Overseas Aid

Lord Collins of Highbury Excerpts

Wednesday 27th February 2013 Lords Chamber

[Baroness Northover]

My noble friend is right to ask for that. It is extremely clear that the OECD defines what does and does not count as overseas development assistance. Most of our peacekeeping, for example, goes through the UN. Some 6% of that budget counts as ODA, and the rest does not. With the EU civilian missions, 100% counts under the ODA rules. This is extremely clearly defined. Where the MoD supports humanitarian assistance—the Navy, for example, supplies tents, as it did in Jamaica after the hurricane—that is counted as assisting and not as providing military equipment. These things are clearly defined.

[Lord Collins of Highbury]

My Lords, as the right reverend Prelate said, Labour supports a co-ordinated approach to tackling conflict that brings together defence, diplomacy and development. The Prime Minister’s attempt to suggest that aid money may be used to off-set deep defence cuts is misleading and will not stand up to scrutiny. I ask the noble Baroness to reassure this House that the absolute purpose of the proportion of money that we continue to spend is to alleviate property, improve basic services and support job creation, all of which are central to ending conflicts everywhere.

[Baroness Northover]

My Lords, I have to say that the noble Lord is misleading. I suggest that he read the Prime Minister’s words. He says:

“Conflict states haven’t met a Millennium Development Goal between them”,

and that,

“it’s obviously true that if you can help deliver security and help provide stability … that is the base from which all development can proceed”.

We all agree about that. He does not say that he is filling in some MoD black hole; he is saying, as the noble Lord stated at the beginning of his question, that we need to work together to ensure that we establish security for people in these fragile states in order that development can build upon that.

Health: Neglected Tropical Diseases

Lord Collins of Highbury Excerpts

Wednesday 30th January 2013 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, thank the noble Baroness, Lady Hayman, for initiating this important debate. Although neglected tropical diseases are the most common infections among the world’s poorest communities, they receive little attention in the media. As we have heard, while they are not always fatal, their effect on individuals and communities can be devastating. They disproportionately affect the world’s poorest and most vulnerable people and are a serious impediment to economic development in many developing nations.

There is no doubt that the coming together of the global health community in January 2012 to plan a new way forward for achieving a world free of these devastating ailments was a historic occasion. The commitment to the control or elimination of 10 NTDs in line with targets set by the World Health Organisation marked the beginning of a new and co-ordinated effort.

As we have heard, the lives of millions of people have improved since the launch of this plan. However, more resources and political will from all Governments will be needed if we are to achieve the WHO’s 2020 goals. The control and elimination of NTDs is feasible through mass drug administration but failure to also address the underlying causes, including the environmental conditions that contribute to their spread, such as clean water, improved sanitation initiatives and vector control, will make this task almost impossible.

The barriers and risks to achieving the WHO targets include: conflicts and the consequent movement of people; population growth; vector or intermediate host control; resistance to medicines and pesticides; expectations overtaking science; inadequate support for research; and, of course, climate change. We still have a world where some 780 million people are without adequate sanitation and safe drinking water; 40% of those without access to improved water sources live in sub-Saharan Africa, where many of the NTDs are prevalent. The biggest challenge is in India, where more than half the country’s population—625 million people—are without basic toilet facilities.

An integrated approach is essential if we are to meet the WHO targets. As we have heard from the noble Earl and my noble friend, there are other risks attached to promoting mass drug administration, including the undermining of already fragile and overstretched healthcare systems and the difficulties involved in relying on volunteers to assist with drug distribution in targeted communities.

However, schemes such as the Bangladesh Ministry of Health and Family Welfare’s Little Doctors programme are shining examples of how education, public health and drugs can be combined effectively. In addition to providing regular treatment, the programme teaches students from upper grades to assist teachers with de-worming days. The Little Doctors also share hygiene and other health messages with their classmates and families to help prevent reinfection.

To ensure that the objectives of the London declaration are delivered, we need clear government strategies. I, too, would like the Minister to explain what action the Government are taking to improving access to clean water and improved sanitation. What steps are being taken to build healthcare capacity and generally to improve public health and education in the target areas?

EU: Budget

Lord Collins of Highbury Excerpts

Thursday 17th January 2013 Lords Chamber

[Baroness Northover]

As I said to the noble Baroness’s noble friend, the noble Lord, Lord McConnell, the EDF has clearly been a very effective measure in this regard. DfID is extremely keen to make sure that that is protected and that the EU’s aid contributions are poverty-focused. Within the EU budget there is clearly also a focus on near neighbours. We need only look at what has happened across the Middle East and north Africa to see how the security, stability and economic progress of those near neighbours are important. The new accession countries are also important. However, we are keenly aware of the importance of the EDF and its poverty focus, and we are seeking to increase its focus on the poorest.

[Lord Collins of Highbury]

My Lords—

[Lord Pearson of Rannoch]

My Lords—

--- Later in debate ---

[Baroness Northover]

I have just given an answer saying that the EDF is very poverty-focused. What the EU is doing is looking somewhat wider, but that is a worthwhile project as well.

[Lord Collins of Highbury]

My Lords, DfID’s own multilateral aid review published in March last year rated the European Development Fund and ECHO among the top performers. It also identified clear reform priorities in order to demonstrate results and deliver greater value for money from the UK aid that is channelled through the EU. Can the Minister provide an update of the department’s assessment of the EU’s progress on achieving those reforms?

[Baroness Northover]

DfID is closely engaged in this area and I have met Commissioner Piebalgs a number of times. We are sure that they are heading in the right direction.

Rape in Armed Conflict

Lord Collins of Highbury Excerpts

Wednesday 9th January 2013 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, pay tribute to the noble Lord, Lord Lester, for initiating this important debate. Wartime sexual violence is one of history’s greatest silences. However, as my noble friend Lady Kinnock described, since the 1990s there has been an increased awareness of sexual violence in wartime due to the significant impact of armed conflicts on civilian populations. According to UN Women, 90% of casualties in contemporary conflicts are civilians, and the majority of those are women and children.

Sadly, the effects often continue beyond war. Post-conflict studies from Rwanda, where up to half a million women were raped during the conflict, show a spiral of continuing violence against women. The same cycle is being repeated in Syria right now, with reports from organisations like Human Rights Watch of Syrian government forces and militias sexually abusing girls as young as 12.

This country needs to live up to its commitment to protect women. Violence against women as a tool of war remains one of the least prosecuted crimes; we have to do better to ensure action against the perpetrators. However, we must be tough not only on the crime but its causes. This means that we must tackle the underlying problems of lack of empowerment, education and inclusion.

The unanimous adoption 12 years ago of Resolution 1325 on women, peace and security was a landmark decision in which the situation of women in armed conflict was specifically addressed. The resolution called for their participation at all levels of decision-making on conflict resolution and peace-building. The UN recognised that women’s exclusion from peace processes not only contravened their rights but weakened the prospects for sustainable peace. Since the adoption of Resolution 1325, four supporting resolutions have been adopted by the Security Council. All focus on three key goals: strengthening women’s participation in decision-making; ending sexual violence and impunity; and providing a system of accountability. Together, the resolutions provide a powerful framework and mandate for implementing and measuring change in the lives of women in conflict-affected countries.

As a member of the UN Women executive, Britain has a responsibility to help ensure that UN Women has commitment both from us and the international community. I hope that the Minister will reassure the House that the Secretary of State for International Development, Justine Greening, will make that a priority. UN Women has great potential, but that potential will not survive without our support. Currently it does not have the long-term backing that everyone agrees is necessary for the organisation to take off. The aim is to join up the work that is done across the UN on gender equality and women’s empowerment, pooling resources and effort to increase its impact and reach.

As we have heard from the noble Lord, Lord Lester, and others in tonight’s debate, girls and women who are raped and become pregnant have rights under the Geneva Convention to have full medical care, which must include their choice of an abortion. I repeat the clarification sought by the noble Lord on what appear to be contradictory statements previously made to the House by the Minister. Due to time limits I will not repeat the exact quotes, but it is vital that we have clarification on this issue.

I also want to repeat the question and the point made by my noble friends, in particular my noble friend Lady Kinnock. Will the Government follow the call by Norway to seek changes in the American Government’s attitude on this important issue?

Treatment of Homosexual Men and Women in the Developing World

Lord Collins of Highbury Excerpts

Thursday 25th October 2012 Lords Chamber

[Lord Collins of Highbury]

My Lords, if there is a coalition I am extremely proud of it is the one that has initiated and backed this debate. In particular, I too thank the noble Lord, Lord Lexden, for putting down the Question which has prompted the discussion.

This country can celebrate the fact that all the major parties are united on this subject. Over the last 25 years the situation for lesbian, gay and bisexual people in Britain has changed significantly. I am also proud that much of that progress was made under the last Government though we should not underestimate the problems that remain, in particular the level of homophobia in our schools. However, Britain can now rightly claim to be a beacon of equality to the world of gay people. Sadly, as we have heard in this debate, this progress is not reflected in the developing world. From Iraq to Uganda, lesbian and gay people are still systematically persecuted. As we have also heard in this debate, this prejudice often stops gay people accessing the healthcare, education and employment they need.

This is why decriminalisation worldwide is so important. However, even in countries where homosexuality is legal, lesbian and gay people are often subjected to human rights abuses. South Africa was the first country in the world to enshrine the human rights of gay people in its constitution in 1993. Yet lesbians in South Africa still live in fear of so-called “corrective rape”. As we have also heard, the freedom of expression and association of gay people is regularly denied in countries closer to home such as Russia, Ukraine and Serbia.

As the noble Lord, Lord Black, has said, we cannot pretend that this does not affect us here. Gay people around the world look to Britain to offer them refuge from this discrimination. Britain and our partners have an important role in challenging these human rights abuses. It is not, however, without risk. There is increasing opposition to the “western” notion that gay rights are human rights. We need only to look at the recent resolution, proposed by Russia at the United Nations Human Rights Council and passed with the support of 25 other states, affirming that “traditional values” should be the basis of human rights. This has given credibility to the abuses perpetuated by anti-gay Governments around the world. This is one of the many reasons why diplomatic action is so important. I welcome the way that the FCO is now working closely with organisations such as Stonewall, the Kaleidoscope Trust and others that have been mentioned in the debate, on how they can oppose these efforts to legitimise human rights abuses of gay people worldwide. Placing conditions on the recipients of development aid might also play a role, but we cannot ignore the risk that removing aid from countries for human rights abuses against gay people may affect the poorest in those countries. Not only would that give fuel to those who argue that homosexuality is something being imposed on those countries by the West, it may—as we have also heard in this debate—worsen the situation for gay people. They are likely in any case to be among the poorest and most disadvantaged in countries that receive aid, and unable to access jobs, education or healthcare. Nor can we ignore the fact that we are not the only suppliers in the aid marketplace. It would be disastrous if we pushed recipient countries into the arms of donors such as Iran and China, and we must not lose what influence that we already have in those countries.

As we have heard—and this is a main issue—real progress on gay equality will ultimately come from grass-roots movements. However, we need to help create the conditions where those local gay rights movements can emerge. So in conclusion I should like to ask questions of the Minister. What direct assistance will the Government provide, either financially or politically, to support the development of lesbian, gay and bisexual movements worldwide? What will the Government do to encourage aid charities, through which significant amounts of DfID investment is delivered, to support lesbian, gay and bisexual individuals and movements globally? Finally, will the Government ensure, through the UK Border Agency, that lesbian and gay people are provided with a real safe haven when they flee from the persecution that has been described today?

HIV and AIDS in the UK

Lord Collins of Highbury Excerpts

Thursday 1st December 2011 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, congratulate the noble Lord, Lord Fowler, on initiating this excellent debate. I have huge respect for the work that he has done and continues to do in raising awareness of HIV and AIDS.

I also pay tribute to all the members of the Select Committee for producing such an excellent and timely study. I say “timely” because only this week the Health Protection Agency warns that the virus is on the rise again in the UK. As we have heard in today’s debate, more than 100,000 people will be living with HIV in the UK by the end of the year, and, as the noble Lord, Lord Fowler, said, more than a quarter of HIV infections remain undiagnosed—that is, in people who have not yet had a test and do not know that they are infected.

The HPA reported that new diagnoses of HIV in men who have sex with men have hit a record high, with around 3,000 men diagnosed in one year. That is the largest annual figure ever recorded. It was 1,820 in 2001, 2,660 in 2005, and 2,790 in 2009. As many noble Lords have said, it is time to break the silence and stigma around HIV, and this report is a very welcome step in helping us to do that.

Early diagnoses and the excellent treatments now available from the NHS mean that many have a chance of avoiding the worst consequences of this virus. As the noble Lord, Lord Fowler, reminded us, when the epidemic began 30 years ago, people with HIV swiftly became sick, developed AIDS and died of infections, such as pneumonia, which their bodies could not fight off. Today, combinations of antiretroviral drugs keep people alive and healthy, and can give them a relatively normal lifespan as long as they stay on the medication. This means, too, that the number living with the virus continues to rise.

Early preventive action not only saves lives but saves money. This is where I also want to amplify the conclusion in the report that a new priority must be given to prevention. As many noble Lords have said, spending on preventing infection is seriously inadequate—just £2.9 million compared with the £762 million treatment bill. I very much regret that the Government dismiss out of hand the committee’s recommendation for an advisory committee for HIV prevention research. Such a committee might give us a clearer indication of the effectiveness of some of the public campaigns.

An area that I want to stress in particular, evidenced in the committee report, is the link between prevention strategies and treatment. As my noble friend Lady Gould and others have said, that link is tested. As I have said, more than a quarter of those with HIV in the UK do not know that they have it, which means that they may be unwittingly passing it on to others and may not be diagnosed until they are ill and treatment is more difficult.

As my noble friend Lord Rea said, in 2010, 50 per cent of all new diagnoses were made late—in other words when the CD4 cell count falls below the level at which treatment is recommended. The proportion diagnosed late is higher in heterosexual men—63 per cent—and heterosexual women—58 per cent—than among gay and bisexual men—39 per cent. Black African and Black Caribbean people are more likely to be diagnosed late than white people. People diagnosed over the age of 50 are more likely to be diagnosed late than younger people. While progress is being made, it is being made very, very slowly. At the current rate it could take 50 years to eradicate the late diagnosis and start treatment on time.

As the noble Lord, Lord Fowler, reminded us, of the 680 people with HIV who died in 2010, two-thirds were people who had been diagnosed late. On the other hand, the outlook for people who are diagnosed promptly is excellent, with life expectancy just a few years shorter than that of people without HIV. Will the Government do more, as the Select Committee and the HPA ask, to increase access to HIV testing? For example, the report advocates that such testing is routinely offered to new patients of GPs and at hospital general admissions in areas of the country where rates of HIV infection are high. While I welcome the Government’s positive comments, including reviewing the ban on the sale of home testing equipment, I believe, as the noble Lord, Lord May, said so effectively, that more needs to be done to incentivise public health commissioners to prioritise HIV testing. With responsibility for HIV prevention moving to local authorities, it is vital to look for ways to ensure they are prioritising this issue and to invest in effective targeted prevention work. It must be a key performance indicator. Like others, I very much hope that it remains in the final public health outcomes framework. However, there are currently no plans to include a specific public health outcome measure on HIV prevention or sexual behaviour. I should like the Minister to respond to that.

This lack of emphasis from central government is exacerbated, as we have heard today, by the distribution of budgets and responsibilities in the new health structure proposed in the Health and Social Care Bill. As local authorities will not be paying for HIV treatment out of their budgets—this will be funded by the NHS Commissioning Board—like others, I am concerned that there is no cost-saving incentive to prevent further transmission. The Bill proposes significantly to increase the power of local authorities through health and well-being boards. While I am not opposed to greater local power in principle, I am concerned that the new structure opens the door for an ever-increasing politicisation of public health, which could have a severe impact on less socially acceptable health conditions, such as HIV. There are still considerable negative associations and stigma attached to HIV and a severe lack of knowledge about HIV among the general public, as the National AIDS Trust's recent Ipsos MORI research study report showed. This makes it particularly vulnerable to prejudice and can silence local voices of people with HIV. Stigma, prejudice, ideology or disapproval can threaten evidence-based interventions which meet the health needs of groups most at risk of HIV. There is potential for the increased role for elected officials to pose a threat to the continuation of the high-quality services needed to tackle the HIV epidemic in the UK. Indeed, in some places, HIV organisations have already begun to experience barriers when working with local politicians. Therefore, I urge the Minister to acknowledge how important it is for the Government to understand this and to build suitable protections into their reforms package. This should be through HIV-related outcomes in the NHS public health and social care outcomes frameworks. There should also, in relation to HIV and sexual health, be a detailed mandate from Public Health England to local authorities which sets out the essential elements of a comprehensive sexual health service, as my noble friend Lady Gould urged. It is vital that the Government ensure that stigmatising views of HIV, and around sexual health more broadly, do not affect decisions about local public health services.

As the Select Committee report said, stigma and lack of understanding can undermine HIV prevention efforts. Misinformation circulated about HIV, suggesting that it is a judgment or that it can be cured through non-medical methods, poses a threat to public health messaging. This is especially the case when such statements are made in faith-based settings, given the significant influence of faith leaders in some communities. As someone who still finds leaflets from local churches in Finsbury Park offering cures for AIDS, I know how important such work is, as the noble Baroness, Lady Masham, reminded us. I am therefore pleased that the Government agree with the Select Committee's recommendation about the valuable contribution that faith leaders and faith groups can make to HIV prevention and care services. When linked to projects such as the African Health Policy Network’s Ffena programme, which has trained more than 100 people living with HIV to become advocates for understanding of the condition, we know the policy can make a real difference in our communities. These sorts of projects involving HIV-positive people as advocates and confident service users are a vital tool in addressing stigma through publicising the condition and encouraging dialogue. It is really important that the Government ensure continued support for this work, especially in these difficult economic times.

After recent research that showed that drugs can protect against the transmission of the virus, I also welcome the report's call for immediate reviews into the possibility of putting people on medication sooner and offering it to their uninfected partners. However, I fully accept that such a policy should be considered after detailed research into the particular circumstances pertaining in this country.

Finally, I want to turn to the Health and Social Care Bill's proposals on health and well-being boards. Many noble Lords have mentioned them in the debate. They will be central to the integration of services. However, I share the concerns expressed by many HIV/AIDS charities that the NHS Commissioning Board will not be routinely represented at all health and well-being board meetings. Without the presence at health and well-being board meetings of those commissioning HIV services, there is a real risk that the importance of HIV prevention, as well as the concerns of people living with HIV, will be sidelined in favour of areas where there is a direct financial benefit, and which, perhaps, are not as potentially controversial. I ask the Government to do more to ensure the presence of representatives from the NHS Commissioning Board at health and well-being board meetings and to guarantee that voices representing the needs of people with HIV are heard in the deliberations of those boards.