§ Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Kemp.]
9.30 am§ Mr. Mark Lazarowicz (Edinburgh, North and Leith)I take this opportunity to raise one of the most important issues facing the world community—the crisis caused by the spread of HIV/AIDS, which is wreaking destruction in much of the world and which threatens to do so in much more of it. This is not the first time that the crisis has been raised in the House of Commons and I am sure that it will not be the last.
I pay tribute to the many hon. Members present, whose interest in the issue goes back over many years. It is particularly appropriate to raise it again now given the greater public awareness and concern that I have noticed in the past few weeks. That development was no doubt stimulated by some of the excellent media coverage. Hon. Members may have read the reports inThe Guardian, andThe Sun has also run an excellent campaign on the issue. Furthermore, there has been considerable coverage on the BBC and I am sure that other media sources have recently covered the issue.
It is also appropriate to raise the subject again now because the world's attention is understandably focused on events in the middle east. We must ensure that the same attention continues to be paid to crises such as that caused by the spread of HIV/AIDS. The AIDS crisis could have even more wide-ranging consequences for the world community, not least because of the insecurity that could threaten the entire world. Only a few weeks ago, Colin Powell rightly described the AIDS crisis as being as serious a threat to global security as international terrorism.
The basic facts about the crisis are well known and I do not intend to repeat them at length. However, I want to highlight some of the latest figures on the extent of the crisis. The most recent figures from UNAIDS—the joint United Nations programme on HIV/AIDS—appeared a few months ago. In 2002, the epidemic was estimated to have claimed more than 3 million lives and an estimated 5 million people became infected with HIV, 800,000 of whom were children under the age of 15. That is estimated to bring the total number of people in the world living with the virus to 42 million. Life expectancy in some countries has now fallen by 20 years and UN estimates for world population growth have been revised downwards because 300 million people are expected to die from AIDS in the next half century.
The situation is much worse in some countries and the estimates in southern Africa are particularly severe. About 29 million people now live with HIV/AIDS and infection rates in some countries run at more than 30 per cent. of the adult population. Botswana, for example, is expected to lose one fifth of its population by 2050. Those are staggering figures.
254WH The crisis is not only developing in southern Africa and the epidemic is undergoing fast rates of growth in Russia and the Caribbean. In Asia, in countries such as India and China, the figures are already high and estimates suggest that there are 6 million HIV/AIDS sufferers. The figures suggest that the sub-Saharan rate of infection could be replicated in Asia in the next few decades. The International Development Committee recently reported to that effect.
As hon. Members know, the consequences of the spread of HIV and AIDS are found not only in health programmes, health policies and the health of the individuals affected; the crisis has major implications for development programmes in general because of its impact on economies and social systems. It is estimated that by the end of the decade the per capita gross domestic product in the countries hardest hit by the disease may drop by as much as 8 per cent. AIDS has the knock-on effect of increasing the number of people living in poverty. For example, if a family's main breadwinner becomes infected, that clearly affects the entire family.
There is a real fear—or rather an expectation—that the objectives of halving extreme poverty as part of the millennium development goals may be jeopardised. Key Government workers in developing countries are being lost to the disease and AIDS is reducing the ratio of healthy workers to dependants. In agriculture, AIDS is severely affecting the ability of countries to invest in, or sustain, capital-intensive methods of production. That is exacerbating the food shortages that are being experienced in many southern African states. Farming skills are being lost. Craft skills are no longer being passed from parents to children. A new generation must struggle to find a livelihood. Irrigation schemes are not being maintained. Farms are being abandoned and families are returning to subsistence farming. All that is contributing to the present famine in southern Africa.
The effects go beyond agriculture into the social sphere. The spread of HIV/AIDS, as well as overburdening the health and social security systems, is having a serious impact on education services. Teachers and students die and older children must leave school to look after siblings. The millennium development goal of ensuring universal primary education is also at risk in the worst affected countries.
§ Dr. Jenny Tonge (Richmond Park)Has the hon. Gentleman reflected on the number of AIDS orphans in the world? That will cause a huge social problem in developing countries.
§ Mr. LazarowiczIndeed it will. Another of the awful statistics is that in Africa alone there are more AIDS orphans than there are children in the United Kingdom.
What action is needed from the world community—and from this country—to tackle the crisis? They know what needs to be done. The question is whether the world community will exercise the common will to tackle the crisis. There are three priority areas. First, education is vital. A greater awareness of how to prevent the transmission of the virus is crucial to the successful combating of the disease in the developing world. I welcome the emphasis that the Department for International Development has placed on support for 255WH education programmes in the worst affected countries. It is commendable that it directs its efforts in particular at the 15-to-24 age group.
Money is also a vital question. Above all, there is a need for commitment to a major programme of multilateral funding. All hon. Members in the Chamber must welcome the setting up of the global fund to fight HIV/AIDS, tuberculosis and malaria. That is the most important initiative in this context since the crisis developed. The global fund has certainly enabled greater attention to be focused on fighting those diseases. The Government's support of the fund, which comes in addition to their significant spending on bilateral HIV/AIDS programmes, is very much to be welcomed. Although the UK's commitment is welcome, however, and the £138 million that the Government have committed to the fund for the next five years is a positive step, it still needs more money. A severe funding gap is opening up and serious questions are being raised about its future. After all, although $10 billion was called for, only $2.2 billion has been pledged to the fund by countries and only part of that has been delivered and allocated to programmes aimed at tackling HIV/AIDS. More money is needed from the world community, but also from this country as part of that community.
The third problem is access to necessary drugs. Every hon. Member who has been following the issue will be aware of the continuing failure to reach agreement on measures to allow developing countries access to the cheap drugs that they need to tackle HIV/AIDS and a range of other diseases. I am sure that we would all agree with the Chancellor of the Exchequer about what needs to be done. He said:
It's time that all recognise the responsibilities to help avoid unnecessary deaths and that means we've got to get an agreement for the trade round.He said that the problemis a terrible indictment on a world that has the technology, the drugs and the resources to be able to solve these problems—and when you think of the hurt that any infant death causes you've got to understand that so much more could be done".The Chancellor was absolutely right when he said that and I am sure that he speaks for most people in the country.I mention in passing that even though we hear talk about the growing transatlantic divide, one matter on which there is a lot of agreement, especially where it concerns some of the big pharmaceutical companies in Europe and the USA, is the view that there is a reluctance to reach a fair settlement on the issue in question. I do not have time to go into the debate about the failure to reach an agreement on access to cheap drugs in detail. All I shall say is that only two weeks ago there was yet another failure to reach agreement in the World Trade Organisation. Every day that that agreement fails to be made is a day less in the lives of millions of people in developing countries who cannot afford the drugs that they need for their condition.
Once again, although I praise what the Government have done to take a lead on the issue and want to express my backing for what they have done so far, I should like them to do more. The Government certainly cannot take on the burden for the entire industrialised world. 256WH However, even allowing for that point and the welcome sums that they have pledged, the sums are relatively small. Without going into the rights and wrongs of events elsewhere in the world, I observe that the sums that we are pledging to the global fund are a drop in the ocean compared with those that we have put aside for contingencies for possible events elsewhere.
I am aware that other hon. Members wish to speak, so I shall end my contribution by posing a number of questions to the Minister about the Government's future policy on the international HIV/AIDS crisis. I hope that he can give some positive responses to those questions, so that we can underline today the country's continuing commitment to playing a leading role in the international community's efforts to tackle the crisis. First, there are fears that money is drying up and that the long-term future of the global fund is not secured. The international community should not wait for results from the fund before making contributions. I should therefore like to hear from the Minister what the Government's plans for financial commitments to the fund for the next five years are and, if possible, what their long-term attitude is.
Secondly, the World Health Organisation and UNAIDS have a target of treating 3 million people who have HIV/AIDS by 2005. Does the UK see itself as part of the partnership aiming for that target? How do the Government envisage achieving it?
The third question is on the way in which the health systems in developing countries can deliver the service and the drugs to those who are affected. Bearing in mind that drugs on their own are not enough—there has to be access to the relevant services as well—what are the UK Government's plans for supporting health systems in developing countries and, more importantly, will there be a trend in the financial support from the Government to encourage support for the health systems in the countries that are affected by HIV/AIDS? My fourth question relates to the third. How will the UK's bilateral programmes link to global fund programmes?
Fifthly, what monitoring mechanisms are in place to ensure that the DFID money goes to supporting the health systems? Do monitoring systems exist in all the countries to which we give financial support? My sixth question concerns another important matter. How can the global fund ensure that the country co-ordinating mechanism enables the civil societies in the countries affected to participate not just in making proposals regarding funding, but in their implementation over the years?
Finally, what long-term commitments can we give to the countries worst affected by the crisis? We all know that for a health ministry in a developing country to plan a proper anti-retrovirals programme, it must have commitment from international donors, not just for short periods of, say, three or five years, but for up to 10 years. What commitment are we going to make on long-term contributions to the global fund and to our own bilateral programme? Without long-term commitment, we will not be able to tackle the HIV/AIDS crisis and by failing to tackle it we shall allow it to become more serious throughout the world.
We need a long-term commitment and more funding, and we need them on a continuing basis over many years. I hope that the Minister can give some commitments today.
§ Tony Baldry (Banbury)The hon. Member for Edinburgh, North and Leith (Mr. Lazarowicz) has done us all a service in introducing this debate so well and so succinctly. It is good to see the Under-Secretary of State for Foreign and Commonwealth Affairs, the hon. Member for Harlow (Mr. Rammell) here. I appreciate that the Secretary of State and the Under-Secretary from the Department for International Development are doubtless overseas on Government business, but I am glad to be able to thank the Minister, on behalf of the International Development Committee, for the incredible help that ambassadors and high commissioners give us in our work around the world. They are unfailing in their courtesy, support and good humour, notwithstanding the various demands that we place upon them. Foreign Office Ministers do not often take part in these debates.
I hope that I shall not repeat anything that has been said. The US Government have announced a $15 billion dollar programme over the next five years to combat HIV/AIDS. It is a go-it-alone fund, which will work on its own terms and only through US aid agencies. It will ignore existing structures, relationships and action plans already in place in those countries, especially Africa, already affected most by the HIV/AIDS pandemic. As theFinancial Times recently observed,
As a recent convert to the war on Aids, the US administration has latched on to a simplistic vision of what to do, based on the example of a single country—Uganda. It knows little of the measures in place in different parts of the world and has not recognised that each country needs to shape the best local response. It is here that the Global Fund plays an important role.I would go further. The issue is not just the global health fund, but the European countries' response to the United States' proposals. Although the US effort is a bold part, it is only a part of the total financing needs. Its limits are implicit in the fact that it is directed only at HIV/AIDS. It does not deal with malaria or tuberculosis and the American fund will he operational in only 14 countries.The global fund will require new donor support of about $7 billion this year and next—roughly $3.5 billion a year—to meet the needs of the high-quality proposals that it is considering. A reasonable financing framework is thus clear and I believe that Europe collectively should match the US initiative with our own $3 billion a year contribution, while Japan and other donors should contribute at least $1 billion a year in addition. That would make a total of at least $7 billion a year during 2003 and 2004. Half of that should be devoted to the global fund and the other half should be spent on programmes that would indirectly bolster, rather than undermine, the fund.
As the same article in theFinancial Times noted,
Silence from Europe at this moment would be deadly for the Global Fund. If the US is the only country to put up large new sums for the war against Aids, then it will be a US programme. On the other hand, with a bold European response to Mr. Bush's daring initiative, the transatlantic alliance—under great strain over Iraq—would prove to the world that it continues its historic commitments to freedom and human betterment. Impoverished and dying people around the world await a clarion call from the US and Europe together.258WH International partnership to combat an international problem is imperative, but what has been the UK Government's response? I appreciate that this is not the Minister's brief and I hope that he will prevail on the Under-Secretary of State for International Development to respond to any questions raised in the debate that he feels are worthy of a more detailed response.
I do not doubt the commitment of the Treasury and the Department for International Development to fight HIV/AIDS, but a recent interview given by the Chancellor is telling. He has, rightly, said that there needs to be far faster progress on trade-related aspects of intellectual property rights—TRIPS—at the current World Trade Organisation negotiations at Doha, which means Governments, such as the US Government, doing much more to make drug companies, such as GlaxoSmithKline, allow their drugs to be patented. Disappointment about the fact that a recent vaccine for AIDS has failed is well understood, but the Chancellor also alluded to the Government's new idea of an international financing facility.
§ Dr. TongeI am sure that the hon. Gentleman would hate to give the impression that the vaccine initiative had totally failed. Only one vaccine was being developed for the western strain of the virus and many other trials are taking place in the world.
§ Tony BaldryI was simply pointing out that there must be disappointment about the fact that the present vaccine trial has failed.
The problem with the international financing facility is that it does not have the support of the United States. It does not necessarily have the support of UK non-governmental organisations, because it does not make clear where the UK will stand on overseas development investment after 2015, nor what will happen to the UK's commitment to reaching a target of 0.7 per cent. of gross national income for overseas development investment.
In sub-Saharan Africa, 30 million people are victims of HIV/AIDS and as many as one in four people in countries like Zambia have AIDS, so Africa will not necessarily meet the United Nation's 2015 goals even with the international financing facility. Africa is the only continent going backwards as we speak and although the world is ravaged by the HIV/AIDS pandemic, Africa is at its epicentre. The World Food Programme estimates that 14 million people face serious food shortages in southern Africa this year, with the same number in Ethiopia and the horn of Africa, partly because hunger begets AIDS as AIDS begets hunger.
What is needed is not an international financing facility for HIV/AIDS but a straightforward commitment to the facilities and mechanisms that already exist. We do not need to invent or create new financing mechanisms; we need to support those mechanisms that already exist, such as the global health fund. I recognise that that fund has its problems. I suspect, however, that those problems are not caused by the structures that it offers, but are a result of the financial commitments that it receives from us and from our partners in the European Union.
259WH I hope that I can prevail upon the patience of the House by sharing a letter that I recently wrote toThe Independent, in which I stated:
Sir: Prior to the International Aids Conference … the devastating report from UNAids demonstrated the urgent need for renewed policies on HIV/Aids in both the developed and developing worlds to combat the pandemic in poorer countries.On the part of richer countries to prevent HIV/Aids, it is clear that the Global Health Fund simply isn't working. Whilst such trust funds act as a good mechanism to raise the profile of a specific issue it is less good when the issue's profile is high but only a lowly third of money pledged is actually reaching the Fund. Money surely would be better invested direct to African countries' administrations and local NGOs. On treatment also there is a need for further commitment from countries like the US, Canada and Japan at the forthcoming Doha trade round to ensure that poorer countries are given the capability to copy patented HIV/Aids drugs produced in other better equipped countries.Nonetheless, on the part of some poorer countries themselves, if more aid is to go to their governments, then still more needs to be done to recognise the extent of the pandemic. No doubt the recent South African court case was a massive move forward but ambiguities still exist in their approach and until these are removed treatment and prevention will stagnate.The reward would not only be preventing the HIV/Aids crisis escalating ever more; recent estimates also suggest that the economic boom for everyone would be US$186bn each year. I suspect this would benefit African countries more than the recent G8 summit.I hope that the Government will give the global health fund every possible support. More importantly, however, I hope that they will encourage our European Union partners to match what the Americans are putting into the fund to ensure that it has the requisite funds necessary to do over the next two to three years what it was set up to achieve.
§ Tony Worthington (Clydebank and Milngavie)As the hon. Member for Banbury (Tony Baldry) said, this is a timely debate, particularly as President Bush has announced a huge expansion in AIDS financing—£10 billion is a lot of money and in normal circumstances, it would be welcomed enthusiastically. Apart from anything else, as the hon. Gentleman said, it will put great pressure on other countries, including ourselves, to increase our contribution to work on AIDS, particularly the global health fund. However, the way in which Bush is doing it raises great doubts.
I want to raise two issues. First, as the hon. Gentleman said, why has the President virtually ignored the global health fund and allocated only $1 billion of the new money to that fund? That represents only $200 million a year from 2004; he has decided to disburse $9 billion unilaterally. I also want to talk about links between the treatment of AIDS and reproductive health services. By doing so, I shall demonstrate how Bush's decision to keep money out of the global health fund and his attitude to reproductive health are linked.
Initially, the United States embraced the global health fund and although it was criticised for not giving enough, its contribution was far in excess of any other donor. Why is it turning its back on the global health 260WH fund as a disburser, setting up its own administrative procedure and limiting its funding to 12 sub-Saharan countries and two Caribbean countries? That is happening when the global fund does not have money for a third disbursement of grants in October, which leaves most sub-Saharan countries, including several badly affected countries, such as Malawi, out in the cold. That also has major implications for the global health fund's choices about the distribution of its funding. It also implies disaffection with the fund. That is even odder when one knows that Tommy Thompson, who is Bush's Secretary of Health and Human Services, was elected to the chair of the global health fund only a couple of days after Bush's announcement on the $10 billion. Of course, Thompson would have known that he was to be elected before that date because his only opponent had withdrawn.
Part of Thompson's job is to be chief fundraiser for the global health fund. His task is surely more difficult if his Government do not put their major resources into the fund. It is even odder that Thompson did not travel to the board meeting in Geneva to take up his position as chair. I quote from the apology that he sent to the meeting:
I am sorry that I am unable to be with you in Geneva today but President Bush has asked me to be with him when he addresses his Advisory Council on HIV/AIDS in Washington".That sends a clear message: America first, the world second.It is extraordinary that Thompson was not allowed to organise his diary so that he could attend the board meeting when he was supposed to take over as chair of the global health fund. It is stranger still because Thompson's lengthy message to the board expressing his joy at taking over the chairmanship made no mention of Bush's huge increase in funding for international AIDS work, which was announced only a few days before in the state of the union message.
The situation is odder still because the chief executive of the global health fund, Dr. Feachem, made no reference to the $10 billion from Bush in his report to the board. He also came here to talk to the all-party group on AIDS but did not mention Bush's $10 billion until I asked him about it. It is surreal; there is an earthquake going on in AIDS funding yet the chair and the chief executive of the global health fund pretend that the ground under their feet is steady.
A further oddity about Bush's announcement is the fact that his figures for numbers of people to be treated with anti-retroviral drugs are achievable only if there is access to cheap generic drugs produced outside the United States. However, the US has been blocking such access in the Doha talks. Additionally, the new initiative is to be administered by USAID—the United States Agency for International Development—which, in its present statute, requires products supplied as foreign aid to be made in the United States. There are also doubts about the American bureaucracy because promises are made but it takes a long time for money to be channelled in a way that meets with the approval of Congress. I hope that the Minister will explain what is going on—I wish him good luck.
261WH During International Development questions last week, the Secretary of State for International Development, who is on the board of the global health fund, expressed some disaffection with the fund's operation. I hope that the difficulties can be sorted out because the global health fund is a first-rate idea. The issue is far too important for those difficulties to be allowed to persist.
§ Mr. LazarowiczDoes my hon. Friend agree that the proposal made a few minutes ago by the hon. Member for Banbury (Tony Baldry), who chairs the Select Committee on International Development, that Europe should match the commitment of the United States to the global fund is one way of emphasising to the United States the world's commitment to the fund? Would he therefore agree to endorse the European Union making a similar contribution to the fund as the USA?
§ Tony WorthingtonI hope that we and the EU make a much greater contribution to the global health fund than the USA: that is the point of what I am saying. The USA's contribution is $200 million per year for five years from 2004.
I also want to raise concerns about the relationship between AIDS work and reproductive health services. I am sure that Bush's decision to distribute funds bilaterally rather than through the global health fund is related to his appalling actions with regard to reproductive health. If he allocated money to the global health fund, it would be more difficult for him to keep the peace with the religious obsessives who back him.
Bush is in debt to, and under the control of, a small group of southern fundamentalist Christians who are obsessed with abortion and contraception. The way for a country to reduce the number of abortions—particularly unsafe ones—is to follow the example of Belgium and Holland. They have liberal abortion laws, thorough education about relationships and total access to family planning services. Belgium and Holland have the lowest abortion rates in the world, but Bush's followers support policies that push up the number of abortions—in particular, unsafe ones—and contribute to the appalling rates of maternal mortality in many countries.
The fundamentalists who programme Bush want to ban abortion and access to reproductive health services. Following their orders, Bush withdrew all funding from the United Nations Population Fund on the pretext that it was supporting the Chinese Government's one child per family project and coercive abortion. That was contradicted by his own investigating team and a group of hon. Members from this House. The UNFPA is working in 20 counties in China: it is weaning the Chinese away from compulsion and lowering abortion rates, but the zealots had their way with President Bush.
At meeting after meeting, the Bush Government are now trying to destroy the pace-setting Cairo conference, which found a worldwide consensus policy in this contentious area. It includes the explicit statement that abortion is never an acceptable method of family planning. The bedrock of the Cairo conference is that women throughout the world should have access to reproductive health services and that is under attack from the Bush Government.
262WH The Americans are urging on the poorest people in the world policies that would create a riot if they were tried in the USA. Can anyone imagine the consequences in America and Britain if their Governments said that they were going to withdraw access to family planning? The American Government's policies go against the American constitution's statements on freedom of information. The consequence of their policy is that they have withdrawn their supply of condoms from many parts of the world. When the first President Bush was in power, America supplied 800 million condoms to the developing world: it now supplies only 300 million condoms per year, which means that the average Botswanan would have access to one condom supplied by the international community per year.
By cutting the number of condoms, they are condemning to death thousands of people who could be protected if that very cheap method of prevention were available. I do not usually quote the words of the Mozambique bishops, but this is their advice to their flock:
If you are HIV positive and you have unprotected sex and you infect someone you have in the eyes of God, committed murder. Or if you are HIV negative and you have unprotected sex with someone who is infected and they infect you, you have in the eyes of God, committed suicide. So my children, wearing a condom is not a sin … but not wearing one is.That is the voice of sanity. In the words of the Mozambique bishops, Bush's policies stimulate murder and suicide. Now, during Bush's $10 billion AIDS initiative, his AIDS policy is running slap bang into a collision with his reproductive health policy. Will his AIDS policy allow condoms to be used as the only means of preventing that disease, but not for family planning? That would be absurd, but it is likely to happen.American policy on AIDS would prohibit the sending of money to integrated health clinics offering AIDS treatment and family planning with information about abortion or abortion counselling. However, under the same policy money could be sent to a clinic treating only AIDS. In a country like Tanzania, which can spend only $3 or $4 a year per person on health care and where health clinics are sparse, American policy will require that the AIDS service is in a different place and run by a different agency from the health clinic. That is official.
This is not United States imperialism—it is worse than that. Under imperialism, an empire imposes its own way of life on another country. Bush would not dare impose such a policy in America because he would be ridiculed out of Washington. However, he is trying to impose just such a policy on the poorest people in the world and through it he is causing their deaths. That is one of the reasons why he has steered the money away from the global health fund and why he will distribute it bilaterally.
The tragedy of all this is that reproductive health services and AIDS policy should be much more closely linked than they are. That was said in the Cairo + 5 document, as follows:
Governments should ensure that provision for STIs"—sexually-transmitted infections—and AIDS are an integral component of reproductive and sexual health programmes at the primary health care level.263WH That is also the policy of the International Planned Parenthood Federation and, in the words of its director general, Steven Sinding:The same systems that enable people to space and limit births and protect themselves from STDs"—sexually-transmitted diseases—are essential to halting the spread of HIV.The family planning association movements practically invented sexual and reproductive behaviour change and they went a long way towards establishing community-based services throughout the world. Both of those are essential in the fight against AIDS. However, the AIDS community and the family planning community behave as if they had nothing to do with each other. AIDS activists place emphasis on treatment and family planners often act as if they had no role in HIV/AIDS prevention. The donors have a major role to play in bringing the two groups together.
Bush's actions drive people in exactly the opposite direction. In the developed world, HIV transmission was regarded initially as being largely restricted to the gay and illicit drug-using communities, rather than through heterosexual transmission. Treatment was also captured by the large pharmaceutical companies, who saw that more money could be made from keeping wealthy people alive than from preventing people from dying. There was a lack of resources for vaccines or effective barrier methods controlled by women. There are still people who are obsessed with giving people in the poor world access to expensive retrovirals and they are failing to provide the resources for prevention through changing sexual behaviour or barrier methods, such as condoms.
It makes common sense to combine reproductive health services and HIV services, especially in terms of gaining access to young people. That is where the trained staff are and where the infrastructure often exists. Bush's emerging policy of providing condoms in HIV clinics but not to family planning services is counter-productive, both for family planning and for the treatment of the AIDS pandemic; we should wake up to what he is doing.
Mr. Deputy SpeakerOrder. This is a most compelling debate, but I remind hon. Members that it is common practice in 90-minute Adjournment debates to commence the first of the three winding-up speeches no later than 30 minutes before conclusion, which will be at 10.30 am. Hon. Members should take that into account when contributing and making or giving way to interventions.
§ Hywel Williams (Caernarfon)I, too, congratulate the hon. Member for Edinburgh, North and Leith (Mr. Lazarowicz) on securing this debate on an extremely important subject. The brevity of my remarks does not reflect the importance that my party colleagues and I place on the issue.
HIV AIDS is a modern apocalypse which dwarfs everything that has gone before.?264WH Those are the words of Stephen Lewis, the UN special envoy for HIV/AIDS in Africa. "Dwarfs everything" are the relevant words. As I am a relative newcomer to such debates, I shall briefly try your patience, Mr. Deputy Speaker, and that of the House by considering some of the figures, because they beggar belief. The number of people living with HIV/AIDS totals 42 million—5 million people were newly infected in 2002 and about 800,000 of those were children. Those figures are from the World Health Organisation. AIDS deaths in 2002 totalled 3.1 million and 610,000 of those were children. I find it difficult to comprehend those figures.The vast majority—95 per cent.—of HIV/AIDS sufferers are in the poorest countries. In some African countries, 20 per cent. of adults are HIV-positive. In sub-Saharan Africa, where nearly 30 million people are HIV-positive, there were 3.5 million new infections in 2002. Those are astonishing and horrifying figures. The AIDS epidemic is increasingly entwined with wider humanitarian crises, such as the food crisis in southern Africa and the social disruption caused by the need to migrate to find work as people become more involved in the cash economy. Also, conflicts in Africa have caused an increase in HIV/AIDS. The ability of those countries to deal with HIV/AIDS is reduced by crises in the political and economic systems.
As the hon. Member for Clydebank and Milngavie (Tony Worthington) noted, HIV/AIDS is open to attack through health education and the increased use of barrier methods. I was interested to see evidence of a decline in HIV/AIDS among inner-city women in Ethiopia as a direct result of such factors. There has also been a decline in HIV/AIDS in parts of Uganda among young pregnant women. Those are encouraging signs. I shall not refer to the availability of cheaper pharmaceuticals, which clearly is important. A decline in HIV/AIDS needs human intervention, which must be funded. That is my one and only point, and it is that on which I shall question the Minister.
The UK is making contributions to fighting HIV/AIDS. According to my figures, we furnished $215 million to the global fund to fight AIDS, tuberculosis and malaria from 2001 to 2003. The fund was set up by the Secretary-General of the United Nations, whose target is $10 billion per annum. I accept that we are also making other aid contributions, as well as making significant contributions to conflict resolution and development in countries suffering severely from HIV and AIDS. Politics is a matter of priorities, so I shall briefly refer to two of our priorities, without trying your patience, Mr. Deputy Speaker. Based on the Government's figures, we are prepared to spend £1.75 billion on the forthcoming war. That sum has already been committed and I understand that at commencement, the figure may be £2 billion. As far as I can see we are spending £2 billion on war and $250 million on HIV/AIDS.
I do not want to play down the Government's commitment to fighting HIV/AIDS, particularly when one compares their attitude to that taken by some other rich states. We are often told that the demands for health services are infinite, as near as damn it. I am not asking for a comment from the Minister on the potential global demand for services related to HIV/AIDS, but I ask him to consider whether we are spending enough. 265WH Let us not allow people throughout the world, especially those in the poorest countries in Africa, to die because of our indifference, or because our priorities lie elsewhere.
§ David Cairns (Greenock and Inverclyde)I will try and follow the good example of other hon. Members and be brief so that we can give the Front-Bench spokesmen maximum time.
I cannot accept the slightly spurious comparison that the hon. Member for Caernarfon (Hywel Williams) made between the money set aside for possible international conflict and that set aside for HIV/AIDS. One can take any section of Government spending at any time and compare it to another section to make a particular point. The arguments stand or fall on their own merits.
I congratulate my hon. Friend the Member for Edinburgh, North and Leith (Mr. Lazarowicz) on securing this important debate. As a relative newcomer to such debates, it has been a great pleasure to listen to the expertise of colleagues from the International Development Committee. I shall not rehearse the numbers and figures that we have heard over and over again today, numbing though they are.
It is a cliché to say that countries throughout Africa and Asia are simply being ravaged and paying a terrible price due to HIV/AIDS. It is not just individuals—hundreds of thousands, tens of millions of individuals—but entire families and communities that are devastated by the illness, including people who do not even have the infection. The hon. Member for Richmond Park (Dr. Tonge) mentioned orphans; perhaps she might expand on that point in her speech. The challenge is not just to cure individuals of a disease, but to mend broken townships and cities and entire regions and countries.
Before I turn briefly to African and Asian issues, I want to talk about HIV/AIDS in the west. My hon. Friend the Member for Clydebank and Milngavie (Tony Worthington) touched on that subject. When the disease broke and awareness of it had its first impact, there was a sudden and welcome demise in unsafe practices, which had the predictable result of slowing the growth and spread of the disease. We have to remind ourselves that that happened about 20 years ago and an entire generation has grown up in the post-AIDS era. The doomsday adverts that we remember from the late 1980s increasingly have no bearing on the sexual practices of the current generation.
Complacency is the great threat in the west. Some sexual practices and venues are being reintroduced that closed down 20 years ago, which will increase the spread of the disease in the west at the very time that we are trying to do something about it in the southern world. We must not take our eye off the home front, as we concentrate—rightly in this debate—on the southern world. We all pay tribute to the health organisations, statutory bodies and others, but they need to refresh the message in this country that AIDS is still around, incurable and a killer. People suffering from HIV/AIDS will die as surely in Greenock as they will in Mozambique. Perhaps it will take longer in the west, because of access to palliative medicines, but it is still a killer and we should not take our eye off that ball.
On the global scale of the challenge, in Zambia, HIV prevalence is about 27 per cent. of 15 to 49-year-olds. In certain parts of Africa, one is always on the lookout for 266WH new ways in which the disease is spreading. I understand that one particularly virulent means is the interaction between long-distance lorry drivers and prostitutes. That is spreading the disease rapidly and non-governmental organisations are working on education programmes to try to do something about that.
The position is gloomy for much of the world and the messages that we are portraying today are dire. However, there are positive signs, including some evidence of increasing awareness of AIDS, which is the first step. We must pay tribute to the organisations spreading an educational message. The focus of today's debate is to emphasise that much more needs to be done. My hon. Friends and Opposition Members have highlighted means of doing that and I shall not go through those again. More money is the cornerstone. There must also be support for the global fund, greater access to drugs and a new approach to patenting important life-saving pharmaceuticals.
I shall briefly mention the international financing facility, although I shall not go into it in depth. The hon. Member for Banbury (Tony Baldry) mentioned it in what were, unfortunately, slightly disparaging tones. I have great hopes for that facility. It is not an international financing facility to combat HIV and AIDS—there is much more to it than that—but the scale of the figures mentioned in the document of my right hon. Friend the Chancellor of the Exchequer is considerable. The figures go up to the £100 billion mark. That is a step change. My right hon. Friend is worried, and rightly, that we are nowhere near meeting the millennium targets. If we carry on at the same rate, we shall miss them. The hon. Gentleman implied that if something is not broken, we should not fix it, but I think that my right hon. Friend the Chancellor is right to be worried and to be considering other ways of achieving the step change needed.
I shall finish, if I may, on a personal point, which picks up on the second part of the well made speech of my hon. Friend the Member for Clydebank and Milngavie. Since my election to this House in 2001, I have deliberately steered clear of all issues relating to the Church. That is for personal reasons, relating to my previous career as a priest. I spend much time turning down offers of television interviews inviting me to give forth on issues varying from who should be the new Archbishop of Canterbury to war and peace matters. However, this issue is too important to allow such niceties to stand in the way. I yield to no one in my admiration for the work that the Catholic Church does throughout the world. Men and women from comfortable western families have given up a life of luxury to go to the most inhospitable, unfriendly, barren environments on the planet. They have given their lives and put themselves on the line to do work on which we stand here, in our comfortable Westminster surroundings, and opine. Their work in orphanages, schools, education and running programmes is magnificent. I know many such people personally and I make no criticism whatever of their commitment or that of the Church to helping the needy, the impoverished and those ravished by sickness and disease.
But—here is the "but" and my hon. Friend was absolutely right about it—it is incontrovertible that the use of condoms slows the spread of this killer disease. The whole argument about contraception has been 267WH swept aside by the need to prevent a further genocide—genocide caused by an illness. We know how we can stop that and we have to stop it. The Catholic Church, quite simply, must change its view on the use of condoms. It must change its view on the explicit nature of sex education. Sex education such as that I had at school, which involved looking at sea urchins, is simply not fit for the purpose in the 21st century. The Catholic Church must have a complete, Copernican revolution in its attitude to sex education and its attitude towards gay men, in particular. This issue is too important. Lives are at risk. People are dying. The Church is a church of compassion. It must show that compassion and change its course.
§ Dr. Jenny Tonge (Richmond Park)I congratulate the hon. Member for Edinburgh, North and Leith (Mr. Lazarowicz) on introducing the debate. I do not think that we can debate this topic often enough. If ever there were a weapon of mass destruction, AIDS is it. It may well kill far more people over the next 20 years than the bubonic plague ever did. People all over the world face an absolutely horrific scenario. Perhaps that is not so much the case in the west—yet—but if we become too complacent, it may affect us just as badly. Mother nature has provided her own weapon of mass destruction.
We have had some excellent speeches. We have been told about figures: the number of victims and the billions of pounds that are being spent on the issue—it is figures, figures, figures all the time. The hon. Member for Banbury (Tony Baldry) talked about the USA's efforts to combat the disease, the hon. Member for Edinburgh, North and Leith talked of the problems of financing the global fund and the hon. Member for Caernarfon (Hywel Williams) stressed the importance of the figures.
I pay tribute to the hon. Member for Greenock and Inverclyde (David Cairns). I assume that he is a Catholic and was a Catholic priest. I admire him for the way in which he spoke. We need more people to say what he said.
As always, the hon. Member for Clydebank and Milngavie (Tony Worthington) gave a powerful speech. I spent 25 years in reproductive and sexual health in my professional life before I became a Member of Parliament, and I would have been proud to deliver that speech. I agreed with every word, dot and comma. I commend the speech to the House; it should be printed and put up on the wall of every hon. Member's office. I will not go on, because I do not want to embarrass the hon. Gentleman, but it was a seriously good speech.
Several points have not been emphasised quite enough. To start with, there is the availability of drugs. Developing countries need anti-retroviral drugs—particularly, to prevent mother to child transmission—but the problem is not an easy matter of simply providing drugs, however cheap they are. That will not conquer the epidemic or do the trick. The drugs are far too complicated to take and need to be backed by things that are simple for us in the west, such as good nutrition, if they are to work. How many people in developing countries can we honestly say are fed properly 268WH nowadays? I am sad that the global fund and the American contribution, about which the hon. Member for Clydebank and Milngavie talked, are concentrated primarily on drugs.
I am sad that not enough emphasis is being placed on health systems. Some countries have not got the necessary roads and, even if there were a clinic, people would not be able to get to it. We have to deliver clinics and nurses. We do not need doctors, but we do need health workers who are educated in the delivery of AIDS drugs if those drugs are to be any good at all. If we do not have such workers, the drugs will be taken improperly, resistance to the disease will develop and we will have to start all over again. I feel passionately about that, and I am sick of hearing people castigate the drug companies when we are not placing enough emphasis on health systems.
Some recently published research is quite damaging in that it gives the wrong message. It is claimed that people in the third world use dirty needles and that health systems are inadequate and dirty and do not follow good practices. Those factors will certainly contribute a small amount to the spread of AIDS, but no one should make the mistake of thinking that they are the reason for its spread. It is not so, even if those things may be a small contributing factor.
We have not heard much about vaccines—although something was said by the hon. Member for Banbury. Vaccines are the ultimate weapon against any infectious disease, and the global fund, the Americans, the Gates Foundation, which has contributed a lot, and the International AIDS Vaccine Initiative have done sterling work. Trials of AIDS vaccines are going on all over the world, but there are not enough of them. We must ensure that funds enrich research into AIDS vaccines because that will lead to the end of the epidemic, as it did for smallpox and as it soon will do for polio.
The other thing that has not been mentioned is the effect of debt on developing countries. In passing, we should remember that African countries spend $14 billion a year on servicing their debt. The global fund has estimated that those countries need about $10 billion to do something that will have an impact on the AIDS epidemic. AIDS destroys economically active people in the population and will destroy the ability of any country to service its debt because fewer people will be working. As I mentioned during an intervention on the opening speech, AIDS orphans are becoming a huge problem, and developing countries will have to spend a lot of money on those children who have never known a family or a mother and a father. They live rough on the streets, not receiving an education and at risk from all sorts of factors. We expect countries in Africa to service their debt to the tune of $14 billion a year when less than that amount would greatly help the fight against AIDS. That is crazy. Giving with one hand and taking away with another is nonsense.
Finally, I shall compare the amounts of money that the world likes to spend on various things. I said that the AIDS virus is the most powerful weapon of mass destruction in the world. We have already heard from the hon. Member for Caernarfon that the USA is thinking of spending about $200 billion on war with Iraq, against which its contribution to the fight against AIDS pales into insignificance. Far less than 1 per cent 269WH of that amount goes into expenditure to tackle AIDS, and that includes the ear-marked $15 billion that the Americans are spending independently on the AIDS crisis. It is a disgrace that that is going on in our world.
I am pleased that a Foreign Office Minister is here to answer today's debate. If we truly have a wonderful special relationship with the United States, and if our Prime Minister is prepared to follow blindly whatever the President of the USA says, what return are we getting? Let us see some action on the other fronts that the hon. Member for Clydebank and Milngavie mentioned, and let us see action on all those international treaties from which the USA is pulling out.
We learned from the hon. Member for Clydebank and Milngavie that the USA's expenditure on AIDS is entirely cynical. It is making jolly sure that reproductive health and abortion services are not being funded. As a professional in that area, let me say that there is no way that an AIDS epidemic can be prevented unless reproductive health and abortion are also tackled. All those subjects are as one. Another reason why the USA is behaving in that way—this also explains its actions in the World Trade Organisation—is that it is funding the drugs industry.
I am getting black looks from Mr. Deputy Speaker so I shall finish by mentioning just one more thing. We were told that the distribution of condoms from the USA amounts in Botswana to one condom per annum per man. Who in the Chamber could cope with that?
§ Mr. Robert Key (Salisbury)I could cope quite simply; I had a vasectomy years ago.
Of all the debates that you and I have sat through over many years, Mr. Deputy Speaker, this must have been one of the most interesting. It will present the Minister with a challenge when he makes his wind-up speech.
I congratulate the hon. Member for Edinburgh, North and Leith (Mr. Lazarowicz) for giving us another opportunity to debate this important issue, which has been debated with great success over many years. I was elected back in 1983—the dark ages of AIDS. The foundation of the all-party group on AIDS was a milestone at a time when ignorance was rife in a era of Government health programmes involving tombstones on television to impress on the public the consequences of an AIDS epidemic.
One of the first things that we had to learn was that it is no good being judgmental about AIDS and adopting a high moral tone. It is no good blaming everything on lifestyle choices, as some hon. Members did in the 1980s. One hon. Member said to me: "A plague on them; they made a choice; let them die." That was in line with wide public perceptions at the time, and it is fortunate that things have moved on.
It remains a mistake in 2003 to be judgmental about AIDS, particularly in developing countries. Being judgmental when considering such an important matter is a temptation that we should resist. We simply cannot 270WH apply European and American cultural stereotypes to entirely different social and cultural situations elsewhere in our world. I would like to sit some of President Bush's advisers under a mango tree in Gambia on a Saturday morning—I have done that—to talk to the village imam and elders about AIDS, contraception, family planning and so on. That usually results in uncontrollable mirth on the part of listeners and, I regret, very little comprehension.
The hon. Member for Edinburgh, North and Leith was right to discuss the consequences of the situation for the entire world, and Colin Powell was right when he said that it is as serious a threat as international terrorism. The Bush Administration's record on frustrating the work of the United Nations Population Fund is not good. I want to say to the President, as one Christian to another, that there is no evidence that the fund promoted coercive abortion in China or anywhere else. Does the President understand the consequences of his policy? The UN has estimated that cutting the USA's $34 million contribution to the fund will lead to 800,000 more unsafe abortions and the death of 4,700 mothers and 77,000 children under the age of 5. That is not a happy outcome from a change in presidential policy.
Another unfortunate consequence, particularly in countries in Africa, is that orphans are created, and there is terrible suffering and enormous medical need. Yet what do we do? We recruit their nurses for the national health service of the United Kingdom. Last year, 2,114 nurses were recruited from South Africa, 473 from Zimbabwe, 432 from Nigeria, 183 from Zambia, 195 from the Gambia, 155 from Kenya, 100 from Botswana and 75 from Malawi, in addition to the 994 recruited from India. That is not a good idea. It may be to the advantage of the nurses, and we cannot blame them for wanting to enhance their careers, but should that be the public policy of the United Kingdom Government?
My hon. Friend the Member for Banbury (Tony Baldry) referred to the UK's commitment after 2015. I wholly endorse what he said about giving the global health fund the support that it needs to persuade the European Union to match US funds. There is an EU problem in that there is increasing evidence that the American Administration seeks to influence European parliamentarians to oppose development work and, therefore, development money for southern Africa if it involves reproductive health care issues. We must take that on board very seriously.
My hon. Friend also mentioned vaccines, which are hugely important. I hope that Government agencies, such as the Centre for Applied Microbiology and Research, will encourage work on vaccines in partnership with our universities and their pharmaceutical partners.
The hon. Member for Clydebank and Milngavie (Tony Worthington) discussed the importance of Cairo and gave the Mozambiquan bishop's magnificent quote, which I shall use often. However, as a Christian who has a huge respect for the Roman Catholic Church, I would go further and say that the best thing that could happen to it would be that it accepted married priests and women bishops very soon. They might inject a little of the sense that the hon. Member for Greenock and Inverclyde (David Cairns) introduced into our debate. The hon. Member for Caernarfon (Hywel Williams) 271WH discussed the huge impact on children as something that particularly affected him, and I salute him for making his comments.
The hon. Member for Greenock and Inverclyde is a Member for whom we changed the law of this land. I spoke passionately in the debate on that occasion. It was a very good debate, which I suspect the hon. Gentleman read. If he did not, he can always check my website and find it there, because I am proud of what I said and proud that I voted to change the law so that he could come along this morning to tell us how the Catholic Church should be reformed and, furthermore, to do so while wearing a purple shirt. I congratulate him on that particular flourish.
The Minister must answer some serious questions. If he cannot do so now, he will in due course find someone who can. What total amount of money has our country given to the global fund? I am keen to know what our Government are doing to encourage other international donors to give more money, and our influence should be used to that effect. From where does the money for the global fund come? Is it from additional funds—perhaps from an unusually generous Chancellor of the Exchequer—or is it from the budget of the Department for International Development?
The Vice-President of Malawi, Justin Malewezi, who runs that country's campaign against AIDS, has raised a problem. He said that there is an upper ceiling for proposals and that any proposals
over $300 million would be thrown in the bin".Can the Minister confirm whether that is the case? Is there an upper limit on proposals for expenditure from the fund?The commission on intellectual property rights, which is funded by DFID, is an initiative of the United Kingdom Government that I warmly welcome. Will the Minister confirm whether its report reflects official Government policy? It is important to know that, because it makes some very significant suggestions. I would be grateful if the Minister would address that issue.
In conclusion, we must not forget that we, too, are a part of the debate about the international impact of the crisis. I wish to draw the attention of the House to early-day motion 691, which is entitled "Contraceptive awareness week 2003". It points out that there is still great cause for concern in our country, in which 41,200 people are living with HIV, 31 per cent. of whom are undiagnosed. The number of people living with diagnosed HIV is rising each year. We should be careful before throwing stones in our own glass house.
§ The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Mr. Bill Rammell)I should genuinely like to thank my hon. Friend the Member for Edinburgh, North and Leith (Mr. Lazarowicz) for securing this important debate. It is a long time since I have heard such well argued and passionate comments from so many Members. They demonstrated genuine understanding. It is also a first for me to hear in a debate about the personal contraceptive practices of Front-Bench Members, although I am sure that that practice will continue.
272WH This is an important debate. Tragically, the scourge of AIDS is reversing the development gains of the past few decades, at a time when 46 per cent. of Africans live in extreme poverty. The Government are therefore committed to encouraging the entire international community to play a full part in tackling the HIV/AIDS epidemic, which is having a huge impact in many poor countries on health, social development, education, food security and, as my hon. Friend argued, economic growth. The epidemic hits agricultural activity extremely hard and contributes to the tragic famine that is unfolding in sub-Saharan Africa.
In the brief time available, I want to focus on the Government's important work on tackling the epidemic in developing countries. The Government's response to the epidemic covers many vital issues. It includes supporting state-of-the-art interventions in prevention, care, impact mitigation, access to treatment, which is crucial, research and—many hon. Members have referred to this—mobilising the additional finance required to tackle HIV/AIDS.
Last year, the Department for International Development invested more than £200 million in HIV/ AIDS-related bilateral work, which is an increase from £40 million in 1997. In anybody's book, the increase is both substantial and welcome. That money is being used to fund several specific tasks. First, it will support national plans to reduce the epidemic's impact. Secondly, it will ensure that national responses are multisectoral and are sustainably embedded in national budgets. Thirdly, it will enable countries to build capacity to deliver high-quality preventive treatment and care for people living with HIV/AIDS and for orphans. Fourthly, it will address underlying causes of vulnerability, particularly human rights, stigma, discrimination and gender inequalities.
To support that programme, the value of DFID's overall programme in Africa is set to increase from £640 million to £1 billion by 2006, which is a genuine indication of the Government's commitment. We want a major element of that money to be used for preventive purposes. For example, we are supporting innovative multi-media work in South Africa, where the HIV message is relayed through television soap operas and on the radio, which is often the most effective way to get the message across.
In Russia and China, we are working to reduce the incidence of HIV infection in injecting drug users. In Mozambique, we are trying to improve users' lives through life skills programmes aimed at HIV prevention. In Kenya, we are working with community-based organisations to care for AIDS orphans. As well as that important bilateral support, we are providing important contributions to support HIV/AIDS programmes run by multilateral agencies, which include the United Nations. Our work on prevention is extremely important.
Although we face a huge task, we should be optimistic: there is initial evidence, particularly from Africa and Asia, that HIV can be beaten. Examples include Cambodia, Uganda and Thailand, where condom use has significantly increased, and Senegal, which has been a model of good practice in HIV/AIDS prevention for some time. Progress can be made, but there is an urgent need for other countries, in which political leadership is essential, to learn from those 273WH successful countries. This week, Nelson Mandela said that one of his regrets from his time as President of South Africa is that he did not give sufficient priority to the issue. Everybody needs to respond to that message from someone who is enormously respected, particularly throughout the developing world.
Many hon. Members have called on the Government to do more. We are not complacent, and we are making a significant contribution, particularly through our actions through the global fund to fight AIDS, tuberculosis and malaria. We have pledged $200 million over five years, and $80 million of that has already been disbursed.
I pay tribute to the work undertaken by the Chancellor in conjunction with the Department for International Development, especially in creating the new international finance facility. I agree with my hon. Friend the Member for Edinburgh, North and Leith, that the comments made by the hon. Member for Banbury (Tony Baldry) were somewhat disparaging, and unjustified if one considers the case being advanced. We are not resiling from our commitment to increase our aid financing effectively and eventually to move towards contributing 0.7 per cent. of gross national product. However, that does not contradict the focus of the programme in trying to establish a partnership with businesses and civil society to increase those funds significantly, and that should be welcomed.
I agree with the comments made by the hon. Member for Richmond Park (Dr. Tonge), who spoke for the Liberal Democrats, that we should not neglect or decry the work being done to find a vaccine for AIDS. In the longer run, that is the most effective contribution that we can make. Although the first candidate AIDS vaccine in widespread trials was unsuccessful, HIV is a complex virus; many other candidate vaccines are in the pipeline, and we must support them. DFID has already committed £14 million to international AIDS vaccine initiatives and £16 million to the Medical Research Council's initiative.
In the short time remaining, I shall respond to points made by hon. Members. First, on the status of the UK's contribution to the global fund raised by my hon. Friend the Member for Edinburgh, North and Leith, we support the call for increased funding from the rest of 274WH Europe. We will take up the case and argue it strongly; the UK is one of the largest Government donors to that fund, and we want it to continue.
My hon. Friend also raised the World Health Organisation and UNAIDS' target of 3 million people in developing countries on anti-retroviral therapy by 2005, asking whether the UK was part of that partnership. We are not partners, but we support the goals of the international HIV treatment coalition in respect of increasing access to treatment of HIV/AIDS. We are funding work in support of the goals and will continue to look at the strengthening of health care systems within developing countries.
My hon. Friend asked about monitoring mechanisms to ensure that DFID money goes to support health systems. There are annual reviews in countries to assess the programmes and to ensure that they meet those goals. We are working closely with UNAIDS and other international agencies to monitor the efficacy of the countries' responses, and we will continue to do so.
My hon. Friend raised the issue of the contribution and role of civil society, with particular reference to implementation and monitoring. The full and genuine participation of civil society at country level in the preparation, implementation and monitoring of proposals is vital to the fund's success.
I wholeheartedly agree with many of the points made in the excellent contribution from my hon. Friend the Member for Clydebank and Milngavie (Tony Worthington). The financial initiative recently announced by President Bush should be welcomed, as it is a substantial financial contribution. However, there are some legitimate concerns that that money will be diverted from family planning services. We must look carefully at that and raise it with our American partners.
It is worth my underscoring the fact that the initiative is at a very early stage of development and has not yet been approved by Congress. There is a long way to go, and many of the points made today need to be considered in that context.
Finally, the hon. Member for Richmond Park professed passionate opposition to disarming Iraq. There will be no hope of tackling the AIDS crisis if we do not tackle proliferation and if weapons of mass destruction are used, the institutional order of our world will be in ruins. That should concern us all.