§ 2 pm
§ Mr. Deputy Speaker (Mr. Frank Cook)
Before we start our proceedings this afternoon, perhaps it would be helpful to point out that there is business in the parent Chamber today that is likely to incur several Divisions, as we all probably know. I give prior warning that the Chair will suspend for 15 minutes or each occasion, but a strict score of the time will be kept. Of course, penalty time—or injury time, as we call it—is allowed towards the end. We would normally finish at 4.30 pm, but the likelihood is that we will complete our business this afternoon somewhat later than that.
§ Hugh Bayley (City of York) (Lab)
Several colleagues on both sides of the House and I made applications for this debate to enable the House to discuss the findings of the Africa all-party group's report on AIDS, which was published two weeks ago. We are grateful that Mr. Speaker saw fit to call a one-and-a-half hour debate on this important subject so soon after the publication of our report. We also sought this debate so that we could press the Government to implement our recommendations. I say "the Government" and not just "the Minister" advisedly, because we have made recommendations for Secretaries of State in several Departments.
I wish to thank colleagues on both sides of the House for their contributions to the report, particularly to the oral evidence-gathering sessions that we held to collect views on the subject. I also wish to thank the all-party AIDS group, which gave a great deal of support and advice to our relatively younger, more recently formed group. I wish to thank those who submitted evidence to our group, and Penny Jackson, the administrator of our group, who did a tremendous job of analysing the evidence, preparing drafts of the report and dealing with dozens of redrafts from members of the group, many of which were mutually inconsistent and contradictory.
As the chairman of the group, I should declare as interests the money that we received to enable us to produce the report, from the Royal African Society, the Henry J. Kaiser Family Foundation, Merck and Co. Inc., the Catholic Fund for Overseas Development and ActionAid. I would also like to thank officials of the Department for International Development for providing informal briefing to our all-party group and for drafting formal evidence, which was submitted to us, and my right hon. Friend the Secretary of State for International Development, who gave a great deal of time at the oral evidence session at which he appeared.
The UK Government have significantly increased the priority given to fighting AIDS in Africa. That is made clear by their "Call for Action" document, which was published on world AIDS day last year. DFID is currently in the process of reviewing its policy on HIV/AIDS. Since 1997, the Government have almost doubled aid to Africa. They have increased funding for HIV/AIDS work from £38 million, which it was in 1997, to £270 million a year, and commit ted more than $280 million over an eight-year period to the global fund to fight AIDS, tuberculosis and malaria, which makes the UK the world's second-biggest donor in this field. Our Government have also led the donor community in 400WH supporting the UNAIDS Three Ones proposal: each country affected by the HIV/AIDS pandemic should have one national strategy for combating the disease, one national AIDS commission to oversee that work and one way to monitor and report progress in the fight against the disease. So much has been done by our Government, but the report's key finding is that much more still needs to be done.
The AIDS pandemic in Africa is an exceptional humanitarian crisis. At present, more than 25 million people, perhaps even as many as 28 million, in Africa are infected by the disease; 70 per cent. of those in the world who have HIV infection are in Africa, and there are now 11 million to 13 million orphans—children who have lost one or both parents to the disease—in Africa.
In 2002, there were seven countries with an HIV prevalence rate of more than 30 per cent. for those aged 15 to 49. In nearly every African country the situation is getting worse, and the long-term social and economic effects will get worse still. Richard Feachem, director of the global fund who gave oral evidence to the all-party group, described the HIV/AIDS pandemic as the worst disaster in human history—worse than the black death, which halved the population of this country in the 14th century and affected people across Europe.
It is a disaster that to a significant extent could have been avoided if African and donor Governments had acted sooner, and the disaster is still accelerating. How much worse it will get depends on how soon and how effectively African Governments, donor countries and the private sector respond to the disaster. However, there is still a window of opportunity to mitigate some of the effects and to develop coping strategies to deal with the consequences of a pandemic—the rapidly increasing number of orphans in Africa, for example. But as the months and years go by, the opportunities to cope and to mitigate will reduce. We therefore urgently recommend that the Government provide additional support and take further action in the matter. This is an exceptional crisis, which requires an exceptional response from the donor community.
The report makes several key recommendations: first, that the UK aid budget should be increased. The Government already support the target to devote 0.7 per cent. of our gross national income to official development assistance, and we now ask them to set a timetable for reaching that target.
Secondly, we ask the Government to launch their proposed international finance facility, which is a means to the end of achieving the goal of higher spending on development assistance; thirdly, we ask the Government to increase the financial support that they provide for AIDS programmes; and, lastly, we ask them to raise with the European Commission the possibility of diverting the €10 billion in the European development fund that is currently unspent to an emergency package of relief for those with AIDS.
We recommend also that our Government, other donors and African Governments support the full range of health responses to the pandemic: for example, improved nutrition, because food is the first line of defence against disease; more resources devoted to prevention services and to voluntary counselling and testing; more resources for treating opportunist 401WH infections affecting people of HIV-positive status and more funding for drug therapies to prolong the lives of those who are HIV-positive.
We come, however, to the conclusion that prevention is the most effective and cost-effective response to the pandemic. Pound for pound, money spent on prevention saves more lives than money spent in any other area. The top priority must be to ensure that resources earmarked for prevention are not diverted to other interventions. We must provide the full range of treatments, but we will need additional resources to do so.
The costs facing health systems in developing countries threaten to overwhelm them. Where there is insufficient money to do everything that ought to be done, choices must be made about where the priorities lie. Those choices must be open and transparent. They must be made at a national level in Africa and based on the principles of equity—people with equal needs should be treated equally—effectiveness, and cost effectiveness, so that the maximum number of lives are saved. They also need to be open to public debate. They should not be taken by officials or Ministers in private rooms in the capital; the people directly affected must have a say in the priorities.
Few developing countries have experience of setting explicit health priorities or of having public debate about public policy issues in general. They will need technical assistance to do so. I suggest to the Minister that the Department for International Development should commission specialists—medical ethicists and health economists—to prepare a tool kit on health priority setting for developing countries. That proposal was supported by the National Audit Office, which has recently published its own assessment on the Government's work on responding to HIV and AIDS. In paragraph 22 of its report, the NAO says that DFID should
update…its strategy to provide…supporting guidance and advice for country teams on key operational issues such as treatment".The all-party group also felt that the Government need to address the high death rates of teachers, nurses and other key workers, such as lawyers, economists and Government administrators. If professionals dying from the disease are not replaced, there is no possibility whatsoever of sub-Saharan Africa achieving the millennium development goals by 2015. The problem with replacing those people as they die is that the colleges training teachers and nurses are also losing members of staff at an alarming rate to the disease.
The United Kingdom is particularly well placed to support and help African countries to respond to the challenge of replacing professionals dying from the disease. The UK has a wealth of experience in post-school distance learning, which has been gained from the Open university. I have had discussions with the professor of education at the Open university, the BBC World Service and programme makers, who have put together distance-learning packages. Those discussions have led me to the conclusion that distance learning is a realistic practical response that can be made to work in partnership with educational institutions in Africa. Indeed, the Open university already works in 402WH partnership with the Open university of Tanzania, which it helped to create, and a university in South Africa which provides distance-learning packages for teachers. In addition, the Open university UK provides courses in Ethiopia.
The Department for Education and Skills should seriously consider devoting resources and providing support to the Open university to expand the work done in that area. The reason for highlighting the DFES is that DFID rightly prioritises primary education. It is the DFES that has tile reservoir of knowledge and experience of using the television and radio—infrastructure that generally works well in Africa, especially in urban areas—to help replace the numbers of teachers and other professionals being lost.
The NAO also offers support to this proposal. In appendix 2 of its report, it says that the UK Government should ask:Does the country have the capacity to deal with the results of AIDS attrition of key public sector workers (such as health and education sector workers)?It is right to draw the matter to our attention, but the same must be done in relation to skills employed in the private sector. The millennium development goals will not be met by aid alone. Our markets must be opened to trade from Africa, and the private sector will provide the economic growth that comes from trade.
In our report, we also stressed the need for social rescue packages in Africa to care for the increasing numbers of AIDS orphans. I know that my hon. Friend the Member for Northampton, North (Ms Keeble) will be speaking about that later in the debate, if she catches your eye, Mr. Deputy Speaker. At present, most AIDS orphans in Africa are cared for by their grandparents, but the current generation of AIDS orphans will also have children. We know that in Botswana, the likelihood of a young man in his late teens getting HIV and dying from AIDS later in life is 90 per cent. So 90 per cent. of the AIDS orphans in Botswana who have children will themselves die from AIDS. The question that we must face is that when they die, by definition—because they are orphans—their children will not have grandparents. So who will care for that second generation of AIDS orphans?
It is not a crisis that can be solved by the public sector alone. The private sector must provide prevention services and care to their employees in Africa and their families. Some companies have already taken a lead on that, and have created models of good practice. We call on the Department of Trade and Industry in the UK to work with those British companies that have created examples of good practice to spread that practice through the UK-baled business sector that is working in Africa.
We should like to see coherent and co-ordinated policies throughout all Departments in the UK Government. We think that DFID should be the lead Department, but others Departments, such as the Foreign Office, the Ministry of Defence, the DTI, the Department of Health, the DFES, the Home Office and even the Department for Constitutional Affairs and DEFRA need policies on HIV/AIDS too. Can the Minister let us know what mechanisms are in place to ensure appropriate cross-government co-ordination of policy?
403WH When the all-party Africa group was formed, its members hoped that we would not simply be a study group, but that we would create a team of parliamentary activists who would talk up the Prime Minister's and the Government's commitment to Africa, and also help to drive Africa's needs up the political agenda in both Houses of Parliament at Westminster, and in other institutions, such as those of the European Union. Following the publication of this report, we have already met the International Monetary Fund. We met Peter Heller, the deputy director of its fiscal affairs department, yesterday to discuss the concern that was expressed to us by Dr. Peter Piot from UNAIDS, that Uganda was unable to make use of all the money that was offered to it by donor organisations to address the AIDS crisis, because it would have taken the spending in its Department of Health above the expenditure ceiling set by the IMF. There is a real problem here, although I am happy to say that the IMF is seeking to resolve it.
On Monday next week, the IMF will meet the main agencies—the World Health Organisation, the global health fund, UNAIDS, USAID and DFID—in Washington DC to work out how to resolve the contradiction between the need to increase resources for health spending as an emergency measure to combat AIDS and the untoward macro-economic pressures that might result from a large increase in public spending. The answer must be to find a way of reducing these pressures, and not to cut health spending to do so.
Interestingly, a key way to reduce the inflationary pressures that a large increase in public expenditure would create in those countries would be to train more nurses, barefoot doctors—if I may describe them so—and public servants. There would then be less inflationary pressure on wages. A n Open university-inspired distance-learning package may be a way to address the macro-economic pressures that the IMF identifies.
On Tuesday next week, I will meet IMF representatives in Washington DC when I am in the chair of the NATO Parliamentary Assembly's economics committee. I have invited Mr. Heller to meet the committee to give us feedback from the meeting with the aid agencies on Monday. We will also meet the managing director of the IMF, Rodrigo Rato, to discuss the problem with him.
In passing, I should say that the NATO Parliamentary Assembly committee delegation to the United States includes Members of Parliament from 10 EU states, including an ex-Prime Minister of Italy, Lamberto Dini, and the ex-Deputy Prime Minister of Finland, Suvi-Anne Siimes.
The Africa all-party group will seek meetings with the Secretaries of State of four key Government Departments: DFID, the DFES, the DTI and the Department of Health. When the post-election settling-in period has passed, we will seek meetings with Members of the new European Parliament and the new European Commissioner for Development and Humanitarian Aid.
Finally, I congratulate the Minister on what his Department has achieved so far, which has been a step change in our Government's response to the AIDS crisis in Africa. However, a further step change is needed. Far 404WH more help is needed if we are to find a decent, human response to the worst humanitarian crisis in human history.
§ Mr. Deputy Speaker
Order. I remind the Chamber that it is customary to commence the first of the three Front-Bench winding-up speeches 30 minutes before the sitting's conclusion. Assuming that there are no Divisions between now and then, that will be at 3 pm, which allows 37 minutes.
Five Members are seeking my eye, and I am anxious to get as many in as possible—all of them, if I can. I ask Members to bear the circumstances in mind not only when making their own contributions, but when accepting or responding to interventions.
§ Mr. David Chidgey (Eastleigh)) (LD)
I take your comments on board, Mr. Deputy Speaker. I congratulate the hon. Member for City of York (Hugh Bayley) on his introduction to this debate on behalf of the group.
Tucked in the corner of page 27 of today's edition of The Independent, in a section entitled "World in Brief", is a report that southern Africa is in the world's worst crisis. It says:Southern Africa faces the worst humanitarian crisis in the world, with Aids, hunger and weakened capacity to govern, James Morris, UN special envoy for humanitarian needs, said. Some 30 million of the 40 million people worldwide infected with HIV live in sub-Saharan Africa. The average life expectancy has dropped to just 46 years and there are already 11 million orphans.The point is that that is tucked away in the corner of page 27 of that broadsheet newspaper. That demonstrates how Parliament and others have a responsibility to bring to the attention of a much wider audience the catastrophe that is facing Africa.
The AIDS epidemic is a threat to the stability of society and states, as well as to African peoples. Therefore, sporadic projects are not in themselves enough. We need to increase our funding ratios overall. The lack of political will and the social stigma of HIV/AIDS are major obstacles to international action and have already contributed vastly to the pandemic. The United Kingdom's forthcoming chairmanship of the G8 and the EU presidency will provide us with an ideal opportunity to seek to secure increased budgets and better disbursement of money and to provide a lead on the major issues that have affected our ability to tackle and address the AIDS pandemic.
AIDS is at different stages of intensity in different regions. Individual states face different social, economic and political factors, which affect their vulnerability. We need to develop an overall strategy that is co-ordinated and coherent, with carefully targeted individual programmes. DFID must improve on both those fronts. In referring briefly to the funding aims, I reinforce the comments that have been made. We must aim to establish a timetable for the target of 0.7 per cent. of our gross national income within the next Parliament. We must aim to persuade the European Union urgently to divert unspent funds—some £6.53 billion lies unused—towards tackling AIDS. We must aim to establish the 405WH international finance facility and to increase UK funding to the global fund to fight AIDS, TB and malaria to an appropriate level. We should contribute 6 per cent. of the total that has been allocated because we have 6 per cent. of the total donor GNP. Proportionality will be absolutely right.
As the report produced by the all-party group points out, there are three waves to the AIDS epidemic. First, there are the current infection rates. Secondly, there are HIV/AIDS deaths. Thirdly, there is the impact and what happens next. Our report focuses on the effect HIV/AIDS has on communities, their economies and their key workers. I should like to highlight two themes in the report. The first is impact mitigation. There is a need to address the wave effects by extending the healthy lifespan, especially of key workers and primarily through the care and treatment programmes.
Secondly, there is capacity building. We need to harness the capacity of the non-governmental organisations, businesses and community organisations through increased funding. That is not enough on its own if there are no structures or personnel to implement the programmes. The capacity to implement programmes is itself under threat from the impact of AIDS. Those are serious long-term issues. Finally, there is a need to understand and support the grass-root level organisations that have so far been underused. In many cases, they have sufficient knowledge and commitment to address the issue of AIDS in the community.
I recently visited the Soweto hospice as part of a Foreign Affairs Committee inquiry. There is nothing quite so salutary as seeing what volunteers are doing to provide succour and comfort to those who are dying of AIDS. There is also an enlightening and encouraging aspect in the work of the volunteers. Several hundred local people have been trained to work in their communities, providing basic health care to those who are dying from AIDS. We should not underestimate what the local organisations and communities can do with the minimum of help from people with the necessary medical expertise. It happens throughout the communities, even in Soweto, which we often consider as somewhere that is unable to cope with these basic issues.
The National Audit Office found that only 1 per cent. of the funding we provide is spent on impact mitigation. Only 6 per cent. is spent on capacity building and 34 per cent. is unclassified. We can rightly ask the Minister where that funding is going.
I want to draw attention briefly to the aspect of our report that recommends a balanced approach to addressing HIV/AIDS. That must be done through prevention, care and support, treatment, and impact mitigation. In practice, impact mitigation receives by far the least attention, mainly because anti-retroviral therapy is the most effective, although also the most costly, form of treatment.
I shall not repeat what the hon. Member for City of York said, as other hon. Members wish to contribute. I shall move straight on to our need to understand the impact on the communities and economies of the countries suffering the AIDS pandemic. I was at a meeting in Johannesburg fairly recently with senior 406WH executives from across the business community in what would otherwise be a burgeoning economy. My colleagues from this Parliament and I were told that the key businesses in the African economy had to plan for losing their total work force every three to four years, because of the impact of HIV/AIDS. One can imagine what that means for planning, for investment, for recruitment and training and for trying to keep a business going. The situation is even worse in the mineral extractive industries.
§ Sitting suspended for a Division in the House.2.46 pm
§ On resuming
§ Mr. Deputy Speaker
I have been informed by the usual channels that a further Division will follow immediately, but until we see evidence of that on the screens, we will proceed.
§ Mr. Chidgey
The United Kingdom is the world's second largest donor for HIV/AIDS. The key problem is not how much money is spent, but what it is spent on. The NAO's report shows that DFID does not know what impact its programmes are having and that it cannot therefore measure their effectiveness.
Ministers have been rebuked for failing to keep account of how much money is being spent on fighting HIV/AIDS, and DFID apparently does not give enough priority to AIDS when working to tackle the HIV/AIDS problem. It omits the disease from more than half of its strategy papers. The failure to tackle HIV/AIDS has jeopardised the achievement of the millennium development goal of halving the number of people living in extreme poverty by 2015.
The Minister must know the NAO's report backwards, so rather than my recounting its criticisms, perhaps he would reply to the points that were made in it.
§ Tony Worthington (Clydebank and Milngavie) (Lab)
I would love to follow that speech, but I am not going to. I hope that the Minister fully rejects it, because the National Audit Office report was humbug. I congratulate my hon. Friend the Member for City of York (Hugh Bayley) on securing the debate and on the report. It is what we should all do as Back Benchers.
I want to concentrate on the way that we treat AIDS and the relationship between HIV/AIDS and reproductive health. There is no doubt that because HIV/AIDS first came to prominence through gay sex and intravenous drug use, we neglected the fact that the infection would eventually overwhelmingly affect women. If we had seen that in the first place, we would have seen that it was a reproductive health issue.
407WH Recently, I have been very privileged to be involved in consultations in New York and Switzerland where major organisations have realised that in our reaction to the issue a wrong turn was taken. They see that reproductive health and AIDS must be linked much more closely. I was in New York at a meeting jointly called by the United Nations Population Fund—UNFPA—and UNAIDS that included the World Bank, DFID and the European Union. They all said that the linkages between reproductive health and AIDS had to be dealt with much more thoroughly and that we had missed a very considerable trick.
The silos of funding are an absurdity: there is a large silo for HIV/AIDS and a smaller silo for reproductive health. There are boundaries between sections of the same department.
§ Sitting suspended for a Division in the House.
§ 3.4 pm
§ On resuming—
§ Tony Worthington
As I was saying out of New York will come a statement to the big AIDS conference in Bangkok from the World Health Organisation, UNAIDS, the United Nations Population Fund, the World Bank, the European Union and DFID that there should be much better treatment of the links between HIV/AIDS and reproductive health
I was delighted to read in a letter from the Secretary of State that, following the launch of the Government's AIDS strategy next month,there will be a strong message to DFID country offices to ensure that implementations of HIV and Reproductive Health programs are integrated wherever possible and practical.That is a major step forward.
The other event that I went to was in Montreux. It was organised by the WHO and dealt specifically with mother-to-child transmission. From an HIV viewpoint, the difficulty with mother-to-child transmission is that one simply takes the fact that the mother is about to have a child and is HIV-infected and deals with the problem at that point. However, we will never reach UN targets if we start there; we must start with the mother not being infected in the first place and continue with the care of the HIV-positive mother in relation to future children. There must be integration between HIV services and reproductive health services.
We have achieved a major step forward. My hon. Friend the Member for City of York said that prevention was still the most import ant issue—I would say easily the most important—not just for Africa but for the rest of the world, the highly populated world that may follow. I congratulate him on his report and I thank him for the opportunity to contribute to the debate.
§ 3.6 pm
§ Mrs. Annette L. Brooke (Mid-Dorset and North Poole) (LD)
I add my congratulations to the all-party parliamentary group and the hon. Member for City of York (Hugh Bayley) on his contribution to the group and his success in obtaining this debate.
I want to make a brief contribution on children. Orphans and vulnerable children are often referred to as the forgotten children of the AIDS crisis, but it cannot be said that children are forgotten in this report. I want to use my time to highlight some of the issues relating to them.
More than 13.4 million children under the age of 15 have lost their mother or father, or both parents, to AIDS, and the number is rising fast. Nearly 80 per cent. of those orphans live in sub-Saharan Africa, and the number of orphans in Africa alone is predicted to increase by 180 per cent. from 1990 and reach a staggering 8.8 million by 2010. With HIV and infection rates rising rapidly, the number of orphans will increase sharply in the years to come and the impact will continue for at least the next two or three decades. In addition to the children orphaned, millions more are highly vulnerable because their parents suffer from AIDS or because their families are heavily affected, but there are also children who live with HIV/AIDS.
HIV/AIDS has a significant impact on the protection of children's basic rights. Under the United Nations convention on the rights of the child, a child has the right to survival, development, protection from abuse, neglect and economic exploitation, the right to participate in decision making in matters concerning them, the right to have their best interests treated as the primary consideration and the right to be free from discrimination. An appropriate response to the massive problems thus demands that children's voices are heard in the planning and implementation of HIV/AIDS programmes as part of the greater involvement of civil society. Youth representation in national HIV/AIDS plans and poverty reduction initiatives is also a necessity.
Children orphaned or made vulnerable by HIV/AIDS experience a wide array of problems. In addition to the severe psychosocial distress of losing one or both parents, they may lack food, shelter, clothing or health care. They may be forced to drop out of school or be required to care for chronically ill adults or younger siblings. They face discrimination, abuse, exploitation or exclusion from their community as a result of stigma. Without parental guidance and protection, they may themselves become vulnerable to HIV infection.
In many communities, traditional ways of caring for orphans and vulnerable children, such as the extended family system, are being severely strained by the many aspects of the impact of HIV/AIDS. The challenge is to find ways to help communities to care for the unprecedented number of children and families rendered so vulnerable.
There is a growing number of child-headed households. As livelihoods are increasingly threatened, children are forced to take on a premature adult role. They are forced to drop out of school and take up work, which is often in hazardous conditions. Young people may find it difficult to gain access to the all-important preventive messages to which hon. Members have 409WH referred. Sexual health services may become out of reach after the children have been forced to leave school. Clearly, there must be support mechanisms to plug those gaps.
The impact of HIV/AIDS on children's health goes beyond the growing number of them who are infected by it. Families that are living with HIV/AIDS will, if they are able to, spend a higher proportion of their income on treatments, which reduces the income available for other health care needs. A parent's level of illness may make it difficult for them to care for their children and that has further knock-on effects. There are issues about the transmission of the infection from mother to child and massive preventive work is needed on that. In most cases, girls are the most heavily affected. They are more likely to drop out of school to care for family members, are at greater risk of abuse and are much more vulnerable to infection. Prevention and care programmes have typically failed to address their vulnerability to HIV/AIDS. Those gaps must be addressed through strategic interventions at all levels.
We have spoken about the loss of skilled workers, particularly teachers. The loss of them has now reached a crisis proportion in parts of Africa. There is not enough capacity in the education systems to give protection to children, who need to be equipped with knowledge and skills that will reduce their chances of contracting sexually transmitted infections.
In addition to all those effects, there are the long-term economic implications of continuing to neglect the needs of orphans and vulnerable children. A recent World Bank study indicated that countries such as South Africa could face economic collapse within several generations unless the AIDS epidemic is combated. We are in the middle of a vicious circle. If we do not break it sooner, rather than later, we know what the future might hold for many people.
What can be done about the specifics, relating to children, on top of the general measures that were proposed in the report? I support World Vision's call on the Department for International Development to advocate and provide support for the completion of national orphans and vulnerable children's strategies with time-bound action plans in all countries with generalised epidemics. We had commitments in 2001 under the United Nations Assembly special sessions on HIV/AIDS, and we were supposed to have reached those commitments by the end of 2003. All of them need to be revisited, and we need some commitment to progress.
I would also just like to mention the goal of free universal primary education. It was among the millennium development goals and it is important in the overall picture if we are to make life better for children. The cost barriers to education must be removed and assistance must be given to keep children productively in school. There must be a strategy and an action plan that also includes all secondary school subsidies. Similarly, the removal of all health care user charges for children is an important goal. I hope that DFID will be proactive in all those areas.
410WH We must remember the forgotten children and take action now on behalf of the orphans and vulnerable children.
§ Ms Sally Keeble (Northampton, North) (Lab)
I, too, commend the work that my hon. Friend the Member for City of York (Hugh Bayley) did in leading the inquiry, which was one of the most stimulating that I have been involved in since I became a Member of the House. It was extraordinarily well managed and the report was extremely well written. I would like to pay tribute to everybody who helped with it and that includes the advisers.
I welcome the fact that DFID is producing a strategy and is giving greater priority to HIV/AIDS. I also welcome the commitment to funding anti-retrovirals. I shall briefly focus first on orphans and vulnerable children and, secondly, on anti-retrovirals. Those were the two pressing and important issues, both during the inquiry and when travelling around Africa before and after it.
My hon. Friend the Under-Secretary of State for International Development will see that the all-party group report says that orphans could suffer the most catastrophic single impact of the AIDS epidemic. The report sets out all the facts to support that view and I am sure that he has taken them on board, or will do so. Therefore, I do not intend to repeat them all. There are already about 11 million orphans in sub-Saharan Africa, and the number is projected to increase to 42 million.
The personal stories behind the facts are horrendous. After the inquiry, I went to Kenya and met one of the people who had given evidence. I saw her work and met one of the orphans for whom she was caring, a little girl called Anna, who was five years old and was orphaned at four after being a primary carer for her mother. Although she did not get HIV/AIDS from her mother, she had contracted tuberculosis from her, because TB and AIDS often go together. It is estimated that, in sub-Saharan Africa, 90 per cent. of TB cases are AIDS-related. A huge amount of medical care is needed in addition to the work that the woman I met was doing to support other AIDS orphans.
It is essential that proper measures are established to deal with the problems of HIV orphans—they cannot be averted, because the parents are already dead or infected. This crisis cannot be put aside; it must be dealt with. However, the most recent Department for International Development strategy document that I have seen, which followed the original "Call for Action" document, hardly mentions orphans and vulnerable children. There are no clear recommendations. It is not enough to assume that if everything else is in place and there is economic growth, benefits will trickle down to health systems and so on. The all-party group makes it clear, as does the UNICEF document, "A framework for the protection, care and support of orphans and vulnerable children living in a world with HIV and AIDS", that orphans and vulnerable children need a social rescue package of distinct and specific 411WH interventions, including access to school, pre-primary schooling, health and social care, legal safeguards of their inheritance and parentage, and counselling. We sometimes overlook counselling, but it is needed to help children to manage their grief.
The World Vision report—I think that it is the same one that the hon. Member for Mid-Dorset and North Poole (Mrs. Brooke) referred to—says that 40 per cent. of Governments in countries with generalised epidemics have no national policy to provide support to orphans and vulnerable children. One reason for focusing on that is that in our country, where we have benign conditions compared with those in Africa, we have real difficulties with children's policies, and for the same reason. They are cross-cutting and are often secondary functions in complex large Departments, and children are voiceless and voteless.
We have a Minister for Children for the first time, and even now not all the functions relating to children are under her control. Imagine what it would be like if my right hon. Friend the Minister for Children had to deal with about 4 million orphans. That is roughly the scale of the problem confronting the worst-affected African countries. I should like to draw to the attention of my hon. Friend the Under-Secretary to the all-party group's recommendation on the need to support African Governments to ensure that they have policy coherence across Departments with a clear ministerial lead, not just on HIV/AIDS, but on orphans and vulnerable children.
Many colleagues have spoken previously about anti-retrovirals. There is a need to ensure that there is proper treatment for women in pregnancy and childbirth, but I was particularly struck on my most recent visit to Africa by the need to underline the all-party group's call for the provision of anti-retrovirals as part of a strategy. The failure to provide the drugs properly is having a catastrophic result, because they are being misused. I have seen that in country after country. People are pulled back from the brink of death, but they have no long-term prospects.
I understand why the patients and their carers go down that road, because that is often best. If parents stay alive for six months, or a year of two longer, it gives their children a better chance in life. Any parent will try to ease the pain, prolong the life of their child and get those drugs in the hope that something turns up in the meantime, but it means that those powerful drugs are being misused with serious consequences. I had not realised how powerful they were, until I saw someone who had been pulled back right from the brink of death by the drugs—for six months, but then what happens? The reactions can be much worse from intermittent use of the drugs.
People will get and use the drugs. The issue for the international community is not whether we can hold back on the supplies—we cannot, and it is the height of control freakery to think that we can prevent people from using them—but to ensure that the supply lines that already exist, through a whole network of voluntary groups, private health organisations and other outlets, are properly supplied, and that the right support is provided, so that the drugs can be properly administered and used.
412WH I urge my hon. Friend, when he looks through this detailed report, which will take a lot of time to digest, to pay attention to two particular points. First, he should focus on the question of the anti-retrovirals—we must enable them to be used properly or they will continue to be used improperly. Secondly, he should focus on orphans and vulnerable children. As DFID develops its strategy and applies pressure for country strategies on HIV/AIDS, it should aim to ensure that those country strategies contain and give priority to orphans and vulnerable children. That is not averting a catastrophe, but dealing with one that is already in place.
§ Mr. Nigel Jones (Cheltenham) (LD)
I add my congratulations to the all-party group on Africa on producing the report "Averting Catastrophe—Aids in 21st Century Africa". The report makes grim reading, but also makes many positive proposals. I declare an interest, in that I am chairman of the all-party group on Botswana, and will therefore confine my remarks mainly to the AIDS problem in that country, which is mentioned several times in the report.
Botswana is a massive country in area—it is bigger than France and Belgium put together—but has a tiny population of 1.7 million. Unlike many African countries, it is a success story. The people have succeeded through a combination of good luck—they discovered diamonds shortly after independence in the 1960s—and good government. They did not have a war over control of the diamond mines, but used the wealth instead for schools, clinics and infrastructure. In raw figures, the average income of the people of Botswana is 10 times that of most other countries in sub-Saharan Africa and, through decent health care, the average life expectancy rose almost to European levels.
I first visited Botswana in 1999 on a Commonwealth Parliamentary Association delegation, led by the hon. Member for Glasgow, Pollok (Mr. Davidson). It was on that visit that I began to understand the enormity of the HIV/AIDS problem. We visited Jwaneng, one of the diamond mines run by Debswana, the company that is 50 per cent. owned by the Government and 50 per cent. by De Beers, and around which a town had been built. We were briefed on the work of the mine, its immense capital investment, and security measures to ensure that no material was stolen. However, the manager who gave the briefing seemed a little distant, and I asked him whether there was anything else that he wanted to tell us: there was. That morning he had received the results of the first voluntary anonymous saliva tests on his work force. The tests had revealed an HIV infection rate of 30 per cent. across the pay grades. We discussed the implications of that, including how one feeds that sort of information into a business plan. It meant that investment in recruitment and training would have to increase, and that new people would need to be drafted into the work force when victims started to show signs of terminal illness.
Last year—four years later—I led a delegation of MPs and Members of the other place to Botswana. We visited another diamond mine at Orapa. We received 413WH another briefing, including a section on what the company had done to counteract the impact of HIV/ AIDS. In the four years since the result of that first test, Debswana had decided that it was cheaper to screen its entire work force and, if they were infected, to give them the currently available medicines to keep them alive. If staff members were not infected, they were counselled regularly on how to remain disease-free. Throughout the country, in taxis and on posters everywhere, there is the ABC sign encouraging people to abstain, be faithful and condomise.
As a result of that policy there is some light at the end of the tunnel. Indications at Debswana show that by using anti-retroviral treatments it may be possible to keep people alive and active for an additional 10 years, thereby recovering some of the investment in training. The encouraging news is that the rate of new infection among younger members of the work force has dropped. The message seems to be getting through.
Unfortunately, the picture is not the same throughout Botswana. Debswana's work force is a tiny fraction of the country's working population. On the flight home last year I sat next to the respected BBC journalist Michael Buerk, who had been filming for world AIDS day. He had been to a copper mine in Selibe-Phikwe, where the work force had just received the results of their first saliva tests, four years after the test result in Jwaneng. The results showed an infection rate of not 30 per cent. but 70 per cent. Over the country as a whole the latest estimate is that 39 per cent. of adults are believed to be infected with HIV.
I mentioned that life expectancy in Botswana had risen because the country could afford decent health care. Without AIDS, by 2010 the average life expectancy in Botswana was expected to reach 74 years, which is pretty respectable. Now, with AIDS, that average life expectancy is predicted to be only 26—a generation and more of progress will have been wiped out. The situation in Botswana is so bad that the President, Festus Mogae, is on record as saying, "Our country faces extinction".
If it is bad in Botswana, a relatively rich country in African terms, just imagine what it is like in poorer countries that cannot afford the drugs, clinics, doctors and nurses needed to counter the problem. I visited Uganda with the Commonwealth Parliamentary Association a few years ago. The visit was led by the hon. Member for Clydebank and Milngavie (Tony Worthington). We met the enthusiastic head of the main hospital in Kampala. He told us that he would try any new drug to fight AIDS and that if he gave one dose of one of the latest anti-retroviral drugs to an HIV-positive pregnant woman just before she gave birth, there was an 80 per cent. chance that the baby would not be infected by HIV. I told him that that was marvellous. "Yes", he said, "but we don't use it." I asked him why not, and he explained that it costs £2 for the treatment, which was more than the annual budget for health care for an individual in Uganda.
"Anyway", he added, "the mother is going to die, so who will look after the baby?" I had a problem in understanding that. He was telling me that a baby would die because the country could not afford the equivalent of the price of half a pint of beer.
414WH I am often asked what Botswana has to do with us in Britain. The answer is that the variant of the HIV virus in Botswana, the C-type virus, is exactly the same as that which is increasingly being found in Britain, Europe and North America. In other words, the epidemic's escalation in Africa is connected to Britain's increasing HIV levels.
There are a few encouraging signs. Work is continuing to try to develop vaccines to prevent people from contracting HIV in the first place. The Botswana Harvard partnership started clinical trials late last year. It will be some years before trials are completed and HIV is not an easy virus to produce a vaccine against because it mutates when attacked.
It is in Britain's interest to be involved in the research to find a vaccine. It is also in the interests of the USA. When I heard that I he US Government had committed $87 billion to the reconstruction of a single country, Iraq, I could not help but feel that a fraction of that money would be better spent in finding a vaccine to save not only future people in Botswana but in preventing the spread of AIDS in Britain, Europe and elsewhere. I welcome the debate for the chance to show that many Members of this House care deeply about this awful problem.
§ John Barrett (Edinburgh, West) (LD)
I start by adding my congratulations to the hon. Member for City of York (Hugh Bayley), not only on securing the debate but on presenting the background to the issue and the case for action so well. We have worked together on the International Development Committee for several years, and it is clear from the evidence that we have taken in our inquiries that there are few bigger issues and few greater challenges facing the world than halting and reversing the global spread of HIV.
As the hon. Gentleman pointed out, the challenge is nowhere greater than in Africa, where, during a number of visits, I have seen at first hand the devastating impact of the illness. At the same time, I have seen positive signs of good, effective educational, preventive and treatment programmes. We know that well funded assistance that is targeted in the right way can make an enormous difference, and the debate has rightly focused on how aid from this country can be increased and improved.
The all-party Africa group, which the hon. Gentleman did so well to set up, summed things up in the title of its report, "Averting Catastrophe". That is the reality of where we are. In many communities and countries, we are literally facing a catastrophe. The statistics that have been quoted by many Members throughout this debate are nothing short of frightening. There are 40 million people living with AIDS, 70 per cent. of whom live in sub-Saharan Africa. About 2 million people in the region are dying annually. The country prevalence rate is as high as 33 per cent. in Botswana. HIV infection has risen from 4 per cent. to 39 per cent. in Swaziland in just 10 years.
However, the prevalence rates among young people are perhaps the most alarming feature. As the all-party group points out, infection is as high as 45 per cent. in the 15 to 24-year-old age group in Botswana, and as high as 51 per cent. in Lesotho. Without proper and 415WH sustained action, we run the real risk of witnessing the complete wiping-out of a whole generation in those countries. They are nations that, even without the HIV crisis, exist as very fragile members of the international community.
It is wrong to think of this as a poor man's disease, as it is often presented in the media. That is only part of the story. The other side of the story is that HIV and AIDS are hitting many educated professionals, as well. That presents even greater dangers, with teachers, doctors and nurses dying daily from the virus. It is clear that HIV/AIDS threatens the very education and health care programmes that we seek to expand in these countries. With so many farmers dying, the knowledge and experience that is crucial to farming the land is simply not being passed on from one generation to the next.
The challenge is clear. The real question, which has been posed throughout the debate, is how we respond to it. Despite the National Audit Office report last week and the negative headlines that were generated for the Minister's Department as a result, I acknowledge and commend the immense work done by DFID. Members from both sides of the Chamber recognise the enormous contribution that the Department makes to the global fight against AIDS. However, just because something is being done well does not mean it cannot be done better. The all-party report and the NAO paper lay down a case for the Government to respond to. DFID has been consulting on its HIV/AIDS strategy, and those reports and this debate should play an important part in that consultation process.
It is clear to me that the issue of HIV is so great that 90 minutes in Westminster Hall, while welcome, is simply not enough. What we really need is a full debate on the Floor of the House on the Government's strategy for tackling the disease at home and abroad. However, in the short time available today, what do I think should be done?
The Minister will know from my correspondence with his Department, which started pretty much after I was elected, that I believe strongly that the Government should raise UK aid levels to 0.7 per cent. of GDP. At the very least, DFID and the Treasury should set a timetable for meeting the UN target, and I was pleased to see that the all-party group made that its first recommendation.
I have never understood how the Department for Transport can produce a 10-year transport plan—the recent White Paper on air transport focused on the next 30 years—but when I and others raise the 0.7 per cent. issue with the Government we are told that moving beyond current targets is a matter for future Parliaments. If the Government are to sustain their position as a leading player in international development, they cannot shy away much longer from setting a timetable.
I have no doubt from the correspondence that I have received from my constituents that there is a general feeling of good will outside this place towards the 0.7 per cent. target. Unfortunately, reports such as that published by the NAO last Thursday, although important, can damage that good will. With any Government spending, what is important is not only the amount that is spent, but ensuring that it is spent effectively and efficiently. I fear that, without assurances 416WH that such money will be spent as effectively as possible, the public will question the Government spending more money on overseas aid.
To be fair, I should point out that the NAO reports what DFID is doing right in terms of giving people on the ground the flexibility and autonomy that they need to be effective. The problem is that the Department is failing with its impact analysis. As parliamentarians, we have an absolute duty to our constituents to ensure that taxpayers' money is spent well. Not knowing what impact their money is having makes the job of justifying such spending much more difficult. That is not only about the efficient use of the public purse; there is a practical side to it. Proper impact analysis is crucial to learning what works. With any programme or set of programmes, we need to know what went right, what went wrong, what had no effect and what can be done better. The Government's overall HIV/AIDS strategy must make that a priority.
This is not only about effective Government spending. There is also a case for the EU to reform the way in which it gives out development aid and to take a much more pro-poor attitude. It could do so by following the example set by DFID. My party and I have been fairly critical of the lack of transparency with which EU aid is distributed and of the lack of a proper poverty focus. That is not helped by the confusing administration whereby a number of agencies are responsible for distributing aid, such as the external relations directorate-general, the European Commission's humanitarian aid office and EuropeAid. Considering that the EU has such a considerable budget for aid, and considering the amount that we give the EU for that purpose, it is vital that the money is spent just as efficiently as any other money that the Government spend.
These are not new arguments; they have been presented to the Government and to multilateral institutions for many years. At the same time, though, the arguments must be presented to the Governments of African nations. There is a clear consensus that the people of Africa should determine and mould their own futures. Without proper action to tackle HIV/AIDS, it is clear that many people in Africa will not have a future. That is why it is so important for African Governments, civil society and others to play a leading role in formulating, with international support, their own action plans. We hope that the New Partnership for Africa's Development has a key role in that.
I could say much more, but it is important that the Minister has enough time in which to respond. No doubt we will have similar debates in future. We face an enormous challenge in tackling this disease, and history will judge how we faced that challenge not only by what we say, but by the decisions that we make and the action that we take in the months and years ahead.
§ Mr. Julian Brazier (Canterbury) (Con)
Like others, I congratulate the hon. Member for City of York (Hugh Bayley) on securing the debate and, more importantly, on his chairmanship of the all-party group and the report that it has prepared on this devastating situation.
AIDS is a silent enemy, often hiding behind the wall of stigma and discrimination in this country. However, its intangible nature makes it no less real, as all today's 417WH speeches have illustrated. Although drug treatments and public education have curbed its spread in most parts of the developed world, sadly that is certainly not the case in most of Africa, particularly sub-Saharan Africa. On top of that, I saw on the BBC website just this morning that it is believed that, even today, the majority of people in sub-Saharan Africa who have contracted HIV are unaware of that fact if AIDS has not yet developed.
AIDS has now been acknowledged as the biggest threat to Africa's development and the No. 1 overall cause of death in Africa. About 25 million Africans are living with HIV and AIDS, and there are 13 million AIDS orphans, a fact on which a number of earlier speakers dwelt. Sub-Saharan Africa is by far the most-affected region of the world, according to the United Nations and the World Heath Organisation. Only 50,000 out of 4 million sufferers are receiving the required treatment in the region. In Swaziland, for example, the UN says that school enrolment has dropped by more than a third, largely because girls are taken out of the classrooms to be used as carers.
AIDS hits hardest where there is widespread poverty and inadequate health care, where many people go hungry and malnourished, where men leave their rural homes to travel to cities to find work and where girls and women are ignored when they refuse to have unprotected sex. That was discussed at greater length in our previous debate on the subject. Those conditions apply extensively in sub-Saharan Africa.
AIDS is not just a health issue; it is something that affects individuals, a disease that shatters families, communities and whole countries. Beyond the huge personal cost of losing a loved one to AIDS, there is the economic loss to the country and its ability to sustain the next generation. In some countries, AIDS is wiping out whole sections of the work force in key roles: teachers, farmers, health workers, civil servants and young professionals. HIV/AIDS has caused more long-term damage to national economies than we realised until recently. As it kills so many young adults, it weakens the mechanism through which human capital is accumulated and transmitted across generations.
In Botswana, which the hon. Member for Cheltenham (Mr. Jones) spoke about, in Malawi, Mozambique, Swaziland and other countries, people die on average in their 30s. Previous speakers have rightly dwelt on the plight of the children left behind; shocking statistics hammer home the point that generations who are needed to fuel the economic development of those countries—in plainer language, to care for the children—are being lost to the epidemic.
We had a good debate on the issue six months ago and, looking back on it—I do not say it sourly—I found the Government's response disappointing in one respect: almost all the targets quoted were monetary. The hon. Member for City of York made a cogent case for more money and the all-party group had the ingenious idea of diverting the huge pot of unused money in the EU—an unaccountable institution about which a number of us have concerns relating to transparency. However, targets in the long run must not be how much is spent on programmes, but what difference they make on the ground.
418WH I make no apology for returning to the five proposals at the heart of tackling AIDS: first, a more integrated approach, combining the scientific expertise of pharmaceutical companies with the practical experience of non-governmental organisations that work on the ground, and working with the host Governments and their various agencies. It is crucial for the global health fund to adopt a co-ordinated strategy when disbursing funds, rather than finding ad hoc projects.
Without the slightest shadow of a doubt, the finest example in Africa of a co-ordinated assault on HIV/AIDS is that of Uganda, where the Government took the lead and undertook a blunt HIV prevention campaign. They deserve huge credit for recognising the magnitude and impact of the disease as early as 1987, when half the world did not even know what the word meant, and for adopting the ABC approach.
I was intrigued by the comments of the hon. Member for Cheltenham about the diamond mine that he visited, where the management picked the Ugandan programme off the shelf as a model, as their Government are doing rather less. As he said, the ABC approach is, first, to teach abstinence to young people; secondly, to teach people to be faithful to their spouses and partners and, only thirdly, to use condoms. That highly organised national planning exercise mobilised Government Ministries and NGOs; the Churches played a big role and the business sector, the media, and, crucially, schools, all worked together. The impressive outcome of such efforts was a reduction of more than 50 per cent. in HIV sero-prevalence over just four years. As far as I know—I stand to be corrected—Uganda is the only country in Africa that has achieved a huge reduction in the rate of new HIV infections.
Secondly, Conservatives believe that it is vital to build up the infrastructure that is necessary to administer medical care, focusing in particular on drugs. Apart from Uganda, most countries in Africa still do not have that wider infrastructure. If people are to have the benefit of treatment for HIV/AIDS, they must have access to as full a range as possible of medical care. I particularly like the idea in the report of the hon. Member for City of York and his group of using distance learning through the Open university and others for filling the desperate gaps that are now appearing in the human infrastructure of the health services in those countries.
Thirdly, following on from that, we would ensure that a significant proportion of the UN global health fund is spent on purchasing the anti-retroviral drugs that are needed to treat people with AIDS. Pharmaceutical companies are already selling their drugs far cheaper in Africa than they are in Europe. For example, all six of GlaxoSmithKline's HIV/AIDS medicines are available in the poorest countries at prices up to 90 per cent. lower than those charged in the developed world. That impressive example of corporate social responsibility should be encouraged. There are examples of corporate social responsibility in other sectors as well; the hon. Member for Cheltenham gave an example of an enlightened employer.
Fourthly, Conservatives believe that the global health fund should purchase anti-retroviral drugs to be administered to pregnant women. I want to leave the Minister as much time as possible to reply, so I shall not repeat the extremely cogent point of the hon. Member 419WH for Cheltenham. As an example of a lifesaver, that is surely the one area where the smallest sums of money can produce the largest returns.
Our fifth and final proposal is that the global health fund should work harder to encourage research and development by pharmaceutical companies into diseases in the third world. Those companies, which are in business to make a profit, invest hundreds of millions of pounds in drugs, the majority of which do not make a return on the investment. Sadly, the drugs least likely to make a return on the investment are those for developing countries. If we were to give companies guarantees on their intellectual property rights—there are other routes as well—we would encourage them to ensure that desperately needed investment in more powerful drugs with fewer side effects is actually made. I apologise for this analogy, but that is the critical club in the golf bag that is needed to tackle this absolutely hideous problem.
To conclude, it is far too easy for us in the developed world to think of HIV/AIDS a somebody else's problem, affecting those who are nameless, faceless and a very long way away. It is up to us not to pass the buck but to confront the issue and do our utmost to assist, educate and nurture the sufferers—especially in Africa, which, proportionately, has the worst problem—their orphans and those who are not yet infected but whose ignorance about the illness is one cause of its continuation.
The Parliamentary Under-Secertary of State for International Development (Mr. Gareth Thomas)
Thank you, Mr. Cook. I, too, join others in congratulating—
§ Mr. Deputy Speaker
Order. I would be remiss in my duties were I not to remind hon. Members that when the House took the decision to conduct proceedings in this Chamber, it determined that the occupant of the Chair be addressed as Mr. Deputy Speaker.
My apologies, Mr. Deputy Speaker.
I am grateful to my hon. Friend the Member for City of York (Hugh Bayley) for securing this debate. I congratulate him not only on that bat on his continuing advocacy for HIV/AIDS sufferers in Africa. I also congratulate him on the timing of the publication of the report and of this debate, as we in the Department for International Development are working on publishing a strategy shortly. It will deal with many of the concerns that hon. Members have raised today and will demonstrate that the Government are significantly scaling up their response to this appalling crisis.
I know that the Secretary of State enjoyed giving evidence to the all-party group, and I certainly enjoyed my opportunity to discuss the conclusions of its report. I agree with the point that all hon. Members made that this is an exceptional crisis deserving of an exceptional response; the UK Government must do dramatically more than they have so far, and more funding in particular will be needed as part oft he scaling-up of our response.
A number of hon. Members touched on the scale of the challenge facing us. Last year, AIDS killed 2.3 million Africans, some 3.2 million Africans became 420WH infected, and overall 26 million Africans were living with HIV/AIDS. It is also worth mentioning India, because we must not only address the impact of HIV/AIDS in Africa when considering our response. Some 4.5 million people in India are living with HIV/AIDS, and if its rate of growth of infection continues, by 2010 there will be more people living with HIV/AIDS in Asia than in Africa. We need to make sure that our response is coherent not only in terms of what is needed in Africa but for other continents.
On 1 December last year, we published a "Call for Action" setting out what we believe are the fundamentals of what is necessary to scale-up the international community's response to HIV/AIDS. They are: stronger political direction, higher levels of funding, much better donor co-ordination, and better HIV/AIDS programmes.
On stronger political direction, we are working to push the response to the crisis up the agenda in all the international forums in which we have a role. HIV/AIDS in Africa will be one of the key priorities of our presidencies of the G8 and the European Union. We are busy working on a new UK HIV/AIDS strategy; that will be a key step in a UK cross-government response intended to accelerate our contribution to combating the epidemic.
As my hon. Friend the Member for City of York said, we are the second largest funder of work on HIV/AIDS and sexual and reproductive health. We spent £270 million in 2002–03, which is a sevenfold increase on the £38 million that was being spent when we came to power. We have committed $280 million to the global health fund, and in line with that commitment we provided £30 million to the fund in May.
One of the tragedies of the response to HIV/AIDS is that many of the other international multilateral organisations that have a role get nothing like the publicity that the global fund has rightly been able to secure. We need to think about our funding of and work with other bodies, such as the World Health Organisation and UNICEF, which is the UN's children's organisation, and with UNAIDS as the key co-ordinating mechanism. In response to that, we have recently doubled our funding to UNAIDS.
My hon. Friend suggested that a toolkit was necessary for the setting of our priorities for developing countries, and I agree with him. That is a function for UNAIDS rather than the UK. Similarly, the World Health Organisation must lead in giving developing countries the technical advice that they need on treatment and care, and our funding helps to support it in doing that.
I strongly support too the all-party group's recommendation on the need to support the proposal for the international finance facility. That has the potential to deliver huge additional funds to help us tackle HIV/AIDS and to address the other necessary millennium and development goals.
My hon. Friend expressed a series of concerns about the possibility of developing countries or the International Monetary Fund seeking to put a cap on the total resources available for the fight against HIV/AIDS, because of economic and inflationary concerns. I understand the importance of that debate, and I welcome the fact that the all-party group has sought to 421WH push it up the agenda. The benefits of substantial resources for HIV/AIDS may outweigh those genuine economic concerns, if donors can commit to delivering resources predictably and over the long term. However, the debate that the all-party group has started is important, and I welcome the fact that it is to have further dialogue with the IMF on those issues.
Co-ordination is absolutely critical. In Uganda last year, there were some 30 different donor missions on HIV/AIDS. In Angola—in response to the issue raised by my hon. Friend the Member for Northampton, North (Ms Keeble) about access to anti-retroviral drugs—there were 15 alone just to consider the issue of treatment. One of the UK Government's key tasks is to try to stimulate better donor co-ordination and harmonisation with the priorities of other Governments' plans. It is particularly significant that, at the international conference in April to promote UNAIDS's Three Ones agenda, which the Secretary of State helped to chair with UNAIDS and the US, we were able to secure the support of all leading donors.
My hon. Friend the Member for Northampton, North and the hon. Member for Mid-Dorset and North Poole (Mrs. Brooke) raised the particular issue of orphans and vulnerable children. I agree absolutely that we must do much more in that regard. When I was asked to appear before the International Development Committee on that issue, I highlighted the fact that only six countries in Africa have strategies specifically addressing the needs of orphans and vulnerable children, and that only four have legislation to back up those strategies.
We are working with UNICEF to try to change that. We need costed plans and strategies, and we are supporting UNICEF's work in that area. My hon. Friend and the hon. Lady rightly highlighted that getting children back into school, getting parents treated, and getting money to households to help them to deal with orphans are three of the fundamentals of an 422WH effective response in-country to HIV/AIDS. Our strategy will demonstrate the UK Government's commitment to giving further priority to the issue.
My hon. Friend the Member for Clydebank and Milngavie (Tony Worthington) highlighted the importance of the integration of policies on sexual and reproductive health with those on HIV/AIDS, which is fundamental. I saw for myself when I visited the Sonagachi slum in Calcutta how work by a health clinic to train sex workers in understanding the risks of sexual and reproductive health and HIV/AIDS was helping to make a significant impact on levels of HIV/AIDS infection in Calcutta, compared with other cities in India. Clearly, interventions such as that will continue to be necessary.
The hon. Member for Canterbury (Mr. Brazier) raised the ABC strategy of the Ugandan Government. I agree with him that they deserve considerable praise for their political leadership, for their success in reducing HIV/AIDS, and for the significant sums of money that they have committed to the problem. There is a role to play in encouraging a delay in the onset of sexual activity, but when we consider the issue, we must recognise that large numbers of women in Africa living with HIV/AIDS have been infected by their husbands, so the third prong of the ABC approach—the issue of condoms and of her advice about sexual and reproductive health—is absolutely fundamental. We must do more in working with, for example, the United Nations Population Fund to extend access to condoms and information about sexual and reproductive health. The strategy that we hope to publish shortly on our work on sexual and reproductive health will, I hope, give further comfort.
I do not think that the hon. Member for Eastleigh (Mr. Chidgey) mentioned that the National Audit Office report praised DFID's approach, comparing it well with those of other like-minded donors, saying that our approach is flexible and responsive, and acknowledging that we have significantly increased our spending on HIV/AIDS-related work. We shall compile a full report on that work, and I am sure that the concerns raised by the NAO will be properly dealt with in our forthcoming HIV/AIDS strategy.