HIV: Women and Girls

Mike Freer Excerpts

Tuesday 12th April 2016 Westminster Hall

[Mike Freer (Finchley and Golders Green) (Con)]

I beg to move,

That this House has considered tackling HIV in women and girls.

It is a pleasure to serve under your chairmanship, Ms Buck. I start by thanking my right hon. Friend the Prime Minister, the Secretary of State for International Development, my right hon. Friend the Member for Putney (Justine Greening), and her ministerial colleagues for their ongoing commitment to international development and the 0.7% spending target, despite the best efforts of the august Daily Mail and other media. It is good to see that our ministerial colleagues remain firm in their commitment to international development.

As chair of the all-party group on HIV and AIDS, I called for this debate to provide an opportunity to reflect on the progress made and the challenges ahead in the response to HIV and AIDS and, in particular, in ending the AIDS epidemic as part of the sustainable development goals. I want to use the debate as an opportunity to press my right hon. Friend the Minister on the Government’s commitment to the SDGs, which were adopted in September 2015 by UN member states to galvanise efforts to meet the needs of the world’s poorest by 2030.

The final framework outlined in the agreed text contains 17 goals and 169 targets—it is not a brief document. One of those targets is:

“By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”.

If the aim of ending AIDS as a public health threat by 2030 is to be achieved and if we are to bend the curve of the epidemic to manageable levels, the bulk of the progress must take place in the next five years. Without that, the epidemic could spiral out of control, and we can expect a spike in treatment resistance. Investment not made at this stage will lead to greater treatment costs at a later date. The joint United Nations programme on HIV—UNAIDS—agrees and has released fast-track targets. The 90-90-90 targets aim to ensure that by 2020, 90% of people living with HIV know their status, 90% of them are accessing treatment and 90% of those accessing treatment are virally suppressed. If we achieve that, the number of onward transmissions of HIV will be significantly reduced.

Meeting the targets is a stepping stone that will ultimately make it possible to end AIDS as a public health threat by 2030 and avoid an estimated 28 million HIV infections. The latest figures released by UNAIDS show that nearly 16 million people are now accessing antiretroviral therapy, or ARVs. That compares with the figure of 1 million 10 years ago. That is good progress. In 2014, there were 2 million new HIV infections, compared with 3.4 million in 2001. Those figures show that progress is being made, but they underline the need to do more.

[Mrs Helen Grant (Maidstone and The Weald) (Con)]

I congratulate my hon. Friend on securing this important debate. Does he agree that unfortunately, as a result of stigma, prejudice and discrimination, many people with HIV and AIDS are driven underground and therefore do not seek treatment? We must do all we can to deal with that injustice and prejudice.

[Mike Freer]

My hon. Friend makes good points. We often think of stigma and prejudice as affecting poorer parts of the world and, unfortunately, many parts of the Commonwealth, but stigma remains an issue even in the UK. Even in the UK, people seeking treatment for HIV will often go to a sexual health clinic outside their local area because they are afraid of the stigma that can be attached to being seen as being HIV-positive. We have made significant progress, but a lot remains to be done in the UK and in particular the developing world. My hon. Friend makes an important point.

There are still around 20 million people living with HIV who are not accessing ARVs. Just half of those living with HIV are simply not aware of their status. I want to talk about some of the key issues facing the AIDS challenge and the HIV challenge. Since 2000, adolescent deaths have tripled. AIDS is the leading cause of death for adolescents in Africa and the second greatest cause of adolescent deaths globally. Some 60% of new HIV infections are among young women. Globally, HIV/AIDS remains the biggest killer for women of reproductive age. More than 5,000 young women and girls acquire HIV every week. In southern Africa, adolescent girls and young women acquire HIV seven years earlier than their male peers, which has a devastating impact on their life chances. HIV/AIDS is a major barrier to the ability of women and girls to participate in education and to become and remain economically active. If we want to achieve gender equality across education, health and economic participation, we have to tackle HIV/AIDS in women and girls.

We know what needs to be done to achieve the target to end the epidemic by 2030. We know that we need to challenge and end the stigma and discrimination faced by those living with HIV/AIDS. That stigma acts as a barrier to people being tested and accessing the services they need. We need to improve access to treatment for those who are diagnosed as having contracted the virus. With just 25% of girls having a full understanding of how HIV is transmitted and prevented, we need to improve education. We also need to tackle violence against women and girls. Adolescent girls and young women who have experienced sexual violence are 50% more likely to have acquired HIV.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I commend the hon. Gentleman on securing this debate and on his chairing of the all-party group. Given that the highest incidences of HIV and AIDS among women and girls tend to be in countries with strong historical links to Britain, does he accept that we have a particular responsibility to show international leadership on the issue? Would this not be a good time for the Minister to announce that the Secretary of State will, as a result, be attending the 2016 UN General Assembly high-level meeting on ending AIDS in June this year?

[Mike Freer]

The hon. Gentleman makes a strong point. It is still a shame on the Commonwealth that so many of our Commonwealth partners continue to discriminate against people with HIV and against lesbian, gay, bisexual and transgender people. Later, I will go on to mention some of the challenges with our withdrawal from many of the middle-income countries. It leaves many marginalised groups and many criminalised groups bereft of support, whether that is treatment or even just accessing healthcare in general.

On the Durban conference later this year, the hon. Gentleman will not have seen the answer to my written question that was published about 10 minutes ago, but the Department of Health will be sending ministerial colleagues to represent the UK and the Department for International Development is sending officials. The UK will be represented at the Durban conference—that is hot off the press.

Let me turn colleagues’ attention to some of the other issues. This is not just about the wide range of complexities, whether it is access to treatment, violence, education or economic participation; it is about how we approach research and development, both in dealing with HIV/AIDS and, in the developed world, in accessing the medical tools most needed to meet public health needs. The UK has an important role to play in meeting those ambitious objectives.

Historically, DFID has been a leader in the global response to HIV and AIDS and was viewed as one of the most forward thinking and effective agencies. When he responds, I am sure that my right hon. Friend the Minister will confirm how DFID’s research and development is progressing, so that we can ensure that our standing as a world leader in that field will remain. At one time, the Department had a large dedicated policy team engaged in the AIDS response. It showed financial leadership through increased funding of the Global Fund to Fight AIDS, Tuberculosis and Malaria, but I am concerned that its AIDS and reproductive health and rights team has gradually reduced in capacity and was renamed the sexual and reproductive health and rights team, with HIV being theoretically mainstreamed across DFID’s work.

There is increasingly a perception that DFID does not have the focus on HIV and AIDS that it once did. To be fair, every Minister I have spoken to in the DFID team, including the Secretary of State, has confirmed that HIV/AIDS remains a Government priority and an integral part of the Department’s work; yet the newly published UK aid strategy makes no reference to HIV or AIDS and gives no indication of how the UK intends to contribute to meeting the SDG target to end the AIDS epidemic by 2030. I checked the DFID website, and as far as I can see it appears to be silent on eradicating HIV as a departmental goal. It used to be a specific target and there used to be specific mention of what the Department was doing to eradicate HIV, but the website currently appears to be silent on that issue. Will my right hon. Friend the Minister explain why HIV has not been explicitly included and commit to putting that right?

[Mr Gareth Thomas]

When the hon. Gentleman researched the DFID website, was he able to find any speech by the Secretary of State or one of her ministerial colleagues on Britain’s contribution to HIV/AIDS that had not been provoked by a debate like this one, or by other House of Commons debates or questions?

[Mike Freer]

To be fair, I did not search through all the speeches given by colleagues in the Department. I did see that the most recent targets and policy statements ended in 2015, when the SDGs were agreed, and that some of the other policy documents dated back as far as 2013. To be fair to colleagues in the Department, I am sure that they have made speeches, but I did not search the database. I was searching the targets and policy pages. I am sure that my right hon. Friend the Minister will be able to direct me to what I have missed, but it appears that the website is currently silent on specific targets and policies.

Can my right hon. Friend the Minister reassure me that he will ensure that the HIV response is given a clearer and explicit inclusion in the strategies to meet the needs of women and girls in order to support gender equality, as well as all the other related issues? Addressing HIV is a key component of the women and girls agenda, and I hope he will confirm that it will be made a specific target and policy of the Department and will be clearly and explicitly mentioned on its website. The lack of a clearly articulated HIV strategy sends out a signal that HIV is being deprioritised and absorbed into other areas.

[Mrs Helen Grant]

DFID has put a lot of money into the global fund—I am sure that my right hon. Friend the Minister will confirm the amount, but it is something like £1 billion—which has done some great work in tackling AIDS and HIV. Government support for that sort of multilateral aid is very important. Does my hon. Friend share my hope that, following the multilateral aid review, investment in funds such as the global fund will continue to be significant?

[Mike Freer]

My hon. Friend makes an important point. Our commitment to the global fund is outstanding—I believe we are its second-largest donor. My concern is that, because we are the second-largest donor, the global fund listens to the mood music from the UK Government. One issue that I have raised on many occasions is how our withdrawal of aid from middle-income countries, stopping much bilateral aid and moving through to multilateral aid, leaves many marginalised groups bereft. No transitional funding is put in place. We have started to see that kind of emphasis being reflected in the priorities of the global fund because it takes its lead from its major donors, which is understandable.

If the mood music coming from DFID is to deprioritise and, unintentionally, to leave marginal groups bereft, so the global fund will, perhaps by accident, also leave those marginal groups bereft, as it follows the UK lead in targeting non-MICs. I understand the strategy for MICs, but there is a significant risk that those groups that are most at risk in MICs are, through either cultural differences, stigma or criminalisation, left to fend for themselves. That cannot be a good outcome for the HIV/AIDS epidemic. I hope that my right hon. Friend the Minister will be able to address that.

It would be a catastrophic mistake to lose the focus on HIV/AIDS because we are on the brink of finally being able to control the epidemic as a public health threat. Will my right hon. Friend tell us how his Department is planning to meet the SDG target to end the AIDS epidemic by 2030, particularly for women and girls? What assessment has been made of the Department’s capacity to implement the target? The challenge of achieving universal access to ARV therapy remains ahead of us. As I mentioned earlier, something in the region of 20 million people living with HIV are not accessing treatment.

Last year the all-party group on HIV and AIDS conducted an inquiry into access to medicines that revealed some of the challenges that many low and middle-income countries face in accessing medicines. Treatment prices remain prohibitive in many countries. The price of treatments is primarily driven by licensing costs and decisions about what the market will sustain. Intellectual property rights grant exclusive rights to manufacturers that can make drugs without competition, which leads to high prices.

Affordable first-line treatments are now available in low-income countries in the form of generic drugs. That has been a major step forward in increasing access to treatments. However, the cost of second and third-line treatments remains prohibitively expensive, as such products are largely protected by patents, which keep the price high. Many middle-income countries are excluded from licensing deals that allow generic production, forcing them to purchase drugs at inflated prices. That restricts access to treatment. If a large proportion of people with HIV are women and girls, they will be excluded, because the health system will simply not be available or the treatments are too unaffordable to be universal.

International donors, including the UK, have been scaling back bilateral overseas development for MICs, thereby expecting national Governments to increase domestic funding. As I have mentioned several times, that leaves marginalised groups bereft of access to treatments, and some treatments will simply stop being provided.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Gentleman for securing this extremely important debate. Does he agree that the issue is not only access to treatments but access to technology? During the Easter recess I was interested to read about portable methods for monitoring and assessing HIV. It is clear not only that joined-up thinking is needed across Departments—including Health and DFID—but that we should look at STEM subjects and our contribution to technological advances to ensure that people in rural communities have access to treatment through advances in technology.

[Mike Freer]

The hon. Lady makes an important point. I visited South Africa and saw some of the work being done by Médecins sans Frontières in the townships there. What was interesting was that, despite the poverty, virtually everyone had a mobile phone. Many of the treatments, including the prompts to adhere to ARVs and other information, could be provided by harnessing technology. There is a huge gap that can be tackled, particularly in remote communities. Through the use of mobiles and other forms of remote technology, we have an opportunity to get information to people in remote areas and ensure that they have access to education and, if necessary, some form of treatment. Access to technology is a major challenge that colleagues in the Department for International Development can perhaps look at through the Global Fund.

We need to look the cost of new drugs. I hope that DFID can take a lead in looking at how the current research and development model prohibits access and innovation. Let me give an example about paediatric treatment. In South Africa and elsewhere, there is an absence of paediatric antiretrovirals. In the clinics in many of the townships of South Africa, doctors and nurses have to crumble the tablets and, almost through guesstimates, come up with a dosage suitable for the child or baby because paediatric antiretrovirals are not financially viable for the drug companies. The existing models work against providing universal access to ARVs and containing and defeating the epidemic. I believe that DFID can take the lead in looking at a way of de-linking the cost of research and development from the demands of profitability.

A proposal is under discussion to create a global R and D fund that would operate through a combination of grants, milestone prizes and end-goal prizes. If it were based on an open innovation-type approach, it could reward all those who have taken part, entered the process and contributed to developing the new treatment. That idea is not pie in the sky; it has not been developed by those who seek to undermine the pharmaceutical industry. That kind of development is championed by none other than the Prime Minister. In fact, the Conservative party manifesto contained a pledge—my right hon. Friend the Minister looks puzzled—that this country will

“lead a major new global programme to accelerate the development of vaccines and drugs to eliminate the world’s deadliest infectious diseases”.

I challenge colleagues in DFID to take the lead in looking at different ways of funding R and D to reduce the cost of second and third-line antiretrovirals. The Government have been generous in maintaining the 0.7% funding and in the money allocated for the global fight against malaria and the Ross fund.

Tackling HIV and AIDS in women and girls is a task we cannot shirk. It cannot and must not be subsumed into the main work of the Department and mainstreamed. We need explicit targets and action that we can hold the Government and Ministers to account on. I thank colleagues for attending today, and I look forward to hearing my right hon. Friend the Minister’s response and other colleagues’ contributions.

--- Later in debate ---

[Mike Freer]

We have had a very good debate. I reiterate the point that if the Department’s commitment to women and girls is comprehensive, it has to include and specify dealing with HIV and AIDS. I thank colleagues and the Minister for taking part today.

Question put and agreed to.

Resolved,

That this House has considered tackling HIV in women and girls.