Sustainable Development Goals: HIV

Lord Fowler Excerpts

Tuesday 1st December 2015 Lords Chamber

[Baroness Verma]

My Lords, I reassure the noble Lord that approximately 50% of Global Fund resources are directed to middle-income countries. We use our seat on its board to encourage it to focus on key populations, as the noble Lord is aware. As middle-income countries graduate from aid, we work with the Global Fund, UNAIDS, national Governments and civil society to encourage stronger national responses and greater domestic resource mobilisation.

[Lord Fowler (Con)]

My Lords, there are 36 million people around the world living with HIV, yet WHO estimates that half of them are untested and undiagnosed. Is not the reason why people do not come forward the prejudice against them and the criminal law against gay people and lesbians in so many countries? Given that so many of these countries are inside the Commonwealth, should not the British Government take the lead in campaigning against such injustice?

[Baroness Verma]

My Lords, my noble friend raises a really important point. Stigma and discrimination drive key affected populations underground. At the recent CHOGM talks in Malta, we very much had that conversation. I reassure my noble friend that we spend £6 million a year on research programmes–including understanding how social drivers increase HIV infection—and on supporting people in those countries.

International Development (Official Development Assistance Target) Bill

Lord Fowler Excerpts

Friday 6th February 2015 Lords Chamber

[Baroness Northover]

I understand what my noble friend is saying. I can totally refute that. If the noble Lord were to look carefully at what the Global Fund manages to achieve, because it is a large-scale operation that is able to assist in the poorest of countries with the greatest need, or if he were to look at Gavi, which deals with vaccines and vaccine research, he would see that our supporting vaccinations directly through our bilateral programmes may not be the best way to go. Working with Gates and others in a very large enterprise brings down the prices, invests in research and takes forward vaccination, which has saved millions and millions of children’s lives.

[Lord Fowler]

Would my noble friend also agree that the Global Fund is probably one of the most cost-effective organisations in the world in bringing aid? That is value for money that the British taxpayer gets.

[Baroness Northover]

I am extremely happy to endorse that.

International Development (Official Development Assistance Target) Bill

Lord Fowler Excerpts

Friday 6th February 2015 Lords Chamber

[The Chairman of Committees (Lord Sewel)]

My Lords, I recognise that it is unusual for the Chair to make an intervention in Committee like this, but I understand that clarification is needed. The advice that I have received is that the amendment before us should read:

“Page 1, line 2, leave out the third “the” and insert “a””.

I hope that is of help to the Committee.

[Lord Fowler (Con)]

My Lords, perhaps I may make a short intervention arising from the comments of my noble friend Lord Forsyth and that of the noble Lord, Lord Lawson, when he said that we are not talking in this debate about humanitarian aid. It is of course true that only part of the budget goes to humanitarian aid, but it is a vital part and we cannot just turn our backs upon it. My noble friend Lord Forsyth talked about the National Audit Office report, which I have read, and last-minute financial juggling, but I think that is entirely unfair where DfID is concerned, and I will tell him why.

The majority of that money went to the Global Fund to Fight AIDS, Tuberculosis and Malaria. It was entirely vital that it went to that fund, because around the world there are 3.5 million deaths a year, so I hope at any rate that all those who have spoken today, including those in favour of this amendment, would agree that that was worthwhile expenditure. The idea that—

[Lord Forsyth of Drumlean]

My Lords—

[Lord Fowler]

Let me go on, if I may, because we have just heard the noble Lord. If he will just be patient, then I will let him in. The noble Lord said that this was rushed out in March. To my knowledge, and as far as the Global Fund contribution was concerned, it was anything but rushed out in March. It was in fact previewed and promised by the previous Secretary of State. It has been on the books now for the last two years. The fact that it came out in March does not mean that the Secretary of State had a sudden rush of blood to the head and said, “Right, I’m going to give half a billion pounds to the Global Fund”; it meant that there was a process of careful consideration. It concerns me that that position should have been misstated. That is the reality of much of the aid money that we are talking about. Apart from development, which my noble friend Lord Howell spoke about, we are also talking about these issues.

[Lord Forsyth of Drumlean]

I am most grateful to my noble friend. When I used the phrase “the money had been rushed out”, I was not quoting directly. My source was Margaret Hodge, who is chairman of the Public Accounts Committee. She concluded that it appeared that cash has been “rushed out” to meet the 0.7% target, and added:

“This raises questions about value for money which Parliament will be keen to look into”.

[Lord Fowler]

I am grateful, but not for the first time I think that Margaret Hodge is wrong. When my noble friend talks about last-minute financial juggling, he is overstating the case very substantially indeed. The reality that lies below what we have heard at the moment is that we are also talking about underresourced hospitals where drugs run out and patients die, and around the world where births are taking place on concrete floors. I know that my noble friend agrees with the point that I have just made.

[Lord Forsyth of Drumlean]

When my noble friend says that I am wrong to say that it was rushed out, does he acknowledge that 40% of the budget was spent in November and December 2013, December being the year end? Surely that points to a justification for what I said.

[Lord Fowler]

No, I do not think it does and for the reasons I have just stated. Untypically, I do not think that my noble friend is listening to my argument, because this has been in preparation for at least two years, to my knowledge. That cannot be denied. My noble friend talked about people not reading the reports, but he should read some of the statements made by previous Secretaries of State. It is totally unfair to talk about DfID financially juggling the figures. That is not right; it is responding to a need from around the world because there is a need for consistency. If you are going to develop a vaccine, for example, you need consistency in the money and support that come forward.

I will make one last point. My noble friend started his speech by saying disparagingly that this is a Liberal Democrat measure. It is a Liberal Democrat measure but it is one that is, and has been, supported by all three parties. We have a bipartisan position here. I say to my noble friends who have spoken in favour of this amendment that while that is obviously their view, which I respect—I respect my noble friend Lord MacGregor, for example, and my other colleagues—they are the minority in this debate. The majority in the other place overwhelmingly supported this provision. It would be my guess and estimate that if this ever came to a vote in this House on the principle, it would be supported here overwhelmingly in just the same way.

[Lord Hamilton of Epsom]

Can my noble friend comment on the point made by the noble Lord, Lord Butler, about hypothecation? Is he quite comfortable about slabs of government expenditure being hypothecated so that there is no flexibility at all on behalf of the Treasury?

[Lord Fowler]

I am, in fact, comfortable in this position, because I think that we have a particular duty as far as the developing world is concerned. I would not be happy to have hypothecation in every government measure, but here we have a particular responsibility. There is a lack of imagination about what is happening out there in Africa and in the rest of the world. That is the point. If we have a duty, it is a duty in this respect. I am therefore entirely happy with hypothecation in this respect.

[Lord Purvis of Tweed]

My Lords, as the sponsor, I will attempt to sum up this short debate. Perhaps the House will offer me a degree of forbearance as I find myself in the rather difficult position of having to respond to almost a second Second Reading debate, as well as to an amendment that was not moved by the mover but proposed by another noble Lord, an amendment which was then changed by the Chairman of Committees as we were debating it. To respond directly to my noble friend Lord MacGregor, his contribution, I think, got to the core of what this short debate is about. If this is about the essence of the Bill, let us consider whether a “the” should be replaced by an “a” and get to the core of it. The noble Lord, Lord Butler, and others may have been more accurately covering other amendments in other groups, but I will try to address them briefly with this point.

The United Kingdom has an international obligation which it has undertaken to meet over many decades; that is, the 1970 target. I do not consider it a ridiculous target, as my noble friend Lord Forsyth described it; I consider it a target that has been undertaken by the United Kingdom for many decades and under many previous Governments.

International Development (Official Development Assistance Target) Bill

Lord Fowler Excerpts

Friday 23rd January 2015 Lords Chamber

[Lord Fowler (Con)]

My Lords, I very much agree with what the noble and right reverend Lord has just said.

Following the sad announcement made at the start of business by the Lord Speaker, perhaps I may preface my comments on the Bill by one or two remarks on Lord Brittan—Leon Brittan—and still be within the five-minute timescale.

You can sense the man by the tributes that have been made over the past 18 hours. They came from people like me who knew him well. I knew him in Cambridge where he was, without doubt, the outstanding undergraduate of our generation; I knew him in the Commons and in the Cabinet. One of the last conversations I had with him was about his ambition to play a bigger part in this House. Regrettably, that was not possible. He was the youngest Home Secretary since Churchill. He was moved from that post for, frankly, no sensible reason. He became Trade and Industry Secretary and was just re-establishing his career when Westland intervened. Anyone who thinks he woke one morning and thought, “I am going to leak the Solicitor-General’s memo” is gravely mistaken: it was a very different story from that. However, what is certain is that he was left to carry the can. Happily, the effect was that he went to Europe and made an indelible contribution there.

The man himself was kind, with a gift for friendship; he was wise, and people went to him for advice. Perhaps above all, in the light of some of the comments today, he was a man of honesty and integrity. That is what I remember and recall. It is a vast tragedy that his very last months should have been scarred by innuendo and gossip. It is inconceivable that he would have taken part in any kind of cover-up. Indeed, Geoffrey Dickens, I understand, wrote to him, thanking him for the way in which the Home Office had dealt with his letters—letters, not a dossier. Now that he is dead, I hope that people will not use the release from libel to attack his reputation; he certainly does not deserve that.

I have lost a lifelong friend, but this is as nothing compared to the loss of Diana, the great love of his life, and of Catherine and Victoria. To them we send our heartfelt commiserations and the small comfort that their sense of loss is very widely shared by a vast number of people in this country.

Turning briefly to the Bill, I support it very strongly and I will tell noble Lords why. Over the last two years I have been researching a book on HIV and AIDS. I went to look at the position on the ground in a number of countries. I saw a hospital in east Africa that had not had a budget increase for a decade; where a visit to the hospital took a day in travelling to and fro; where they did their best to meet the demand, but, frankly, many births were far away from the hospital on concrete floors, under a single blanket. In another country I saw a so-called model treatment centre, where drug users queued for long periods; while in another African country where they were treating TB, the queues started forming at 5 am and patients waited hours to be seen.

I am not overdramatising the position—that is the trouble. There are far worse examples. It is the way of life and death in vast parts of the world. The recent outbreak of Ebola is closely connected to the lack of medical support. In Sierra Leone, there are 134 doctors for a population of 6 million.

I often feel that there is a lack of imagination about the health provision for millions upon millions of people in other parts of the world. Worse, I think that sometimes there is an optimistic belief that private giving and philanthropy can solve all the problems. Valuable as voluntary giving is—it is invaluable—it is never going to meet the gigantic demand around the world, so I support entirely the amount of aid that is going to fight these diseases. I support the 0.7% target. Without that international aid, the world would be facing a catastrophe.

I also support the leading part that this Government are taking in making help available. I also reject some of the headline reports we have seen over the past week which allege that the decision in 2013 to meet the target of 0.7% of national income was rushed and last minute. The decision on £500 million going to the Global Fund was about the best-trailed announcement that I can remember.

I regret the time imperative of this debate. Suffice it to say that I entirely back the emphasis that this Government have given to international aid. It is what I would expect from a civilised and outward-looking country that recognises it has responsibilities to try to help the poorest people in other parts of the world.

Ebola

Lord Fowler Excerpts

Thursday 8th January 2015 Lords Chamber

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what lessons they have learnt from the recent Ebola outbreak in West Africa.

[Lord Fowler (Con)]

My Lords, I welcome the opportunity of this short debate. First, I would like to pay tribute to the brave people who have gone from other countries, very much including the United Kingdom, to help tackle the outbreak of Ebola in west Africa. Obviously, I am thinking of Pauline Cafferkey, being treated at the Royal Free Hospital in London, and we all very much pray for her recovery. But I also pay tribute to all the others from different occupations and disciplines who have gone to help, including the 70 volunteers from the National Health Service. They have put their own health at risk and we should remember that, among the 680 healthcare workers who have contracted Ebola since the first outbreak of the disease, no fewer than 400 have died. These men and women have come from other countries in Africa and from around the world and have paid a terrible price for their altruism and selflessness.

Of course, the major casualties of the outbreak have been the 8,000 men, women and children who have died so far in countries such as Sierra Leone, Liberia and Guinea. There is perhaps a failure of imagination by us in the West about what a bare statistic such as that means for families on the ground—the individual tragedies that make up the total, with families torn apart and children left without one or both parents. The epidemic may have now reached a peak, I hope, but whether it has or not, one point is certain: we need to examine what measures should be taken to prevent further epidemics on this scale.

It is also worth remembering that any policy changes that may result from Ebola may also have the effect of helping in the fight against other diseases such as AIDS, TB and malaria, where the death toll is actually even greater. Around the world today there are 1.5 million deaths from AIDS each year, a further 1.5 million from TB and 600,000 from malaria—predominantly of children. The challenge must be to reduce radically this entirely unacceptable total of death.

What are the lessons that we can draw so far from the latest Ebola outbreak? I suggest that there are at least three. The first is that one of the reasons why the Ebola epidemic has spread so widely, so quickly and with such devastating effect is that in many parts of sub-Saharan Africa health systems are inadequate; the staff are under enormous pressure and their working conditions are often far below what any of us would consider acceptable in this country. Again, there is perhaps a failure to recognise the conditions in which medical staff have to struggle to make an impact. A few months ago I went not to west Africa but to Uganda and visited a hospital on the banks of Lake Victoria which had not received a budget increase for 10 years. Inadequate and underfinanced health systems remain the truth in so many African countries.

Sierra Leone is a prime example. The country lies 11th from bottom of the United Nations Human Development Index. The figures for infant, child and maternal mortality are bad even compared with neighbouring Liberia. Up until the crisis, Sierra Leone, with a population of around 6 million, had something like 136 doctors and 1,000 nurses to care for the population. The Health Secretary said in the other place on Monday that the Government,

“have committed more than £230 million to fight the disease in Sierra Leone”.—[Official Report, Commons, 5/1/15; col. 40.]

That is enormously welcome and makes Britain one of the biggest contributors in the world. However, my concern is not just what we are doing now but what we did before to strengthen the health system and what we will do in the future, because the whole need is for consistent policy applied year after year. My concern is that, once emergencies are over, there is a tendency for countries to fall off the agenda. We treat the casualties but we do not do enough to prevent those casualties taking place.

An excellent all-party report by the House of Commons International Development Committee, under the chairmanship of Sir Malcolm Bruce, found a strange lack of interest among the NGOs in even giving evidence on the position prior to the Ebola outbreak. The committee would have expected something like 100 pieces of evidence; it received 10. In passing, I pay tribute to Marie Stopes, Plan and Save the Children for being the exceptions to this trend. Unfortunately, the same view seems to have been taken by DfID. In paragraph 33 of its report, the committee found that bilateral programmes directly managed by DfID for Sierra Leone and Liberia were planned to reduce by £14.5 million in 2014-15 compared to the previous year, a reduction of around 19%. The committee commented that it was “appalled” that the budget was being cut in this way. Since then, policy has changed. Emergency money has been put in. A vast effort is being made to help. I welcome that, but my view remains that the priority of policy should be, above all, to provide consistent support for a country such as Sierra Leone, which is one of the poorest in the whole world.

My second point also concerns consistency. I declare an interest as a non-executive director of the International AIDS Vaccine Initiative, which is a non-profit organisation working to develop a vaccine for AIDS. My point today is a more general one about vaccines. If we can develop them successfully, this can have a dramatic effect, as we have seen in a number of countries in relation to the polio vaccine. But there is one point about vaccine development that is also absolutely certain. They take a long time to develop—sometimes a very long time. For example, the polio vaccine took 47 years to develop and the whooping cough vaccine took 42; with some of the diseases—malaria, for example—the search has been continuing for well over a century. The development time has a number of impacts. It means that the pharmaceutical industry is not always able or willing to invest what could be very substantial sums in development. The result is that, in my view, there is a particular responsibility on Governments to finance development here. The United States does a vast amount in this respect. I fear no one would claim that the United Kingdom proportionately does the same.

The third and final lesson that I believe we should examine is the medical staffing position of some of the poorest countries in Africa to see whether the developed world is taking too many of the doctors and nurses who have been trained in Africa but then come to work and settle in countries of the West and the Middle East, including the United Kingdom, of course. Let me be absolutely clear: the doctors and nurses who have come here have made an invaluable contribution to the health service. There is no doubt about that. But that is not the end of the story. Seen from Africa, the problem is that many of the doctors and nurses who have been trained at some expense have left Africa, which is in vast need of their care, to go abroad. Taking Sierra Leone as an example, around 600 members of National Health Service staff received their primary medical qualification in Sierra Leone. That is small in our terms but absolutely massive in terms of Sierra Leone. Relatively few return.

I do not claim that it is going to be easy to reverse that trend. It is a question not just of salary but of the medical conditions to which doctors and nurses will return. What we should be aiming at is a situation where there is investment in inward migration but also in outward migration—a two-part thing. It is neither desirable nor possible to have a blanket ban on the immigration and emigration of medical staff. Ideally, it should be a two-way process, as an excellent report by VSO makes clear. But what is clear at the moment is that Africa appears to be a very heavy loser from this process and that we in the West would do well to mount an inquiry to see what can be done to correct that position.

These are just three questions that the Ebola crisis raises: whether we are doing enough to develop and produce vaccines; whether our policies in the West are taking away a disproportionate number of doctors and nurses from African countries which badly need them; and, above all, how we can further strengthen the health systems of countries such as Sierra Leone so that further human tragedies can be prevented. My hope is that the tragedy of the Ebola outbreak today may point the way to producing more permanent answers for the future.

AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Thursday 11th December 2014 Lords Chamber

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what action they are taking to support the Global Fund to Fight AIDS, Tuberculosis and Malaria.

[Lord Fowler (Con)]

My Lords, one of my major purposes in raising this short debate is to emphasise a crucial point about public health across the globe. Currently there is vast concern about Ebola, and rightly so. It must be met with all the resources at our disposal. But at the same time we must not forget the even greater challenge posed by the three diseases that the Global Fund was formed to fight—AIDS, TB and malaria.

The figures for deaths tell their own story. In 2013 an estimated 1.5 million people died from HIV/AIDS; 584,000 people died from malaria, and an additional 1.1 million people died from tuberculosis. The burden is heaviest in sub-Saharan Africa, where an estimated 90% of all malaria deaths occur, and—this is perhaps the most disgraceful statistic—in children under five. So, currently, three diseases account for more than 3 million deaths a year, to add to the mountainous totals over the past 25 years. AIDS is an example: the death toll so far is 35 million people. In addition, 36 million people are living with HIV, and in 2013 almost 200 million cases of malaria, and 9 million new tuberculosis cases, were detected.

Having said that, I do not want to downplay or understate the progress made, or the vast contribution that the Global Fund, and the President’s fund from the United States, have made. Without them the world would be in even greater crisis. The latest figures for the Global Fund show that 7.3 million people are on antiretroviral therapy for AIDS. It has tested and treated, or helped to test and treat, more than 12 million people for TB, and has distributed 450 million insecticide-treated nets to protect families against malaria. We have therefore made vast progress since those dismal and tragic days in the 1980s, when AIDS patients died and there was absolutely nothing we could do about it. I pay tribute to the clinicians, the nurses, the volunteers, and all those working for NGOs, throughout the world, who have made this progress possible.

Now we come to what is perhaps the most difficult challenge for any Government. In spite of the progress made, much more needs to be made, and it needs to be made urgently. As UNAIDS says in its latest report, only about three-fifths of countries have risk reduction programmes for sex workers, and 88 countries report that fewer than half of men who have sex with men know their HIV status. Most countries fail to provide drug substitution therapy, or access to sterile needles and syringes for people who inject drugs—even though that is something we started in this country back in the 1980s. Again, most disgracefully of all, antiretroviral treatment for children lags very substantially behind that for adults.

Not all the steps to combat these factors imply increased financial help. If the 80 countries that currently—and disgracefully—criminalise homosexuality were to reform that policy, we would take a massive step forward and reduce one enormous barrier to testing and treatment around the world. There is no question but that that could have a profound effect. I very much hope that in this debate the Government will underline their determination and commitment to do as much as they can to persuade those countries to reform their legal processes.

Just as certainly as that, sustained and increasing financial help is necessary from the nations of the world. Here I pay tribute to the Government for honouring the important pledge, made by Andrew Mitchell when he was Secretary of State for International Development, to add a further £0.5 billion for the Global Fund, as long as other nations join in. There is a slight question about that at the moment, because the total aimed at has not been reached.

Having just praised the Government, if I had a criticism of them it would be that that message about the increased aid should be made loud and clear. At the recent international AIDS conference in Melbourne, where there were Ministers and civil servants—it is by far the most important meeting in the AIDS calendar—we could manage no Minister or civil servant from DfID, and as far as I know, unless he attended very secretly, no British high commissioner. And that was in a Commonwealth country. We need to explain to the world what we are doing and why, and not allow other countries to paint us in terms of the British policy of the Victorian years.

I shall make one last point. With AIDS, antiretroviral drugs have saved millions of lives, but I wonder whether we should put all our eggs in one basket. I believe we should take heed of the warning given today by the review of drug resistance set up by the Prime Minister. Drug resistance can have a profound effect on HIV, TB and malaria. According to Jim O’Neill, who headed the review, drug-resistant infections already kill hundreds of thousands of people a year globally, and by 2050 that figure could be more than 10 million.

There will be further reviews, and I see that it is said, and emphasised, that the role of vaccines to prevent infections, in particular, will be examined. I declare an interest at this point, as a board member of the International AIDS Vaccine Initiative, a non-profit organisation, based in New York, dedicated to developing a vaccine for AIDS. It has been consistently supported by both parties—although this Government’s recent decision to cut help from £10 million a year to £1 million a year in one slash has not exactly helped. I could say more, but I will not, unless I am provoked, because the point I am making is a rather broader one than that.

Vaccines can take, and almost always have taken, decades to develop. This is not necessarily a natural area for Governments, with their four-year time limits—and perhaps even less so for Ministers, whose time limits are usually rather shorter than that. That is why it is so significant that the President’s fund in the United States, which obviously has a much longer timescale, is now devoting a small part of its substantial resources to research into prevention and vaccines. That is an extraordinarily important move and underlines the importance of prevention. Following that, I wonder whether the Global Fund should not do exactly the same thing and provide a more certain source of finance as well as underlining the crucial importance of prevention as well as treatment. That is the point about moving in that direction.

The Global Fund has made amazing progress but it is dependent on government resources from and around the world. The message for all those Governments is: for goodness’ sake, don’t stop now, for we are dealing with three of the main killer diseases in the world today.

Health: HIV

Lord Fowler Excerpts

Monday 17th November 2014 Lords Chamber

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what is their latest estimate of the number of men, women and children around the world who have contracted HIV.

[The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)]

My Lords, according to the UNAIDS Gap report published in July 2014, globally it is estimated that 2.1 million men, women and children became newly infected with HIV in 2013, which is down from 3.4 million in 2001. It is estimated that 35 million people are now living with HIV.

[Lord Fowler (Con)]

My Lords, is not the worst feature of that figure of 35 million people living with HIV around the world that half of them are undiagnosed, and the principal reason is that people are prevented coming forward for testing because of the prejudice and fear that surrounds this area? As we approach World AIDS Day in about a week’s time, will the Government renew their efforts to persuade a change of policy in the 80 countries around the world, several of which are in the Commonwealth, where homosexuality is still a criminal offence?

[Baroness Northover]

I start by paying tribute to my noble friend for his outstanding work in this field, and not least for his new book, which I have been reading with great interest, AIDS: Don’t Die of Prejudice. He makes a very strong case not only for action in the United Kingdom—which, of course, he led on, and which I hope he will agree we have maintained—but for very active work overseas. It is by being inclusive, not stigmatising, and by making sure that prevention, treatment and care are all taken forward for everybody that we will indeed turn this around.

Ebola

Lord Fowler Excerpts

Thursday 6th November 2014 Lords Chamber

[Lord Fowler (Con)]

My Lords, I congratulate the noble Baroness on that quite excellent speech, with which I very much agree. Quite apart from the present effort to deal with the Ebola crisis, I will emphasise just two points on future policy.

The first is that the Ebola crisis again illustrates how deficient the health systems are in so many countries, not least in Africa. There is a lack of doctors and nurses; there is a lack of equipment and of modern buildings. Their health systems are under enormous pressure in what could be termed normal times, let alone abnormal times. Nothing is more urgent than that British aid policy should be directed here. That will also have the effect of tackling other scourges such as AIDS, which even today accounts for more than 1.5 million deaths a year, many of which are, of course, in Africa.

My second point is that if we are to help further, we need to look again at our policy of recruiting medical staff for the National Health Service from some of the poorest countries in the world. The latest figures that I have are that 21,000 National Health Service staff had their primary medical qualification in Africa, including almost 600 from Sierra Leone. This is in no way a criticism of them but we should examine our policy to see that we are not taking medical staff from countries which have trained them and whose need is much greater than our own here. Our aim should be to be self-sufficient and for us to provide more training in those countries which are undoubtedly in the greatest need around the world.

Marriage (Same Sex Couples) Act 2013

Lord Fowler Excerpts

Wednesday 30th July 2014 Lords Chamber

Asked by

[Lord Fowler]

To ask Her Majesty’s Government whether they are satisfied with the enactment and operation of the Marriage (Same Sex Couples) Act 2013.

[Baroness Northover (LD)]

My Lords, the first marriages of same-sex couples took place on 29 March—sooner than we had originally thought possible. We intend to bring the remaining elements of the Act into force on 10 December, enabling couples in a civil partnership to convert it into a marriage, and couples to stay married, if they wish to do so, when one or both of them changes legal gender.

[Lord Fowler (Con)]

I congratulate the Government on their progress but perhaps I could raise one point. Canon Jeremy Pemberton married his partner in April, as a result of which he has had his permission to work as a priest in Nottinghamshire revoked and been banned from seeking a new post as a chaplain and bereavement manager. Given that there are other clergymen at similar risk, will the Minister, as a matter of good will, look at the position and see whether anything can be done to help reconcile the difficulties?

[Baroness Northover]

My Lords, I thank the noble Lord for his thanks to the Government on this. I was a guest at a same-sex marriage very recently and found it extremely moving. The couple had had to overcome so many hurdles to get to a point that so many of us simply take for granted. My noble friend will know that the Bill sought to protect the position of religious organisations and that this is a matter for the Church of England. We hear what he says, and it is worth also bearing in mind that things can evolve. For example, it is good that we should soon see women bishops.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Lord Fowler Excerpts

Thursday 12th December 2013 Lords Chamber

[Lord Fowler (Con)]

My Lords, I congratulate my noble friend Lord Chidgey on his speech and I look forward to the maiden speech which is to follow in a few minutes. I should perhaps declare a new interest. Last week I joined the board of the International AIDS Vaccine Initiative in New York. I agree entirely with what my noble friend has said in introducing this short debate, in particular about the value for money that the Global Fund represents and, of course, the contribution that it is making to the fight against TB. I will not repeat his arguments because I want to come to this issue from a slightly different position.

Over the past 18 months, I have been looking at HIV and AIDS in different cities around the world. What has struck me is that when I explain this in this country, I am met with the response, “You mean, it is still a problem?”. It depends on what you mean by a problem. Last year some 1,600,000 people worldwide died from AIDS, while 2.3 million were newly infected, and for every person who was put on to antiretroviral treatment, two were infected. Some 36 million people around the world live with HIV, including 100,000 in this country, accounting for a drugs budget in the region of £800 million.

It may be true that Africa has the biggest problem, but more than 2 million people live with HIV in India, while in Russia and Ukraine there are major problems of injecting drug users, home-made drugs and shared needles. Of those with HIV, up to a quarter are undiagnosed and, all other things being equal, continue to spread the virus. Even when people are on antiretroviral drugs, many do not adhere to the treatment, storing up all kinds of problems for the future. So, yes, not only is there a problem, but there is an acute and urgent challenge to every Government in the world. Thanks to the Global Fund and to the President’s fund in the United States, enormous progress has been made. The United States Government in particular should be given credit for what they have done—of course, I agree with my noble friend—as should the Government here, who have redeemed the pledge of my right honourable friend Andrew Mitchell to increase their Global Fund contribution. We should also recognise, however, that over the past few years the overall global contribution has remained stable in real terms; it has not increased.

In no way do I deny the progress that has been made because it has been formidable and dramatic in terms of the number of lives saved, but I would suggest that the lesson is that we must not give up now. We should recognise what that means: we are talking about a lifetime commitment to people living with HIV. It is not a condition where, after treating a patient for six months, you can move on to the next one. That is one reason why the world needs to put far more emphasis than it has on preventing new cases of HIV. As I mentioned, I have joined the board of IAVI and did it for this reason. A vaccine gives the best hope for the future: you cut through some of the prejudice that surrounds testing and, from the financial point of view, it opens up the hope of reducing an otherwise constantly increasing bill. That was why—if I may say so to my noble friend—I was surprised and dismayed a month or two ago, before I joined the board, that the Government slashed the help from a hardly princely £9 million or £10 million down to £1 million.

I accept that there is, at present, no cure and no vaccine—which is exactly what I said back in 1986. That means we have to do two things. First, we need to keep up our contributions to the Global Fund. It needs to be underlined that, in the vast majority of cases, that has been money well invested, resulting in tremendous advances and the saving of lives. Secondly, we need Governments globally to engage with the key minority populations where the risk of HIV is highest. It is absurd, unjust and counterproductive that homosexuality is criminalised in so many countries in the world. We also need to treat drug dependence as a medical issue, not just as part of a so-called and unsuccessful war on drugs, and to introduce more clean needle schemes, which we did in this country in 1987. We need to engage with people such as sex workers, where the rate of HIV remains very high, and not simply pursue a policy of looking the other way. We also need to fight discrimination against transsexuals, which often forces them into sex work.

We have made massive progress, much of which is down to the success of the Global Fund, to which I pay tribute. However, we should also recognise that there is still a hell of a long way to go.