about the disease, how one gets it and what one can do to protect oneself out to people who need it in such a society.

In another practical contribution, we are helping to provide condoms in many countries. UNFPA says that, in 2003, the UK helped to pay for 490 million condoms around the world. We often work closely with other donors, especially the United States, to support innovative marketing campaigns to get male and, indeed, female condoms to those who are most at risk.

We also have to recognise that AIDS is far more than about just health. It affects education, social structures, cultures and economies. For example, girls who spend longer in school are less likely to get HIV. In Kenya, we support work in about 2,000 schools, and the first 18 months have already resulted in significant changes such as the delayed onset of first sexual experience, less sexual activity and the increased use of condoms. We are now expanding the programme to reach 5,000 schools.

Malawi, like all countries, depends on education to teach the next generation and to build the skills that the country will need to sustain its economy. However—this is another of the statistics that makes one stop in one's tracks—teachers in Malawi are currently dying faster than they can be trained. In such circumstances, what prospects are there of getting all kids into primary school let alone dealing with the AIDS epidemic? Effective prevention and treatment are not just about saving lives; they are also about reducing poverty and helping economies to develop.

We need to be determined to ensure that treatments reach the poorest people, which is why we are trying to make sure that half of those who benefit are women and girls. Getting women on treatment is good not only for women themselves, but for society, because if mothers live longer, there will be fewer AIDS orphans and the figures will not turn out to be as bad as was feared.

That is a reason why we, with others, continue to invest heavily in supporting the establishment of health services. The UK has invested over £1.5 billion in that since 1997. We are working with communities and people with HIV to help them to play their role in treatment and care. One-a-day drugs have simpler treatment regimes than other therapies, so it is easier not to forget to take them. We need better ways of distributing drugs so that people may access them more easily. Despite the welcome fact that drug prices have come down, only about 440,000 people in developing countries were on anti-retroviral therapy in June, which shows how far we have yet to go to reach the World Health Organisation "3 by 5" target, so we must work harder. We must understand that even if the drugs were free and available in huge numbers, health services, with doctors and nurses, would be needed to administer, treat and care for patients, so we must work on both those fronts.

We must address stigma and discrimination because they often inhibit people from getting the care and treatment that they need. Women may be too frightened of being beaten or rejected by their husbands to get tested for HIV, even though that could help to save their lives or stop their children from becoming HIV-positive. Stigma and discrimination can literally kill, so promoting human rights and tackling the problem, while dealing with issues involving sexuality, represents an important aspect of what must be done.

Many people in developing countries are frankly too frightened of HIV to get tested or to access the prevention services that they need, which is why we are working with the most vulnerable groups in many countries as part of our programmes. For example, when I visited Yunnan province in China earlier this year, I saw a programme that we are supporting with drug users and sex workers. That is a leading province in China owing to the fact that the country needs to address the AIDS threat, so it was heartening to see what it was doing with strong leadership from the top.

We must acknowledge the fact that there is no instant solution to the crisis. If we are to beat AIDS, long-term predictable funding and support are required, which is why as well as increasing our AIDS budget, the Chancellor has proposed the international finance facility as a way of raising additional finance more quickly, which could provide more support for the fight against HIV/AIDS. Predictability is important because ART cannot be turned on and off. Countries need to know that if they start the process—and individuals need to know that if they start taking the drugs—the treatment will be available in the long term because it does not work any other way. Encouraging and supporting developing countries to use the treatment and sustain it over the long term will be a big challenge. We must appreciate that such countries will face difficult choices about who gets the treatment.

Ms Sally Keeble (Northampton, North) (Lab)

Does my right hon. Friend agree that a problem is developing owing to the short-term use of anti-retrovirals? Sometimes the courses are stopped after six months, so can he tell us what is being done to deal with that problem?

Hilary Benn

That is the exact problem to which I am referring. There are worries about the development of resistance, so long-term sustainability is vital. Ministers and health officials in developing countries say that they need to know what they will receive in the long term so that they can plan ahead and thus avoid the problem that my hon. Friend raised.

Research can make a contribution towards tackling the epidemic. The UK Government were the first to fund the international AIDS vaccine initiative, which is an attempt to speed up the process of developing an AIDS vaccine. Of course, such a vaccine is the holy grail because we would be in a very different position if we had it. This year, we joined other G8 members in establishing the global HIV vaccine enterprise, which is another attempt to speed up the difficult process of finding a vaccine.

We also need to develop new HIV prevention technologies, and the UK is supporting microbicides research. That cutting edge hard science is an attempt to develop an effective microbicide—trials are currently taking place in Africa—that women will use. That would enable them to take decisions about their protection, given that it is sometimes difficult for them to get a partner to use a condom. That is one reason why microbicides are important, so we have invested £18 million in the research since 1999.

I say in all honesty that the world faces no bigger development challenge than beating the epidemic. If children's parents die of AIDS, their lives will be much harder than they would otherwise be. If teachers die of AIDS, we will not be able to educate all the kids whom we want to get into primary schools. If nurses and doctors die of AIDS, they will not be able to administer anti-retrovirals or distribute condoms to people in their communities. If workers die of AIDS, the prospects for economic development in many developing countries will be severely damaged. For every one of those reasons, in addition to the terrible human cost of the disease, we all have a practical and moral responsibility to do everything possible to beat the epidemic.

2.46 pm

Mr. Alan Duncan (Rutland and Melton) (Con)

I thank the Secretary of State for his warm welcome to me in this job and his broad and informative review of the growing world crisis. There is little difference on both sides of the House about the problem. Indeed, it is a bit of a challenge to follow the Secretary of State without reiterating everything that he said over the past half hour, but I am nevertheless glad to have the opportunity to debate the matter because it is important to the well-being of the world. No one in the Chamber is in any doubt about the magnitude of the HIV/AIDS crisis and how vital tackling it is to our future and that of others. It is probably the most harrowing cause of misery and poverty in the world today.

The problem in Britain is bad enough because it is estimated that 50,000 people are living with HIV, which is the highest number ever. We are confident, however, that although the situation is appalling for sufferers, we can at least treat the problem because we are a rich country. For the world as a whole, and especially its poorer countries where the crisis is most acutely concentrated, the problem is far worse.

It is hard to comprehend the scale of the tragedy. I have written in my speech that 38 million people are now living with the disease, but I have to correct myself because the Secretary of State says that the figure is 58 million—I am sure that he is right. The suffering that comes with the disease is spreading and the virus is on the increase. Last year, nearly 5 million people became infected with HIV, and 2.9 million died from AIDS. The magnitude of those figures is of course appalling, but the situation is worse than that because the disease often strikes the most vigorous and youthful.

In sub-Saharan Africa alone, some 12 million children have lost one or both parents to AIDS and it is predicted that the number of AIDS orphans will rise to 25 million by 2010. The Secretary of State said that the figure is 18 million, but the scale of the problem is so massive that it almost does not matter how many millions we cite. We must remember that the sufferers live in countries with a national income per head that is typically a small fraction of ours. In the fight against the disease, AIDS to Africa is the equivalent of the Somme to this country in 1916, or even much worse.

As the Secretary of State said, the AIDS crisis is now evident in Asia. India ranks second only to South Africa on numbers of infections. It reaches that high number although only—one says "only"—about 0.9 per cent. of the adult population is HIV-positive, compared with more than 20 per cent. in South Africa.

However, if India's rate of infection were to rise to a mere—in comparative terms—5 per cent., not only would millions more Indians be condemned to death, but so could millions of their neighbours. India's population alone is far bigger than Africa's. If the disease were to spread to Bangladesh, Nepal and Pakistan, we would face a regional epidemic affecting more than a quarter of those alive in the world today. Surely that means—to be fair, I think the Secretary of State said this—that although Africa is the worst affected area at the moment, and thus the natural primary focus of our efforts, there is compelling evidence that future programmes must be designed to arrest a potential massive explosion of HIV/AIDS elsewhere as well.

The figures are appalling and the agony that they represent is especially severe for the developing world: children without parents; parents without children; children unable to go to school because they are orphans; countries unable to create wealth because their work force is dying of AIDS. This is a crisis that the world must know about and we cannot ignore it. So we fully support the millennium development goal to begin to reverse the spread of HIV/AIDS. HIV/AIDS, poverty and the state of civil society are all linked. That goal must be central to any poverty reduction strategy and if, when we have the presidency of the EU and the G8, we make it a high, if not the top, priority, then all the better.

I certainly welcome the Department's HIV/AIDS strategy paper and congratulate the Secretary of State on his Department's work. However, a number of concerns arise from the National Audit Office report on the response by the Department for International Development, which I am sure the Minister will mention when he winds up the debate. The report says that there have been problems with sharing new knowledge on tackling HIV/AIDS with the Department's in-country teams. That is worrying, but I am sure the Minister will address it. The report also states that more guidance and advice on treatment could be given to country teams. That again is vital. There are also concerns about how well the Department measures its strategy's effectiveness. Those are serious issues and it will be interesting to hear the ministerial response.

I recognise DFID's substantial funding of £123 million to India's National AIDS Control Organisation, but that, too, received some criticism from the World Bank, which described the organisation as deficient in its handling of AIDS control schemes. That is a concern when so much money and so much else is involved. I hope, again, that Ministers will say how they think taxpayers' money is being diverted, or used, for that good cause. Of course, it highlights the significance of the debate, which will not go away, which is the relationship between the direct funding of Governments and the role of non-governmental organisations.

The crux of the matter globally is the balance between prevention and treatment. One prevention strategy, the prominence of which has risen, is the promotion of abstinence. It would be untrue to say that any promotion of abstinence is absolutely naive or misguided because it is not. After all, it forms a third of Uganda's successful ABC strategy—abstinence, be faithful, condoms—which is credited with the drop of infection rates from 30 per cent. to 6 per cent. over the past 12 or so years. However, we must be realistic about human nature. Most people are not born as natural monks or nuns and the promotion of abstinence will only ever go so far. Although we can try to change people's way of life by encouraging abstinence before marriage and faithfulness during marriage, people are bound to engage in sexual activity in more risky circumstances. So, above all, prevention must be about creating a culture of condom use.

In Britain, buying condoms is as normal as buying a pint of milk. I do not for a moment underestimate the challenge of spreading that safe sex culture, but it is the key to stopping the virus spreading, and I commend the Department for taking that approach. It is also why Thailand is praised as an exemplar in the fight against AIDS. The number of new infections in that country fell from a peak of 140,000 in 1991 to 21,000 in 2003 because of the Thai Government's persistent message on the vital need to use condoms.

So I hope that the Secretary of State, in his usual adept and diplomatic way, will continue to say to our friends in the American Administration and elsewhere that condoms are a top priority. After all, within the United States prevention of HIV/AIDS has been mainly tackled by encouraging safe sex, and what is right for the United States is also right for the developing world. Resources devoted to tackling HIV/AIDS are precious and we should recognise the American Government's generosity in giving $15 billion over five years towards that aim. However, it would be a terrible shame if some of that were not used as effectively as it might be.

Prevention is also, of course, cost effective, but there remains the question of the vehicle for changing cultures. NGOs have an invaluable role to play in that, and I wonder whether the Secretary of State thinks that the emphasis in direct budget support in recent years has, to some extent, been at the expense of the effectiveness of NGOs. As my hon. Friend the Member for Canterbury (Mr. Brazier) said in his question on Uganda, NGOs often have a reach that governmental organisations cannot match. In communities in which faith plays a major role, faith-based organisations, for instance, can tie in very effectively with the institutions of civil society to achieve changes in behaviour.

Before HIV/AIDS can be prevented, however, there must be popular recognition that the problem exists. That cannot be solely provided by the richer countries of the international community. Indeed, it would be quite wrong to do anything other than recognise that the willingness to tackle HIV/AIDS must come from within each country. That can never fully happen without political leadership from the top, as Kofi Annan has said.

Only if people are told the truth about HIV/AIDS and if the disease is, as the Secretary of State said, not stigmatised can we hope to defeat the epidemic. That is why Chief Buthelezi deserves the highest praise. His family has suffered horribly from the disease and it is real statesmanship to break the stigma and denial of AIDS in South Africa. I hope that the Government will draw President Mbeki's attention to what Chief Buthelezi has said. It really is extraordinary that the President of a country that has 5.3 million sufferers from HIV/AIDS could deny knowing anyone affected by the disease. South Africa is the regional leader and if the Secretary of State and the British Government are prepared to be frank with President Mbeki about the example he sets, the Secretary of State will have the full support of the Opposition.

It would be a terrible mistake, though, to think that an emphasis on prevention should mean that we regard treatment as a secondary issue. Although prevention and treatment may compete for funding, we must not see them as a matter of either/or. Treatment, after all, gives hope. It changes HIV/AIDS from a death sentence to a lifelong illness. That is what having the disease now means in America and Europe. It is quite simply the difference between life and death.

A decade ago, treatment cost perhaps $10,000 a year; now it can cost as little as $200—still unaffordable for most in the developing world, but at least within reach if there is adequate budgetary support. Developed donor countries have an essential role in funding treatment, and we must remember that anti-retroviral drugs, like anything else, benefit from economies of scale. The more funding there is for them, the more affordable they will continue to become for the poorest people in the world. Perhaps the most striking and disturbing statistic of all those mentioned today is the fact that only between 400,000 and 500,000 people in the developing world are receiving the treatment from which others could benefit if there was wider access to those drugs.

We can also hope to see the spread of effective generic anti-retroviral drugs help to dispel belief in magical cures. For some people to preach that certain foods can address the problem is perhaps one of the most evil political deceits of the modern age. With real cures properly available, the word would soon get around that fantasy cures are just that.

I hope that the Secretary of State agrees that to ensure that resources are devoted to the development of affordable and effective anti-retroviral drugs, a generous proportion of the global health fund should be ring-fenced solely for the propagation of pharmaceutical research into such drugs. We shall reach the ultimate goal of a vaccine or a cure for AIDS only if we spend money on researching treatments.

AIDS can be tackled if there is a will. I do not doubt that that will permeates every shade of party allegiance or opinion in the House. The Department for International Development is doing its best. It is doing a good job, and I look forward to its doing an even better one.

3 pm

Ms Sally Keeble (Northampton, North) (Lab)

I shall focus on one aspect of the problem, orphans and vulnerable children in sub-Saharan Africa, and examine some of the problems that they face and the measures needed to tackle those problems. Both my right hon. Friend the Secretary of State and the hon. Member for Rutland and Melton (Mr. Duncan) set out well the global statistics on HIV/AIDS. I welcome the hon. Gentleman to his new portfolio and hope that his commitment to a similar level of work and political commitment from the Conservative party to tackling HIV/AIDS will be matched by a commitment to funding support should his party ever get back into power. The crisis in the developing world has been brewing for some time and it will take a long time to overcome the problems. Both cross-party political support and long-term financial support are needed.

As has been said, there are about 12 million HIV/AIDS orphans in sub-Saharan Africa, but it is possible to get a much stronger, sharper picture of the scale of the problem by looking at individual countries. Zimbabwe has some 980,000 such children—in other words, 14 per cent. of its children are orphans as a result of HIV/AIDS. Lesotho has 100,000 such children—a smaller number, but one that represents 10 per cent. of that tiny country's children. Kenya—one of the worst affected countries—has about 650,000 such children. Approximately 10 Members are present in the Chamber, so if we assume that each of our constituencies has between 50,000 and 70,000 voters, the figures I have given on the number of HIV/AIDS orphans are roughly equivalent to the entire population of all the constituencies of the Members now present.

We sometimes become so mesmerised by the size of the problem that we miss some of the human grief that lies behind it. The stories behind the statistics—what actually happens to some of those children—are far worse. Colleagues, including my hon. Friend the Member for City of York (Hugh Bayley), might remember seeing a video featuring a Kenyan girl who was being helped by an organisation there. In the video, she appeared to be at death's door, but I met her on a visit to Kenya and found that, after a short course of treatment, her condition had improved. There are not the drugs to treat her for long, but her condition has improved. What the video did not show clearly was that, like many other HIV/AIDS patients, she also had tuberculosis—there is a terrible link between the two diseases—and when I met her, she had also only recently completed a course of treatment for tuberculosis. In the short time since the video was shot, both of her siblings who were shown in the video had died of HIV/AIDS, as had her father, although her mother was still alive.

There are plenty of children like that little girl. As I said, the stories behind the statistics are grim. I commend to Ministers at the Department for International Development the excellent proposals on tackling the problem of HIV/AIDS orphans in the all-party Africa group's report. I congratulate my hon. Friend the Member for City of York on his work as chairman of that group. I also commend the five principles set out in the UNICEF framework: to strengthen the capacity of families, to examine community-based responses, to ensure that orphans and vulnerable children get access to services, to provide protection to such children and to raise awareness. I am sure that those principles will be amplified in the forthcoming Capetown conference on the problems of HIV/AIDS orphans.

Careful and detailed consideration must be given to the enormous role that the British Government and DFID can play in supporting countries in the monumental task of putting those five principles into practice. Let me illustrate that with examples from countries where I have seen the work carried out with orphans and vulnerable children. In Lesotho responsibility for work with such children rests with the office of the first lady: she is a superb champion of the cause of those children and an inspiring and highly qualified woman, but she is not part of the Government. She is doing interesting work to influence traditional community figures to take seriously the problems of the orphans, but she pointed out to me the uphill struggle that they face.

Lesotho's economy is in difficulty because it has lost most of the income it derived from migrant labour; it is also experiencing drought and food shortages. Many of the parents who used to work in South Africa are not getting work there any more; furthermore, migrant labourers are especially susceptible to HIV/AIDS problems. The scale of the deaths has led to a lack of community support systems, so there is real difficulty in supporting children. In addition, there is no legal framework to tackle many of the problems affecting the children, such as with their inheritance and property rights: for example, HIV/AIDS orphans have been threatened with having their houses bulldozed or taken away by family members, or questions have been raised about their parentage. The first lady pointed out that, as well as resources, there was a need for support for the structures and legal frameworks needed to unpick some of the complicated problems.

Zimbabwe has about 980,000 such children—about three or four times the population of Leeds, Central. The social services department in Zimbabwe's second city, Bulawayo, has no qualified social workers—they have all left the country. There are more Zimbabwean social workers in one London borough that I know than there are in the whole of Bulawayo. Simple work like managing the procedures affecting the children are impossible, because there are no people who are trained and able to do the work.

Home care systems lack resources, partly because of the Government's problems, so home care is largely carried out by networks previously established by NGOs and other organisations to provide food. Those networks do not have any equipment or food at present, and lack the kits that DFID has funded in other countries. The home carers are extremely good at providing sympathy, warmth and support for children who are about to lose their parents, but they cannot provide anything more tangible. The networks, however, are unable to tackle big increases in school fees and food shortages.

There is a pressing need to support organisations that are trying to provide child care services but whose trained, qualified and committed staff leave because of the political situation. There is a serious need to deal with security problems. In its response to the paper produced by the all-party group on AIDS, DFID asked exactly what those problems were. Quite simply, there has been a big increase in street children, and children experience problems once they become orphans. In Zimbabwe, I visited a shelter that took children in to prevent them from being harassed by the police on the street. Such services are hard to provide even in this country, where we have robust institutions, plenty of trained staff and sufficient financial resources, but it is much harder to do so in countries with a collapsing infrastructure or which lack a basic legal framework on such issues.

The political and economic framework in Kenya differs from that in Zimbabwe or Lesotho and, although organisations working with orphans and vulnerable children do not struggle to pay school fees, which are paid by the new Kenyan Government, they struggle to pay for school books, pencils, uniforms and so on. We may not appreciate the enormous lengths to which some organisations go to try to save children from an early death and to improve their health. I saw a little girl, for example, caring for her mother, who was dying from HIV/AIDS. The little girl did not have HIV/AIDS, but she had contracted tuberculosis from her mother, and it had entered her spine. She had substantial physical disabilities, needed to wear a special corset, and required corrective surgery at some stage. That is expensive in this country, but African organisations that are working with those children and saving them from otherwise certain death and putting them on the road to recovery are scratching around to find the money to provide a complex range of services and give those children a reasonable life.

As I said earlier, drugs are being misused. Time and again, people are given a six-month course of treatment, but they are not properly monitored so the side effects of those powerful drugs are not picked up. Once the course is completed, the patient's health is maintained for a while, only for it to deteriorate again. They may receive more drugs to which they may have an adverse reaction. We must make sure that the drugs that people try to get by hook or by crook because they regard them as a miracle cure are provided in a continuous, safe supply.

It is widely acknowledged that the UK is at the forefront of donor work and that the UK Government have pioneered the thinking behind that work, but I hope that in developing its commendable work on HIV/AIDS, DFID will carve out a special role for support work with orphans and vulnerable children. I accept that we must make sure that we have enough teachers, protect the economy and support active members of society, but I wonder what will happen when those 12 million children grow up. They will not have gone to school and will not necessarily have secure homes. At best, their health will be compromised and it may be downright poor. In addition, they will not be socialised and will not understand how to relate to society or how to participate in adult life.

If we sow the wind, we reap the whirlwind, and a generation of children will grow up without parents or the support networks available to most children. If four UK cities each equivalent in size to Birmingham contained only orphans, or if all our constituencies comprised only orphans, the problem would be recognised for what it is—a major calamity needing a range of educational, health, financial and social measures to resolve the difficulties that those children face. I urge my right hon. Friend the Secretary of State and the Minister to take on board the need to counsel them so that those children can come to terms with the grief with which they have to cope, and to make sure that the society of the future is not beset by the problems that those children experience.

3.16 pm

Tom Brake (Carshalton and Wallington) (LD)

I welcome this debate. Although the Secretary of State and the Minister have been generous with their time in recent months on the issue of HIV/AIDS and there have been regular debates in Westminster Hall, I welcome the opportunity for debate on the Floor of the House. I echo the praise that the Secretary of State offered a number of hon. Members who, through their participation in various all-party groups, are pushing the issue of HIV/AIDS and the way in which the UK can respond to the problem. I congratulate the hon. Member for Rutland and Melton (Mr. Duncan) on his speech. A couple of days into the job, he has already identified the fact that the international development portfolio is a consensual one. That has positive results in ensuring the continuity of international development, but it is not quite so positive from the point of view of an international development spokesman.

I should like to concentrate on "Taking Action: the UK's strategy to tackle HIV and AIDS in the developing world", focusing on a small number of targets that it identifies including the target that 25 per cent. fewer young people should be infected by HIV in Africa by 2005 and globally by 2010, as well as the target to increase access to sexual and reproductive health services for women and girls by 2005. I shall then look at the target that 3 million people, including 2 million in Africa, should receive treatment by the end of 2005, and that at least half of those people should be women and children. Finally, I shall look at the target of being on track to slow the progress of HIV/AIDS by 2015.

The Government, as the Secretary of State explained, have agreed to fund HIV/AIDS-related work to the tune of £1.5 billion over the next three years, which is a positive commitment. We need to ensure that fewer young people are infected with HIV and increase access to sexual and reproductive health services. In July this year, the Government published a position paper on sexual and reproductive health and rights, in which DFID expressed its commitment to addressing social, cultural and economic barriers; to using a rights-based approach; and to tackling issues outside the health sector.

I think that such an approach is vital to ensuring effective HIV/AIDS prevention, treatment and care, because as we know, HIV is more than a health issue and has a multitude of social, economic and cultural implications.

The Secretary of State referred to sex workers—the group that is perhaps most at risk. The rights and interests of women sex workers are particularly vulnerable, and they are disproportionately affected by HIV as a result. DFID's stated commitment is that it will use a rights-based approach to sexual and reproductive health issues, including HIV, and if the approach is properly implemented, it will contribute to enhancing rights, reducing the risk of HIV and mitigating its impact. However, as I think he acknowledges, DFID's rights-based approach is not necessarily pursued by other donors.

I want to bring to the attention of the House and the Secretary of State—I am sure that I do not really need to do so—the impediments imposed by the US Government in respect of making sex work safer. As the House will be aware, in 2003, the US Congress passed the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act. The passing of the Act saw a massive and very welcome increase in US appropriations with regard to HIV prevention, treatment and care internationally. However, it creates a number of funding limitations, including a requirement that no funds made available to carry out the purposes of the Act be used to promote or advocate the legalisation or practice of prostitution. One could argue about whether it is appropriate to fund or advocate the legalisation of prostitution, but I do not think that anyone can argue with the fact that the practice is widespread and has been for centuries, if not millennia, and therefore needs to be recognised and addressed.

In respect of HIV/AIDS and sex workers, experience from many programmes in different regions of the world indicates that successful programmes must have four core elements: building knowledge and self-esteem; providing sex worker-friendly health services; creating an enabling environment for sex workers and their programmes while promoting solidarity and social inclusion through participation of sex workers; and ensuring maximum coverage through forging partnerships with many groups. I do not believe that those aims can be achieved in an environment of seeking to eradicate prostitution, even if the eradication is sought through rehabilitation rather than by the use of criminal law. It is already clear that some groups that have been actively supporting initiatives to improve the health and well-being of sex workers, but are financed by the US Government, have chosen to withdraw from such work. Other such groups are rephrasing the ways in which they describe their activities.

In the long term, such developments may be more damaging to improving the status of sex workers than the withdrawal of funds. Of course, withdrawing programmes that support sex workers has an impact not only on sex workers, but on their clients, who will continue to use them. I am sure that all hon. Members will agree that one of the many lessons that AIDS has taught us is that we need to be open and honest about sexual activity. That is based on more than 20 years' experience and prevention work, and we need to maximise efforts to reduce stigma and improve protection of rights and interests. It is ridiculous to pretend that restricting funds provided to AIDS prevention and support organisations that work in that open and honest way to reduce HIV risk in general, but in respect of sex work in particular, will be effective.

I hope that the Under-Secretary will set out the Government's position and tell the House what opportunities he and the Government have had to raise the issue with the US Government. If the work has not already been done, I urge him to try to document what impact the Department expects. Has there already been an impact, and if so, can the Government quantify it?

It is a further target that 3 million people, including 2 million in Africa, should be receiving treatment by the end of 2005, and that at least half of them should be women and children. The Secretary of State referred to the "3 by 5" initiative. It is an aim of the World Health Organisation that 700,000 people should be on antiretroviral therapy by December 2004, with 1.6 million people on such therapy by June 2005 and 3 million by December 2005. As hon. Members will know, the WHO will not purchase or supply ARVs, but will work in partnership with a range of organisations.

The Secretary of State has acknowledged that that programme may not deliver the target of having 700,000 people on ARV therapy by the end of 2004. According to UNAIDS, 40 million people were living with HIV/AIDS at the end of 2003. At the end of November 2003, only 400,000 people were living with HIV and assessing ARVs in developing countries, and more than a quarter of them lived in Brazil. Furthermore, 400,000 is only 7 per cent. of the total number of people who need treatment. The estimate at the time was that about 6 million people should be receiving it. Currently, only 2 per cent. of those in Africa who need treatment are receiving it.

There is some good news. As I am sure the Secretary of State is aware, the Brazilian authorities have reaffirmed their commitment to building a pharmaceutical plant in Mozambique that will produce generic ARV drugs. A new plant has recently opened in Nigeria to manufacture ARV drugs, thanks to an initiative by Nigerian health professionals working in the US. According to the African AIDS action initiative and the Secretary of State, however, it appears that the "3 by 5" initiative will not deliver. I hope that the Under-Secretary will explain whether he agrees that the initiative will not deliver, and tell us by how much he expects it to fall short and whether the UK Government can introduce any measures in the interim to try to get closer to achieving the target.

I believe that the Under-Secretary has had a meeting with those in the African AIDS action initiative on the subject of its proposal to establish a not-for-profit ARV manufacturing facility in Kenya. It thinks that it could produce affordable treatment that would be accessible to 7.5 million Africans at a cost that is very cheap compared with that of the generic drugs that are currently available. There is one hitch, in that $550 million is required to set up the initiative. I expect a meeting to take place if it has not done so, and perhaps he will set out any feedback about the initiative and tell us whether he thinks that it is credible. As the Secretary of State and the Under-Secretary will be aware, the "3 by 5" initiative kicks in automatically for the countries that are hardest hit, but what can the Government do to ensure that other countries that are affected are also covered?

On the target to slow the progress of HIV/AIDS by 2015 and the vexed subject of the poaching, or recruitment, of foreign health workers, clearly, human resources are crucial in fighting the HIV epidemic in low-income countries, and yet, regrettably, in the UK, a large number of health workers still come to this country from abroad. For some developing countries, although not all, that is a significant issue. Clearly, South Africa is in the camp for which it is a significant issue, whereas, according to local embassies at least, India and the Philippines are in the camp for which it is not.

Interestingly, I raised this issue with the Bulgarians, whose concerns are entirely different in that they have a significant surplus of health workers, and were keen to enter into a memorandum of understanding with the UK Government to formalise some exchange arrangements. Admittedly, that correspondence dates back to February this year. I wonder whether there have been any positive developments in that respect, and whether it has been possible to draw up a memorandum of understanding with the Bulgarians, so that the surplus workers that they say are available and qualified can come to the UK and replace some South African health workers who are desperately needed back in South Africa. The Minister may not be able to respond on that point now, but perhaps he can investigate it and take it up with the Department of Health.

On the issue of foreign health workers, the Government's strategy "Taking Action" clearly states: We will make sure that the UK's own practices for recruiting to the National Health Service do not further exacerbate countries' human resource constraints. We will take action to strengthen the impact of the Code of Practice on the recruitment of healthcare workers, to prevent the use by the NHS of agencies that recruit healthcare staff directly from developing countries unless a bilateral agreement has been negotiated with the country concerned. We will encourage independent-sector agencies and employers to adopt consistent principles. There has been a further announcement—it was made three or four weeks ago—on that subject. In "Taking Action", it is not immediately clear how much more forcefully those rules can be applied than the current ones, which, regrettably, have not been terribly effective at stopping a brain drain of workers from the poorest developing countries. I hope that the Minister can be more specific about what the Government can do on that front.

On the Global Fund to fight AIDS, Tuberculosis and Malaria, the UK has increased its funding, which is welcome. According to several non-governmental organisations, however, the UK is still well short of its contribution if we take into account the UK's share of the global economy and the stated resource needs of the global fund. There is also still an issue—certainly, there was back in May—about how much the global fund is delivering in terms of disbursements, and how many projects are up and running. Back on 10 May 2004, in a written answer, I was told by the Secretary of State that

The total amount pledged to the Global Fund to fight Aids, Tuberculosis and Malaria is currently US$5.3 billion. Disbursements by the Global Fund currently total US$285 million."—[Official Report, 10 May 2004; Vol. 421, c. 60W.] Interestingly, of the $285 million that has been disbursed, $54.6 million, which I work out at roughly 20 per cent., was on administrative costs. First, therefore, it seems that relatively little has been disbursed, and if the ongoing administrative costs of running the fund are to be 20 per cent., that sounds a rather high figure. Perhaps the Minister will comment on whether the rough calculation that I have made is correct, or whether he would expect those administrative costs to go down, which is possible as things gear up and more projects come on board.

The hon. Member for Rutland and Melton, who has returned to his place, referred to the NAO report. I would also welcome clarification from the Minister as to whether the Government now have a better understanding of how much money is being spent by the UK on HIV/AIDS projects.

My final point on the target is the issue to which the hon. Member for Rutland and Melton, who has got up to speed quickly on his brief, referred: the frontiers of the epidemic. Those are countries where prevalence is low but where it could get much higher very quickly, particularly in Asia and eastern Europe. One third of people living with HIV in the world are in countries that do not yet have a generalised epidemic—nearly half the 4.8 billion people in least developed countries live in areas where the epidemic is not yet widespread, even among those most likely to be exposed to it.

In other words, the potential for a massive expansion is there. Even a small increase in infection rates in populous countries such as China, India or Mexico would represent a massive worsening of the global AIDS burden.

Ms Keeble

It is of course important to think seriously about what might happen in China or elsewhere in Asia if an HIV/AIDS epidemic got out of control, but there is a difference between what is happening in Asia and what is happening in sub-Saharan Africa, where high rates are compounded by dire poverty and, in some instances, collapsing economies.

Tom Brake

I agree to an extent, but we should not neglect the potential for an epidemic in Asia or eastern Europe. Irrespective of the conditions that prevail, there is still the potential for an epidemic on the scale that we have seen in many African countries.

Many populous regions in west and north Africa do not yet have generalised HIV epidemics, yet there is considerable migration in those areas. Let me mention in passing that I recently returned from a visit to Ghana with the previous Conservative spokesman on international development, the hon. Member for Buckingham (Mr. Bercow). I suggest that I should not share a visit with the hon. Member for Rutland and Melton, as the consequence appears to be a downgrading.

It was clear that the Ghanaian authorities were responding positively to the epidemic. A range of posters and billboards were on show. One billboard displayed the bottom half of a man's body—clad in trousers, I hasten to add—and the caption "If you can't keep it zipped, keep it covered". I thought that that conveyed the message very effectively. There was also a poster recommending abstinence, so there was an equal balance between the different views on how the problem should be tackled.

The Secretary of State mentioned education. I am glad that he has agreed to meet me, along with the former Conservative spokesman, to discuss our visit. Let me put on record now that there are problems with the fast track in relation to Ghana. Ghana has delivered a plan for education, but is short of funds. I hope that the UK Government will be able to respond.

I spoke earlier of the need to tackle the frontier of the epidemic. There is clearly a rationale in favour of focusing investment in HIV prevention on vulnerable countries where the epidemic is not yet general. In many such places, particularly throughout Asia, eastern Europe and the Caribbean, the HIV risk is not uniform. Key populations are especially at risk, including injecting drug users, men who have sex with men, and sex workers. When the Minister responds, will he tell us how much DFID is providing for the frontiers of the epidemic, as opposed to areas such as Africa where, regrettably, it is already well established? I should also like to know about the Department's policies and strategies for working with the populations that are most at risk.

Hugh Bayley (City of York) (Lab)

I am slightly puzzled by the hon. Gentleman's references to the "frontier" of the disease. The one encouraging aspect of all this is that every child who is born without HIV has a chance of that continuing until puberty. Is not every one of those children the "frontier"? Should we not respond in a way that helps people at the frontier, whether they are in Africa, Asia or eastern and central Europe?

Tom Brake:

Obviously I cannot disagree with that. I am simply saying that we need to focus on countries where HIV is prevalent, but also take account of countries where, although it is not yet prevalent in the same way, the potential is there.

HIV/AIDS is causing death and destruction on a scale not seen since the plague. The UK Government are taking the lead in the fight against HIV/AIDS. They deserve credit for that—I am happy to put that on the record—but even the UK is falling short in its contribution to initiatives such as the global fund.

With the presidencies of the G8 and EU, the UK has a unique opportunity next year to right that wrong and thereby to help unlock the wallets of less generous donors. I urge the Government to exploit their presidencies ruthlessly. If they do not, tens of millions more people will die.

3.40 pm

Mr. Neil Gerrard (Walthamstow) (Lab)

I welcome the fact that we are having this debate and can discuss the strategy that DIFID published in July. I was a bit worried when the Minister started to flatter me earlier because that does not usually do me much good with people whom I associate with politically, but I return the compliment by saying that it is important that there is political leadership. Both Ministers in the Department and the officials in its HIV team have made some important changes in the past year or two. There has been a shift in priorities in the Department.

The strategy was inclusive in the way in which it was produced. There was a lot of discussion during the development of the consultation paper and the strategy with people who work in the sector, with nongovernmental organisations and with hon. Members whom the Department knew were interested. That makes a difference when such strategies are produced. It is a lesson that one or two other Departments could learn when developing policies. If there had been a little more inclusion of that sort, we might have avoided some of the problems that we have had in other policy areas in the past year or two.

Tom Brake

Top-up fees.

Mr. Gerrard

That is a perfect example.

The strategy said, and the Prime Minister has said this on a number of occasions, too, that the G8 and EU presidencies next year would be critical from our point of view, that, during those presidencies, the UK would ensure that AIDS was at the centrepiece of what we were doing, and that it was an issue of high political importance. I hope that that will be true for the Commission for Africa, too. I hope that, over the next few months, the Department and perhaps the Prime Minister will give some more detail of how we will ensure that, while we have the presidencies of the EU and G8, we will do something in terms of the global HIV strategy. I want to see what was said by the Prime Minister and in the strategy actually happen next year.

Tom Brake

Does the hon. Gentleman agree that time is short in relation to the UK's presidencies because they start in January and the Government need to be doing the ground work now?

Mr. Gerrard

Clearly, those presidencies last a fairly short time. I am sure that work is being done. It needs to be done now, so that we can move in and be able straight away to have the sort of influence that we want.

The other issue that I want to raise in relation to the strategy is about co-ordination. The Secretary of State talked about donor co-ordination and the three "ones". Another thing that the strategy mentions is the need for coherence in the UK's development of policy. Page 3 of the strategy refers to improving coherence across UK policy-making on AIDS by establishing an informal cross-Whitehall working group on AIDS". Perhaps the Minister can tell us what progress has been made on that. It has been said already this afternoon that AIDS is not just a health issue. We want to see action by other Departments, including the Department of Trade and Industry and the Department for Education and Skills. The all-party group on Africa report, which I have no doubt my hon. Friend the Member for City of York (Hugh Bayley) will talk about later, referred to what could be done perhaps by the Department for Education and Skills to help to train people and to develop skills that will be relevant in African countries.

So perhaps we can hear a little more about what is being done to set up the cross-departmental working group, so that we can ensure that all the relevant Government Departments are involved in implementing the strategy.

The third issue, which I have raised for the past two or three years, is our level of commitment to the global fund. I certainly welcome the doubling of our commitment, but despite that doubling, some 10 per cent. only of our spending on HIV/AIDS is going through the global fund. I wonder whether that 10 per cent. versus 90 per cent. spending balance is quite right. Important initiatives that have already been mentioned, such as the "3 by 5" initiative, are going through the global fund. At the present rate of progress, we will get nowhere near the "3 by 5" initiative commitments. That is very sad, and it sends an important political message. The making of big commitments not just by the World Health Organisation but by all the Governments who signed up to the "3 by 5" initiative was symbolic. If we fall well short of them, we will send a really negative message.

I do not want to dwell on statistics but it is worth considering one or two of the current figures. Of course, all figures are somewhat speculative because they depend on the extrapolation of diagnoses; however, most people who are infected with HIV do not know that they are infected. Our figures depend on such extrapolations to whole populations, on the diagnoses that do take place, on the testing of pregnant women, and so on. This year's UNAIDS report, produced at the Bangkok conference, suggested that between 34 million and 42 million people are currently living with HIV, the median of which is about 38 million. Some 58 million people have been infected at some point, 20 million of whom are already dead.

The report of the International Labour Organisation, which was also produced at Bangkok, suggests that some 26 million of the international work force are infected and therefore at risk. That shows the potential scale of the economic impact. I was also struck by a figure from South Africa, the scale of which is difficult to comprehend. Johannesburg, a city with a population half that of London, is intending to build five new cemeteries of 120 acres each to cope with the anticipated deaths and burials over the next decade.

I want to say a little about the figures for the rest of the world, but to do so is in no way to diminish the importance of what is happening in Africa, which my hon. Friend the Member for City of York will discuss in due course. The situation in eastern Europe and central Asia gives real cause for concern. In 1998, some 30,000 people in that region were diagnosed as being probably HIV-positive. In 2004, that figure has risen to 1.5 million—a fiftyfold increase in just six years. In India, 5.1 million people are already infected. The rate of increase in infection in eastern Europe and central Asia is indeed frightening. To date, there have been 58 million infections throughout the world, yet according to the latest estimates, there could be 70 million new infections in Russia, India and China alone by 2010.

That is only six years away, which is a huge cause for concern.

I may be straying a little beyond the terms of the debate, but I want to say a few words about Russia—not usually talked about as a developing country. More than 250,000 HIV infections have been reported in Russia, but the real number is probably three, four or five times that. In the Ukraine, 70,000 infections have been reported, when the real figure could be as many as 500,000. We are already starting to see the impact on the economies of those countries and on health spending. It is possible that, purely as a result of HIV infection, Russia's general domestic product could be 10 per cent. down in a few years. The population decline that is already happening there could be grossly accelerated by new infections.

Russia is reaching the point of having a 1 per cent. infection rate in the general population, and I recall another country being mentioned earlier where it was 0.9 per cent. That 1 per cent. rate is usually regarded by UNAIDS and other UN development programmes as being the point at which the epidemic really tips over into the general population. We have seen what has happened before to infection rates in other countries. Once that 1 per cent. threshold is exceeded, it can be incredibly difficult to turn things back.

We need to be really concerned about these emerging epidemics. If we do not act now, we could see similar problems developing elsewhere as happened in sub-Saharan Africa. We need to reflect on the lessons of what has worked elsewhere, which is not easy because there is little hard evidence about what interventions appear to have worked in certain places. It is not that easy to take an approach that has worked in one country and transfer it to another. The reasons are often highly complex.

Uganda is cited again and again. One of the biggest problems there was probably the ending of the civil war. There is no doubt that the spread of HIV has been associated with civil war in parts of Africa. Whatever the reason, it is certainly complex and it is never easy to transfer across to other countries, but we have to take those risks. We need to look at what has worked before and be prepared to spend a bit of money. We are sometimes too demanding in what we expect from experimental programmes that we invest in. We need to be a bit more relaxed. Yes, we are expected to justify the spending of taxpayers' money, but sometimes I feel that we are too demanding in the degree of success that we expect. We should be prepared to take a few more risks because the nature of the crisis is such that, if we are not prepared to do so, some countries will be overwhelmed with the problem.

I hope that the Department for International Development will, over the next few years, become much more engaged with what is happening in the countries where epidemics are emerging—India, China and eastern Europe, for example, where there is real potential for disaster if we do not act. If we act now, we may be able to do something, but in three or four years' time, it may be too late.

My final point is about the consequences for us in the UK. Both the existing and the emerging epidemics have serious consequences for us. A very high proportion of those infected are in Commonwealth countries. If the epidemics develop as they might in Asia, even more people will be infected in Commonwealth countries, and many people in or on the borders of the EU could be infected. It is futile to pretend that international mobility will decrease.

I am sure that the opposite will happen, and with increased international mobility it is pointless to believe, as some on the right would like us to, that we can stop the spread of HIV through physical borders and migration controls.

People in the UK sometimes discuss "imported infections", which worries me, because it suggests that they think that we can put up barriers and insulate ourselves. We must recognise that the growing infection rate in parts of the world with which we have close connections and increased international mobility mean that we are part of the international epidemic. Too often, we talk as if what is happening in the UK is completely different from what is happening in the rest of the world, but there is one epidemic. The HIV virus does not care about immigration controls and international boundaries.

I hope that the Minister will confirm that we will not try to impose mandatory testing on people who enter this country, which would be bad for public health. The hon. Member for Canterbury (Mr. Brazier) raises his eyebrows, but mandatory testing would encourage people to avoid testing and find ways around those tests, such as producing false test certificates, which is a good way to spread infection.

We want people to take the test and receive treatment. I know that we cannot act as the NHS for the world and that we must have rules on who is eligible for treatment, but it will be extremely bad news if we go down the road of mandatory testing. Mandatory testing would sit strangely with the Secretary of State's opening remarks about the need to deal with stigma and discrimination on HIV, and I hope that the Minister will tell us that mandatory testing will be rejected.

I welcome the development by DFID of an HIV strategy, which is a significant step forward. Let us give the Chancellor credit for the last couple of spending reviews, which have provided big increases in funding. Some of us who have been involved with HIV for a good number of years are pleased by the political interest in the matter. A debate such as this would not have occurred 10 years ago, but now we have a strategy, Ministers who are interested in the subject and a Prime Minister who says that the issue is central to the EU and G8. I want to see the maintenance of that priority status and the implementation of the proposals in the strategy.

3.58 pm

Tony Baldry (Banbury) (Con)

As on so many international development issues, the House is broadly agreed on this topic. I would not gainsay or disagree with anything in the Secretary of State's comprehensive opening speech. I compliment my hon. Friend the Member for Rutland and Melton (Mr. Duncan) on his excellent debut at the Dispatch Box in his new role. Given that he was appointed to his brief only early this week, his grip on the detail of such a complex subject was impressive, and we look forward to hearing him frequently at the Dispatch Box.

I will try not to repeat anything that has been said before, but I shall begin by reinforcing what the Secretary of State said about the report produced by the all-party group for Africa, which is chaired by the hon. Member for City of York (Hugh Bayley). He is a colleague on the International Development Committee and his group has produced an exemplary report. The group received secretarial support from outside bodies, but its use of the expertise available in both Houses and of expert witness testimonies meant that it was able to produce a first-class report. It is a model for anyone interested in this matter, and I hope that people will take the time to read it.

As has been noted by both the Secretary of State and the hon. Member for Walthamstow (Mr. Gerrard), however, the problem of HIV/AIDS is not confined to Africa. There is a danger that people sometimes regard HIV/AIDS in the developing world as an African phenomenon, but the disease is growing in intensity in India, China, and in the former republics of the Soviet Union and central Asia. The hon. Gentleman said that some 70 million people may be infected in those countries alone.

One of the most pernicious aspects of the disease is that many people can be carriers for a very long time without knowing that they are infected. As a result, they do not appreciate that they are harming and affecting other people. We must therefore recognise that it threatens all the developing world and not just Africa—even though the situation there is clearly desperate.

No one would gainsay anything in the Government's call for action. I am very pleased that the Secretary of State's comments, and Government policy, acknowledge the need to focus on children orphaned by HIV/AIDS. The change in today's business did not allow time for the Select Committee's evidence on orphans and HIV/AIDS to be tagged on to this debate, but anyone interested in this matter should know that the Select Committee took oral and written evidence on orphans and children made vulnerable by AIDS. That evidence offers some compelling reading.

In its report, the all-party group stated that analysts were already talking about Africa's orphaned generation and that, at current rates of infection, that was unfortunately no exaggeration. It said that at the end of 2003, UNICEF had estimated that 11 million children under the age of 15 in sub-Saharan Africa had lost one or both parents to HIV/AIDS. The report said that, by 2010, there will be 42 million orphans in the region, of whom 20 million will have lost one or both parents to AIDS.

The population of the UK around the end of the second world war must have been about 42 million. It is staggering to think that, in Africa by 2010, the equivalent of the UK's population in 1945 will be AIDS orphans. As many people have said, being a member of the International Development Committee is sometimes harrowing but it is also a privilege. When the Committee travelled to Africa to look at DFID projects, one of our collective concerns was whether sufficient attention was being paid to those orphans. At present, as the Secretary of State said, many are being cared for by grandparents whose own life expectancy is limited. Others are being cared for by NGOs, but care arrangements are often totally random.

Members of the Select Committee were worried whether there was sufficient registration that would ensure that orphans did not get lost in the system. It is vital that those children be registered at birth and have birth certificates; if they do not, they will very often lose out on the little support that is available.

I recall a harrowing cameo at a feeding station in Malawi. Mothers were queuing to get supplementary feeding rations, and a little girl of 12 came forward with a younger sibling of about six. Their parents had died but because the elder child was not a mother according to the technical definition of the feeding programme, and because no documentation was available, those two children were denied any supplementary food. In fact, they were probably two of the most deserving and needy people in the queue that day.

In his response to the Committee, the Secretary of State said about birth registration that the UK does not have an independent policy position on birth registration, but will continue to follow the UNICEF lead in this area. Birth registration is important … We recognise the need to advocate more strongly that governments do more to develop birth registration services. In the short run community identification is a pragmatic solution to the problem. The Secretary of State also acknowledged that there had been a slow national response to children orphaned by AIDS in Africa, and it is an issue to which we will have to pay more attention.

Earlier this week, the Prime Minister made a speech on climate change in which he set some tough tests for how he will judge the success of the UK presidency of the G8. I would hope that the Prime Minister and the Secretary of State could set themselves some G8 benchmarks for international development, especially HIV/AIDS. I listened closely to the Secretary of State's speech, but the only possible benchmark I heard was when he talked of the need during the G8 presidency to try to ensure closer donor co-ordination. Of course that is vitally important, and with so many potential donors—state and NGOs—we cannot have them all knocking at the doors of underfunded ministries of health. However, it would be helpful to give a clear indication of what the Prime Minister hopes to achieve during the G8 presidency in relation to development and, especially, HIV/AIDS.

The Secretary of State mentioned health systems in countries such as Malawi. Those of us who have visited Malawi know that about a quarter of the education budget there now goes to pay for the funerals of teachers who have died. However, we must be careful when talking about the health systems of such countries, because we strip out so many trained nurses and doctors from them. Before the summer recess, Ministers in the Department of Health talked about reinforcing the NHS code on the recruitment of nurses from overseas. Early in September, the Minister of State issued a further statement. I have read the statement closely and the code still appears to be only voluntary. I am sure that the House will wish to return to the issue—perhaps in an Adjournment debate in the Chamber or in Westminster Hall—but I am far from convinced that we will avoid the danger of saying on the one hand that we need to do more for health services in countries in Africa and other developing countries and, on the other, continuing to strip out large numbers of nurses from them. One of the saddest scenes that I have seen recently was at the Lilongwe central hospital, which seemed to have almost no qualified medical staff. Prisoner patients with TB were shackled to their beds. A nurse training school cohort had just finished their training, but almost all of them were coming to the UK. Of course, we cannot prevent people with skills using them as best they can in the world markets, but we will have to consider the issue further.

My hon. Friend the Member for Rutland and Melton talked about condoms. There is a danger in HIV debates that we talk a lot about statistics and funds, but do not always address the two means of prevention—condoms and the search for a vaccine. I hope that perhaps one of the targets for the G8 presidency will be better international co-ordination, through the global health fund and other organisations, of the search for a vaccine. My hon. Friend the Member for Castle Point (Bob Spink) mentioned the work being done by Merck Sharp and Dohme and others, but however good that work is, it is still pitifully little.

A press release that Merck issued for the debate states that it has opened six major treatment centres since January 2002 in the worst affected regions of Botswana—one of the southern African countries with the best governance and best civil society—that 10,000 patients have been enrolled on the anti-retroviral treatment programme, and that 6,700 people have started therapy. Of course, that is worth while but the resource is tiny when compared with the overwhelming need. We all agree about the problem but much greater focus and energy need to be devoted to finding a vaccine for HIV.

I want to make a rather boring, machinery-of-government point, which the Secretary of State did not cover. I am not sure why the National Audit Office chose, out of all the Department's programmes, to have a go at its HIV/AIDS programme. In its criticisms of the role of specialist advisers in countries, the letters "HIV" could almost be replaced with "livelihoods", "health" or "gender". With the best will in the world, there must be an element of subjective value judgment about what specialist advisers in the Department's offices say. Not everything can be reduced to hard statistical outcomes—it is difficult to do that. At some stage—perhaps when the Select Committee next goes through the Department's corporate plan and annual review with the permanent secretary—we may need to consider why the Department believes that the NAO picked on that specific issue and what lessons need to be learned about value for money. It is clearly in all our interests to ensure that people outside do not say that money has been wasted.

We have all read articles in some newspapers that suggest that the HIV/AIDS threat is grossly exaggerated and that the estimates and predictions are wholly unrealistic. When the Under-Secretary winds up the debate, perhaps he could say why he believes that the NAO picked on that specific aspect of the Department's activities—it is one of the few times that the NAO has criticised it—and what the Department believes to be an appropriate response.

I hope that I have not repeated other hon. Members' remarks in the debate. It is good news that the Government have decided to discuss the issue on the Floor of the House; it demonstrates the importance with which we collectively view it.

4.13 pm

Hugh Bayley (City of York) (Lab)

At its heart, the debate is not about a disease, drugs or development assistance but about people. It is about children without parents, hospitals without nurses, schools without teachers and fields without furrows because the farmers are too weak to plough the land. It is about death rates that are hugely inflated by the pandemic, knocking holes in the society and economy of many countries in many parts of the world.

The death toll from AIDS will continue to rise dramatically for at least a decade in Africa and, as other hon. Members have said, in other parts of the world such as Asia and eastern Europe. In the worst affected countries, which are in sub-Saharan Africa, economies will collapse, security will disintegrate and orphaned children will be abandoned as their families and communities are overwhelmed by the worst pandemic and health emergency in human history.

In those places and countries, decades of development progress will be simply wiped out, and far from achieving the millennium development goals, some of them will move further away from them by 2015.

The Secretary of State in an excellent introduction to the debate made the point about the fall in life expectancy in so many African countries. In 1960, the average length of life in Botswana was 47 years. By the mid-1980s, it had risen almost to a European level—62 years. Now, the average life expectancy in Botswana is 37 years. In 1960, in Zimbabwe, life expectancy was 50 years. By 1980, it had risen to 59 years, and it has now fallen to 43 years.

When we look at the scale of the crisis in Africa, we are bound to ask whether it could have been avoided. The answer to that question is, to a great extent, yes, if the political leadership and resources to fight the disease had been there earlier. Again, as the Secretary of State said, there are examples—Uganda and Senegal—where action was taken early and hundreds of thousands of lives have been saved as a result. This is a real lesson for India, China and countries in eastern Europe and central Asia that needs to be learned and acted on. Brazil has learned and acted on it, as has Thailand.

I congratulate the Government on their "Taking Action" strategy, particularly my hon. Friend the Minister, who has led a remarkable invigoration and change of Government policy. It is really a step change in the UK's response, and it will make a difference to the lives of people in many developing countries around the world. The new strategy puts the UK in a leadership position among donor countries, and other countries need to follow suit. If they do so, an even bigger difference will be made to the lives of more people in developing countries. I am utterly delighted that the Prime Minister has decided to give this issue priority during the UK presidencies of the G8 and the European Union next year. That provides the best opportunity to replicate the sort of step change that we have seen in this country's policy in other donor countries.

On funding, there is still a need for substantially more money to fight this pandemic. Last year, UNAIDS said in its annual report that donors spent £2.6 billion on HIV and AIDS assistance around the world. It estimates that £6.6 billion will be needed next year and £11 billion by 2007. The UK is rising to the challenge. When the Government came to office in 1997, the UK was spending £40 million of donor assistance on combating HIV/AIDS. Last year, that had risen to £250 million, and the UK's £250 million compares with the United States' £303 million in aid.

The contributions of other donors around the world are much smaller, however. The third biggest donor is Germany, which contributes about £60 million in aid a year. If the amount of aid given to combat this great health emergency is compared as a proportion of each country's gross national income, Ireland comes top of the list, contributing £430 for every £1 million of its income. That is interesting because it is a Catholic country. Catholic parts of the world have been criticised sometimes for not giving this emergency sufficient priority.

Second in the list comes the United Kingdom, which spends £300 per £1 million of gross national income, and Norway spends almost exactly the same amount. The Netherlands spends half as much as we do—£150 per £1 million of gross national income. Germany and the United States spend about £60, or one fifth of what we spend as a proportion of our national wealth. Italy, France and Japan spend just £20 per £1 million of their gross national income.

I would like to say a word or two about how the money is used. One of the things that it is used for is to buy condoms. Development assistance from all countries buys globally about 1 billion condoms a year, but half of them come from one donor country—from this country—and 1 billion is far too few. Yesterday, my all-party Africa group and the all-party AIDS group, led by my hon. Friend the Member for Walthamstow (Mr. Gerrard), met a distinguished South African AIDS activist and campaigner, Zackie Achmat. He told us that, across Africa, three condoms are provided per sexually active man per year, so it is perfectly clear why the disease is still spreading. In South Africa, the richest country in Africa, the figure is just 10 condoms per sexually active man per year, and there is only one female condom for every six women in South Africa. It is hardly surprising that the sero-prevalence rate among girls is three or four times higher than it is among boys.

I turn now to the all-party Africa group's report and the Government's response to it. I am embarrassed by the kind things that Members on both sides have said about my role, which should not be said because the work was very much a collective effort by Members of both Houses and all parties. I want to say a particular word of thanks to my hon. Friend the Member for Walthamstow. Ours is a fairly newly established group and, at the beginning of our project on HIV/AIDS, we took advice from him and colleagues in his all-party group. That advice was invaluable, and they continued to give us help and advice throughout the production of the report.

As chair of the all-party group, I should perhaps declare an interest. To produce the report, we received funding from five sources and we are grateful to all of them—the Royal African Society, the Henry J. Kaiser Family Foundation, Merck and Co. Incorporated, CAFOD and ActionAid.

I thank the Secretary of State for the detailed and comprehensive written response that he made to the report. We shall make that available, alongside the report itself, on our website and the Royal African Society's website. He was kind to congratulate the committee on the work that it has done, but it is relatively easy to develop policy. It is much harder to commit oneself to policy as a Government. It is heart warming and reassuring to see that so many of the all-party group's recommendations have been fully endorsed by the Government, who have the responsibility to fund the recommendations and carry them out.

I particularly welcome the statement that the Secretary of State made in his response that prevention must remain the mainstay of action. Of course, it is necessary to put large sums of money into medication for those who are HIV positive, but that must not divert resources from prevention, otherwise this epidemic will continue to grow.

I was also especially pleased to find out that the Department for International Development will support Governments to incorporate nutrition and food security into their AIDS strategies. That is essential because a good diet is the first line of defence against this disease. I welcome our Government's commitment to work on nutrition with the World Food Programme and UNICEF on their planning on HIV/AIDS.

I could spend a long time telling the Government how much I welcome and support their response, but there are four aspects of policy on which I would like them to push forward a little further. When the group took evidence, we were told that some €10 billion were unspent in present and former European development funds, so we suggested that the money should be reallocated to programmes to combat HIV/AIDS. I am especially grateful to the director general of the EuropeAid Co-operation Office, Koos Richelle, who responded in detail to us and clarified the situation, as did the Secretary of State in his formal response to our report. We overstated our case, so I am happy to backtrack on that point. However, €1.4 billion of the €11 billion remaining in EDFs six, seven and eight is committed to projects that are currently dormant, and I was glad that the Secretary of State said that that money needs to be recommitted to new projects. When the Under-Secretary winds up the debate, will he give us an indication of the proportion of the €1.4 billion that might be reallocated to work on HIV/AIDS? If, as I suspect, he cannot answer that today, will he undertake to discuss the matter further with the new European Commissioner?

The group heard evidence from Dr. Peter Piot, the executive director of UNAIDS, that Uganda's Finance Minister had told him that he was unable to use all the aid offered to the country to deal with HIV/AIDS because doing so would breach the International Monetary Fund's public expenditure ceilings. We raised the matter with the IMF and Peter Heller, the deputy director of its fiscal affairs department, came to Westminster to meet us. He subsequently convened a meeting in Washington DC on 28 June of the IMF, the World Bank, the relevant UN agencies and donors, including the United States Agency for International Development and DFID. He reported back the following day to a meeting of the NATO Parliamentary Assembly's Economics and Security Committee, which was in Washington at the time. I was pleased that he said that the Bretton Woods institutions were examining ways to get around the problem.

Mr. Heller made the important point that it would be less difficult for the Governments of poor countries to accept aid if it were provided as grants rather than loans because it would put less pressure on their public finances. He also said that aid must be predictable because macro-economic problems are created if aid flows stop and start—my right hon. Friend the Secretary of State referred to such problems in his response. Erratic aid flows also create clinical problems. If people are prescribed anti-retroviral drugs for a year or two, but then the money dries up and they no longer receive them, one consequence, in additional to the dire human consequences for the people concerned, is that viral-resistant strains of HIV will emerge. Those strains will no longer be controllable by drugs and will spread to Europe and other parts of the world.

So there are good clinical and economic reasons for aid flows to be planned years in advance and to be consistent. That underlines the importance of us getting commitments from other donors to do what we have done and to increase dramatically the funding for this particular aid purpose.

I was especially pleased to see the commitment in the Secretary of State's response to work with partners including the Bretton Woods institutions to ensure that HIV/AIDS funding is treated as exceptional investment and not delayed or reduced because of expenditure frameworks. There could not be a clearer commitment to the need for the Bretton Woods institutions to redefine their policies.

In previous debates on the topic, I have stressed my view that clear guidelines about who will be supplied with anti-retroviral drugs need to be used in developing countries. I have suggested that it might make sense for donors to create a toolkit that developing countries could use to help to work out where the health priorities lie. Clinical priorities are fairly clear about the stage of the disease when it is most appropriate to prescribe drugs, but there are other more difficult issues of social criteria, such as keeping the parents of small children alive so that they do not become orphans, and of economic criteria, such as keeping health services and schools functioning.

I recognise that it is a difficult policy area, especially for people in Europe because it would be extremely difficult if we were seen to be setting policies here about who should live and who should die in Africa. For reasons that I understand, Ministers have been unwilling to go as far as I should like. In the summer, I went on holiday to Kenya and spent a little time with DFID health advisers looking at the work that our aid programme is doing on HIV/AIDS in and around Kisumu. I saw that clear guidelines are being developed to ensure that priority is given to those who need it most. I was particularly glad to see in the Government's response to the all-party Africa group's report the statement: We fully support the work of UNAIDS, WHO and other UNAIDS co-sponsors in developing normative guidance and toolkits for developing effective multi-sectoral HIV and AIDS responses. They have grasped a difficult issue and I am pleased to see a clear statement of policy as a result.

I welcome the Government's recognition of the need for African Governments to assess current and future impacts of the epidemic on key sectors of the economy, such as health care and education. The Government's response gives examples of where they have supported assessments of the impact of the disease—that is to say, the impact of a number of people dying—on education in Rwanda, Zimbabwe and Botswana. However, a similar assessment needs to be done in every country where prevalence is high—perhaps where it is higher than 5 or 10 per cent. It also needs to be done in all sectors of the economy. Health care and education are probably the two most important, but public sector management, banking and the legal profession could also be considered. The impact on agriculture should certainly be assessed.

When I was in Malawi during the famine two years ago, I sat around a table with 14 senior officials from its Department of Agriculture. We talked about what would happen if, in a few years' time, they faced another famine. I was interested in how they would cope with it and whether they would learn any lessons, but it was not clear how the lessons would be learned. Afterwards, someone explained that a majority of those 14 officials were HIV-positive and would not be there if there were a famine in five years' time. It is impossible to replace that kind of expertise in two, three or five years. We need to deal with the impact of the disease on key sectors of the economy and to plan now the training of sufficient numbers of people to deal with future needs.

As a first step, every country affected by the crisis needs not only an assessment of the impact, but the development of a training strategy to enable the human resource gaps that exist now and that will grow in the coming years to be filled. One of the difficulties of training people is that the trainers are dying as fast as those they train. The Secretary of State told us that Malawi is losing teachers more quickly than it can train them, but it is also quickly losing those who train teachers.

The all-party group asked the Government to examine whether the UK's experience of distance learning—through the Open university, for example—and the BBC World Service's considerable experience of distribution of distance learning packages through broadcasting in developing countries could be applied to Africa. In their response the Government say that Such programmes would need to be implemented through African educational institutions. The Government are right—only in-country institutions will know what shape the training should take, how best to distribute it, and how to integrate broadcasting and other distance learning methods, such as internet training packages, with other parts of their training framework. I agree strongly with the Government in that respect. Some important work has already been done: an open university has been established in Tanzania, and our Open university collaborates with the university of South Africa, their distance learning university. I hope that the Government will continue to work on that idea.

My final quote should be from an African—Zackie Achmat, whom some of us met yesterday and who is a South African AIDS activist and campaigner. We in the UK are not accustomed to NGOs congratulating the Government, but Zackie Achmat said: Blair has done a superb job on increasing the budget for HIV". Before Ministers smile too widely, I should say that I am sure that NGOs abroad are just as fickle as NGOs here, and our Government will have to continue innovating in policy terms and strengthening our commitment in this field if they are to retain NGOs' support.

The G8 and EU presidencies next year will provide enormously important opportunities to get a greater level of commitment from other donor countries. I wish the Government every success in using the presidencies to build a bigger international base of support for the work that they are leading. I shall urge Members of Parliament whom I know in other G8 and EU countries to press their Governments to deliver when they attend summits chaired by our Prime Minister, and I hope that colleagues here will do the same. If we all pull in the same direction, we might achieve not only in this country, but throughout donor countries and the rich world as a whole, the change of policy that is needed because of the nature of the crisis.