Extract from House of Commons Hansard    Debates for 11th May 2006

Access to Drugs for HIV/AIDS

Mr. Neil Gerrard (Walthamstow):

I did not intend to speak, but as we have some time available, I thought I might add a few comments.

The debate has been useful and interesting. The International Development Committee’s report was also useful. I welcome the comments by its Chairman, the hon. Member for Gordon (Malcolm Bruce), about the intention to return to the subject repeatedly, because doing so would be useful. We have discussed whether the Department for International Development should be setting targets internationally. From the point of view of Parliament in scrutinising what is happening, if the Committee returns regularly to the subject, it would be of great value.

I am pleased that attention is being given to the impact of HIV/AIDS by those who are interested in international development. Eight, nine or 10 years ago, when I was getting involved in the subject in the House, people recognised that AIDS was a huge problem in Africa, but the international development connection was not made. It is made now, and everyone who is involved in such work accepts the central importance of dealing with HIV. That represents real progress.

I shall try not to repeat or to dwell on many of the things that have been said. Points have been made about drugs for children and the malignant effect of current US policy, which is starting to do damage in some African countries.

The commitment to universal access by 2010 is an amazing one when we consider what it involves, particularly if we compare the aim with the current situation. My suspicion is that we probably will not reach the target. We did not reach the three by five target, but that does not mean that it was not worth while. Setting the target changed some attitudes about what we should be doing and trying to do. The three by five target also changed people’s views about the ability to deliver antiretrovirals in relatively resource-poor settings. I recall debates on the subject only two, three or four years ago, in which people said, “It is impossible. You can’t deliver antiretrovirals in poor countries. It just won’t work. People won’t adhere to the drugs regimen. They won’t understand what it means.” All the evidence from the work on three by five is that that is rubbish. It is possible to deliver. People with the opportunity to take the drugs will adhere to the regimen. Rates of adherence compare pretty well with, and in many cases are much better than, rates in the UK, western Europe or the United States. That disproves some of what was said.

The target for four years’ time is a challenge. Even if we do not get there—I have doubts about whether we will—the existence of the target, particularly if interim targets are adopted, will lead to progress and change in some of the countries that most need that. We do not even really know the numbers—how many people we aim to treat by 2010—although we know that it is not the same as the number of infections. In many countries with high infection rates, there is not yet sufficiently detailed knowledge about numbers.

My hon. Friend the Member for Northampton, North (Ms Keeble) made important points about what has been happening in Kenya. The problem there is also a problem in other countries, and it will, in time, be a problem in more. If Governments are corrupt or incompetent, we cannot react by saying that we will do nothing for the people in those countries. We will have to find ways around those problems, and that will probably involve NGOs. We will have to find ways to get money and resources to people on the ground, even if Governments are incompetent.

Mr. Borrow: Does my hon. Friend agree that once treatment programmes have been started they must continue, irrespective of what happens to the Governments of the countries in question, or of the instability that might arise later, and that once people have been given the promise of continued life through a drug treatment programme, the developed world cannot take that away? It is a commitment not for five or 10 years, but decades.

Mr. Gerrard: That is absolutely right. We cannot take the commitment away because of a problem with the Government in a country. However—this is another point about universal access by 2010, and the money that it is said is required to fill the gap—billions of pounds will be required not just between now and 2010, but year after year subsequently. It would be unthinkable and immoral to get treatment programmes running and then withdraw the money that allowed them to continue. That demonstrates the importance of prevention. If our answer is simply to pour in drugs and treatment, and if we do nothing about prevention and stopping the rise in the number of infections, the drugs bill will inevitably go up every year, for years ahead. It will not be possible to cope with that if we allow it to happen. It will not be a question of £15 billion or £18 billion a year, but double and treble that figure, if we let infection rates continue to rise.

Another issue that arose with respect to Kenya—again, this is a matter of continuity—was the establishment in one or two places of successful pilot schemes funded bilaterally or by the GFATM. At the end of the pilot period, the question arises of where the money for their continuation is to come from. In some cases the money has not appeared. That problem has led to people being given treatment and support—given hope—that is suddenly taken away. That is a difficult one. It is not easy. Sometimes when a pilot ends, it is decided that it has not worked and it is cut off. We cannot guarantee that a pilot project will continue for ever. However, if a pilot runs and is successful, there are questions about why it should not continue and how it should be made to continue.

The hon. Member for East Dunbartonshire (Jo Swinson) referred to TRIPS, which I agree are important. The TRIPS agreement was drawn up before antiretrovirals existed, although it was expected to cover lots of other drugs. At Doha, a waiver was agreed so that in some circumstances public health could override intellectual property rights.

However, that waiver is not an answer to the long-term problems in respect of TRIPS. The newer, more effective drugs will not come out of patent for a long time. Even the very earliest HIV drugs such as azidothymidine are not yet out of patent, although they may be getting pretty close to it. There is a long way to go before some of the newer drugs get to that stage.

I agree with the Committee about the need to assess where we are going. To some degree, the drugs companies have learned lessons from South Africa and the appalling, dreadful publicity it gave them. They will not readily go down that road again. However, that has not solved the problems, and I suspect that if there are no changes to TRIPS, we will be in the situation mentioned by my right hon. Friend the Member for Edinburgh, East (Dr. Strang), in which the generics and cheaper drugs will not be available and second line drugs will be required.

I come back to testing and prevention. As I said, we cannot solve the problem by just throwing in drugs and money, because it will go on and on. A false dichotomy used to be presented—that testing and prevention were one thing and drugs were the alternative. However, the approach has to be of a piece; there has to be treatment, testing and prevention. It is pretty obvious why. We cannot persuade people that there is much benefit to being tested if there is nothing to offer them if they test positive. We will have much more success in persuading people to test if there is something to offer them as a result.

Development of testing on a bigger scale is a key to prevention as well. When so many people may suspect but do not know that they are HIV-positive, why should they be too worried about taking precautions against passing on the disease? When we talk about prevention, we focus all our attention on sending messages to uninfected people about how to avoid becoming infected. For some time, I have thought that that is true of this and other countries. We do not do enough to talk to infected people, yet they are the key to prevention, as they can pass on the infection. We do not give that enough attention.

It is not easy. People have to be careful not to blame or stigmatise somebody because he or she is infected. However, there is no question of not paying more attention to effective prevention work with people who are already infected.

Malcolm Bruce: Picking up on something mentioned earlier, does the hon. Gentleman agree that we as parliamentarians, with our contact with parliamentarians in other countries, ought to support those who demand rights and respects? When the Committee was in Malawi, the chairman of the social affairs committee there said that it wished to debate violence against women and the rights of women to discuss their sexual rights, but the men on the procedures committee said that that was not important and should not be given parliamentary time.

Mr. Gerrard: That is right. The debate on HIV/AIDS has moved on a long way from regarding it as a medical problem. It is far wider than that: it is a human rights issue and a women’s rights issue. We need to face up to that fact.

At the 2001 UNGASS, I was with the previous Secretary of State, my right hon. Friend the Member for Birmingham, Ladywood (Clare Short), at a meeting where there was a Minister from another country, which shall remain nameless. When we tried to discuss groups such as gay men, who were at high risk, he said, “Well, we don’t have a problem. We don’t have any gay men in our country: it’s illegal. It’s not possible.” My right hon. Friend’s response, which I thought was a good one, was to offer him a bet on that, which absolutely crushed him, rather than try to have an abusive argument.

I hope that when the Select Committee comes back to address the subject it will look broadly across what is happening in the world. We rightly focus a huge amount of attention on Africa, because of the devastation there. However, we should be looking more closely at what is happening in Eurasia. We are now getting general infection levels of 1 per cent. in Russia, elsewhere in the Commonwealth of Independent States and in some of the Baltic states, and an epidemic is growing in India and China, where the capacity for an enormous number of people to be infected is obvious.

We are still at a stage at which, if we get things right, we can avoid an epidemic developing in India, China and Eurasia which will reach African proportions. However, we have a pretty narrow window of opportunity. While looking at what happens across the world in the future and returning to the subject in subsequent years, I hope that the Select Committee will take account of that.

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