I am grateful for the opportunity to hold this important debate on the day before world AIDS day. I have received apologies from the hon. Member for Calder Valley (Chris McCafferty), who has done such great work on HIV/AIDS on the Council of Europe and wanted to be present for the debate, but has sadly had to return early to her constituency.

I intend to speak for no longer than eight minutes in order to give my hon. Friend the Member for South-West Surrey (Mr. Hunt) and the hon. Member for Walthamstow (Mr. Gerrard), the chairman of the all-party group on AIDS, an opportunity to contribute to the debate. I also speak in my capacity as chairman of the Commonwealth Parliamentary Association virtual working group on HIV/AIDS, and I am grateful for all the support that I get from the group.

Sadly, the problem of HIV/AIDS is not declining. According to international AIDS charity Avert, there are 39.5 million people worldwide living with HIV/AIDS. That figure includes 37.2 million adults, 17.7 million women and almost 2.5 million children. Last year about 3 million people died of AIDS, but 4.3 million more were diagnosed with HIV this year alone. AIDS has now surpassed the Black Death on its course to become the worst pandemic in human history.

Reading the news over recent years, one might have been led to believe that AIDS was a problem only for Africa, but other countries, including the United Kingdom, also have problems. In 2004 there were 58,300 cases of HIV/AIDS, but that rose last year to 63,500. Some, such as the Terrence Higgins Trust, believe that the figure is closer to 70,000.

I praise the Government for allocating £315 million, via the White Paper “Choosing Health”, to improve sexual health services, but as the Minister knows, many trusts are operating under huge financial constraints. The money was not ring-fenced, and much of it that should have gone to sexual health services has been used for other purposes, such as paying off some of the debts. In his talks with the Secretary of State for Health, will he ensure that any future funding is ring-fenced so that the money goes where it ought to go?

The Government promised a £50 million advertising campaign to promote sexual health, but the money never materialised. Only £4 million has been provided for a health campaign, which recently started. Clearly, the Government need to reconsider what needs to be spent to ensure that people, particularly young people, get the information that they require to protect themselves.

On the international scene, with few exceptions the picture is grim, but at least an increasing number of services are being made available. Africa, as we all know, has been hit hardest. Almost two thirds of all those who are affected by HIV/AIDS live in Africa, although it contains only 10 per cent. of the world’s population. During 2005 alone it is estimated that 2 million people died of AIDS in Africa. Since the beginning of the epidemic more than 15 million Africans have died of AIDS.

I was privileged to attend the world AIDS conference this year in Toronto and was appalled to hear first-hand of the problems facing Africa and other countries, including India, where 5.2 million are suffering with HIV. At the conference I had the opportunity to meet many groups and I applaud the work of the voluntary sector and professionals, who do fantastic work in education and by ensuring that drugs are getting through to the community, particularly rural communities, encouraging people to come for testing, and working with other agencies in countries that have a high prevalence of HIV/AIDS or in their own communities, especially universities, helping to remove the stigma.

I welcome the support of Bill and Melinda Gates and Bill Clinton with their amazing foundation. They do so much to help get drugs to the right people and to raise the profile of the issue. I welcome the fact that the Department for International Development—I am delighted to see the Secretary of State in his place, which shows how significant he thinks today’s debate is—has given £1.5 billion since 1997, trying to strengthen health systems in the developing world and over the next three years has committed to a further £1.5 billion.

I welcome where the money is to be spent, but I urge the Secretary of State to look at other areas where money is also vital. Will he target much of the money at his disposal at helping to provide vital drugs that are needed to combat the disease? Cheap drugs, such as Neviraprine, which costs as little as £6, prevents HIV from being passed from mother to baby. I applaud this week’s articles in Metro that pinpoint Ethiopia, where the drug has helped to provide protection for the babies of pregnant women.

I urge the Secretary of State to ensure that in the coming years Government funding is prioritised so that vital drugs such as these are provided to patients. We must also look at other drugs that could make such a difference to people’s lives. Microbicide cream could make a huge difference to prevent the spread of AIDS. I welcome the development of recent years and we are now in the final stages of that drug being tested. For women across the world, particularly in Africa, it will provide independence and empower them to make positive choices to ensure their well-being.

Will the Secretary of State also work with multinational businesses in this country so that all introduce positive work practices for their work force in countries that suffer from the pandemic? Some companies, such as Virgin, SAB Miller and De Beers, are already showing a lead, but we must make sure that all companies that operate within those countries provide a lead.

rose—

Order. It is not the convention of the House for the Opposition Front-Bench spokesman to intervene in a half-hour Adjournment debate at the end of the day, but I am sure that the House appreciates the importance that he attaches to the occasion by his presence.

I, too, am delighted to see my hon. Friend the shadow Minister in his place. We have had talks about this issue and I know how deeply he feels about the problem, so I am grateful for his presence here today.

Clearly, I could say much more about the issue, but I want others to speak. When I attended the Commonwealth Parliamentary Association conference in Nigeria recently I visited a small township just outside Abuja called Lugbe where I met Sister Cecilia and others who do fantastic work on the ground in a Catholic mission. I praise the work of the Catholic Church and other Churches. She introduced me to a lady called Pauline who lost her husband last year to AIDS. She herself was infected and destined to die. She lived in a typical humble setting and many thought that she would die soon. The drugs reached her and when I talked with her she was smiling and grateful, but more than anything else she displayed a vision of hope. Two of her sons beamed as they played around their mother. Had she died, the children would have been known as a cadet family, with the eldest brother looking after the youngest and all helping one another. That would have been pitiful. At least now the children have hope and the mother has a hope of seeing her children grow up. In this case tragedy was averted and I wish Pauline and her family the best of health in the coming years, but not everyone is so fortunate.

On world AIDS day 8,000 people will die of AIDS and, more chillingly, there will be 12,000 new infections. That is the scale of the problem we now face.

I will be brief so that I leave enough time for the Minister to respond. I am grateful to the hon. Member for Ribble Valley (Mr. Evans) for suggesting that he would welcome the presence of colleagues in this debate. This is not a party political issue and never will be.

I want briefly to make three points, two on what is happening internationally and one on what is happening in the UK. The theme of world AIDS day this year is accountability. Organisations outside Parliament are asking us to be accountable for the promises that were made at Gleneagles and other international conferences, particularly on universal access to treatments by 2010. We have made real progress in the past few years. Not long ago, many people were saying that we will never be able to deliver anti-retrovirals in developing countries. Although we did not meet the target of 3 million people by 2005, the “3 by 5” campaign made a step change in the approach to the delivery of drugs.

There are two specific issues apart from the obvious one of finance. The first is that of drugs pricing. At the moment, there are significant differences in prices for second line therapies. That will become increasingly important over the next few years. Some of the first line therapies that are now available quite cheaply will not be as effective, and we will have to try to secure cheaper access to second line therapies. Connected with that is the TRIPS—trade-related aspects of intellectual property rights— agreement and the way in which that might affect the supply of generics. The waiver was agreed at Doha, but no developing country has yet taken advantage of it. I hope that through DFID we can actively help developing countries to do so.

The second issue is that of the pattern of the epidemic—that is, the growing danger of major epidemics in eastern Europe and in India and China. If we get things right, we might stop those epidemics becoming as generalised as they have become in many parts of sub-Saharan Africa. It is partly down to money. However, to a large extent, particularly in eastern Europe, it is not so much a question of what the UK does to provide financial aid but of what we can do in working with those countries on developing sensible policies, particularly those where intravenous drug use is driving the epidemic and there is still considerable resistance from many politicians to adopting policies of harm reduction. If we can have influence through our contacts with politicians in some of those east European countries, we might be able to make a significant difference in time to stop the further development of mass pandemics in eastern Europe and in Eurasia.

Finally, I turn to the situation in the UK. The hon. Member for Ribble Valley mentioned the statistics. We are still experiencing a growing number of infections, although the Health Protection Agency figures seem to show a bit of levelling off in 2005. I hope that that is a genuine trend and that we will start to see a reduction. All the evidence suggests that a major epidemic in the UK is still possible. Although the figures for infections are relatively small, the number of new sexually transmitted infections is evidence that a lot of people out there are indulging in pretty risky behaviour. There is still the potential for a significant increase in infection in the UK, particularly in marginalised populations where men have sex with men, and especially now in African communities. This is not the Secretary of State’s direct responsibility, but there seems to be a contradiction between what we are doing internationally in talking about universal access to treatments and what we are doing domestically in denying treatments to some people in the UK who are infected. That does not make good sense on public health grounds.

I am deeply grateful for the leadership on this issue that has been shown by Ministers in our Department for International Development. We have had an important influence on what has been happening internationally, and I hope that we will continue to do so.

I start by thanking my hon. Friend the Member for Ribble Valley (Mr. Evans) for allowing me to make a brief contribution to the debate.

I would like to express the thanks of the whole House for the life and work of Father Angelo d’Agostino, a noted AIDS campaigner who died in Kenya last week and whom the Secretary of State has met. He was famous throughout the world for his work in founding the Nyumbani orphanage in Kitui, southern Kenya, and for his work in distributing anti-retroviral drugs in the slums of Nairobi. He will be greatly missed, but his work will continue.

Echoing the comments of the hon. Member for Walthamstow (Mr. Gerrard), I thank the Secretary of State for his personal commitment to the battle against AIDS. I would like to thank him not just for the achievement of Gleneagles and the universal access target, not just for persuading the UN to adopt interim country-level targets—the Secretary of State knows that I campaigned for them—but for putting his money where his mouth is. The fact is that DFID is the second biggest donor internationally in the battle against AIDS. By doing that, he shows—and we show as a country—that we recognise that without progress in the battle against AIDS, there can be no progress in development at all in Africa.

I would be grateful if the Secretary of State dealt with three concerns about moves towards universal access. First, I have researched some figures that seem to indicate that the cost of distribution of anti-retroviral drugs is up to five times higher through the global fund as compared with the distribution through PEPFAR—the President’s Emergency Plan for AIDS Relief. That is connected to the fact that PEPFAR is quite happy to distribute anti-retrovirals directly to non-governmental organisations, whereas the global fund tends to prefer to distribute through host country Governments. That is obviously a great concern and the effectiveness of the global fund will be incredibly important in this battle.

My second concern is the continued lack of availability of paediatric anti-retroviral drugs, which I know that the Secretary of State has looked into. My third concern is how we are going to meet the targets for universal access in conflict and post-conflict zones—in countries such as the Democratic Republic of the Congo, where there is little or no health infrastructure. I am not sure that we have a strategy for determining whether we can achieve that and, if so, how best to do it. It is a very important consideration.

I finish by urging the Secretary of State to show the same commitment to achieving the goals of Gleneagles as he showed in securing them. I am sure that he will show that commitment. The hopes of a whole generation of Africans and, indeed, the hopes of the entire House rest on his personal commitment.

I begin by congratulating the hon. Member for Ribble Valley (Mr. Evans) on securing this debate on the eve of world AIDS day, and on the passion with which he spoke. I join him in paying tribute to my hon. Friend the Member for Walthamstow (Mr. Gerrard), who does great work chairing the all-party AIDS group. The hon. Member for South-West Surrey (Mr. Hunt) played a really important part in securing progress on interim targets. He argued the case and got us thinking about it. He had a real impact. I also pay tribute to our absent colleague, my hon. Friend the Member for Calder Valley (Chris McCafferty), who does such a sterling job. I am also very pleased to see in his place the hon. Member for Sutton Coldfield (Mr. Mitchell).

I undertake to draw to the attention of my right hon. Friend the Secretary of State for Health the points that were made about funding in the UK. I really hope that the central message of this debate and world AIDS day this year will be not only about all the things that have already been discussed, but about the importance of tackling stigma and discrimination. That will be central if we are to turn the tide of the epidemic.

We have heard the statistics. When we remember that 15 million children have lost the love and care of those on whom they relied most—one or both of their parents—to AIDS; when we know that a child born in Zambia today has a 50 per cent. chance of dying of AIDS in his or her lifetime; when we know that in Zimbabwe female life expectancy is now just 34 years; and when we see that the epidemic is actually growing fastest in eastern Europe and central Asia, with 90 per cent. of cases in Ukraine in Russia, we know how much of a challenge we have on our hands. Those are awful statistics, and behind every single one lies an individual. I join the hon. Member for South-West Surrey in acknowledging the exceptional work of Father Angelo d’Agostino, who he rightly praised. I also acknowledge the efforts of the civil society organisations and foundations that were rightly praised by the hon. Member for Ribble Valley.

We are making some progress. We and others worked jolly hard to get the commitments last year at Gleneagles, and at the United Nations in June all Governments agreed to work towards achieving universal access to treatment, care and support by 2010. One way of measuring the progress is to acknowledge that there are now 10 times as many people on anti-retroviral treatment in sub-Saharan Africa as there were three years ago. That involves 1 million people. My hon. Friend the Member for Walthamstow and other colleagues were right to point out that, five years ago, that would have seemed like a dream. I remember that my very first visit to Africa was to Malawi, where people were discussing how they might provide anti-retroviral treatment to just some of the population. It shows what we can do collectively when we put our minds to it. However, in Africa we are reaching only a quarter of those who need treatment, and an even smaller proportion in Asia. So, it is progress, but is it enough? No, it is not: we need to do a lot more.

The other thing that we agreed at the UN in June was that countries should set out plans with ambitious interim targets. Forty-four countries have submitted targets, and 20 have submitted fully costed plans. What those countries need to do is very clear and simple, in one sense. They need to build their health infrastructure, and that involves building clinics, ending user fees, employing doctors and nurses, doing the tests and buying anti-retroviral drugs. Those are all things that hon. Members have mentioned tonight. The countries in question have their own funds, but they need our support alongside that. The UK is pushing hard for donors to get their act together—that is why we worked so hard on the “three ones”—so that the help that we give comes in a form that the countries can make best use of.

The commitments on aid made at Gleneagles were important, as is replenishing the global fund. Hon. Members have generously referred to the funding that we have made available, including the £100 million going to the global fund each year. I will look into the point raised by the hon. Member for South-West Surrey about the cost of distribution under the global fund, because we need to ensure that every single pound that we commit gets to work to make a difference on the ground.

The hon. Member for Ribble Valley was right to highlight the importance of preventing mother-to-child transmission. I am pleased to tell him that a further £25 million of DFID support in Zimbabwe will provide more services to prevent transmission from pregnant women to children. We also support similar efforts in several others countries, including Malawi, Mozambique and Zambia. It is also essential, as the hon. Member for South-West Surrey said, that we work in conflict and post-conflict countries, where the Governments are weak. Zimbabwe is one example, and Burma is another, of countries where we work with the UN, non-governmental organisations and faith-based organisations. That helps to build the infrastructure that they need.

We also need to take more steps to bring down the price of drugs. The hon. Member for Ribble Valley was absolutely right about microbicides, and that is why we have already invested £50 million in their development. If that comes off, it will be a really significant step forward, not least because it will put some control into women’s hands. Many women have very little control over what happens to their lives.

I share the concern that has been expressed about medicines for children. That is why, in September, we helped to found UNITAID, the new international drug purchasing facility. That predictable, long-term funding aims to lower drug prices, and to get more people on to treatment. UNITAID’s first board meeting in October agreed $36 million to fund anti-retroviral treatment for up to 100,000 children in 2007 and double that number in 2008, and approved $70 million to expand second-line therapy—where first-line anti-retroviral treatment does not work—to 100,000 patients.

I warmly welcome the Clinton Foundation’s announcement at the UNITAID board meeting this morning of cheaper treatments that will reach 100,000 children. Cipla and Rambaxy are reducing the price of their paediatric anti-retrovirals to $60 a year, which represents a 45 per cent. reduction. That is the good news from this morning. We have made a 20-year commitment to UNITAID, as hon. Members are aware. We are also helping countries to use the flexibilities under the TRIPS—trade-related aspects of intellectual property rights—agreement. They are there, but people have to work their way through them to deal with this public health emergency.

The other point that I want to come to is the fact that although treatment is the priority for keeping people alive today, if we are to achieve an AIDS-free generation—that is what every single one of us wants—prevention is the key for tomorrow and the day after. That will not happen unless prevention is directed particularly at those who are most at risk: young people, women and young girls, men who have sex with men, sex workers and injecting drug users.

We know that women make up almost two thirds of the people living with HIV in sub-Saharan Africa. In some African countries, young women are almost three times more likely to be HIV-infected than men of the same age. Why? It is because of gender discrimination, social restriction, violence, fear of violence and lack of financial security. Women sell themselves for food or money because that is how they keep themselves alive. That makes women much more vulnerable to HIV.

We know that sex between men accounts for 10 per cent. of global HIV infections, yet UNAIDS reports that fewer than one man in 20 who have sex with men can access the HIV-prevention services that they need. We know that in Ethiopia up to three quarters of female sex workers are infected with HIV, yet some donors debate whether it is right to give them condoms. Some donors even place restrictions on working with them. That is not sensible if we want to defeat this epidemic.

Injecting drug use accounts for a third of new infections outside sub-Saharan Africa, particularly in eastern Europe. We know that harm-reduction programmes work—needle and syringe exchanges in particular—but less than 5 per cent. of drug users can access them. We have to put that right and ensure that people are not harassed when they are trying to use those services.

We know that condoms save lives, but they are in short supply. Since 2001, the UK has paid for more than 1 billion condoms. That amounts to the use of about 54,000 every hour, but in Africa there are still only enough to provide eight condoms for each man each year. There are 200 million couples with an unmet need for contraception. That is not good enough.

Therefore, improving services is crucial to achieving universal access. Supply is important, but so is demand. That is why tackling stigma and discrimination really is significant. Stigma and discrimination stop people accessing the services that they need and stop them coming forward for counselling, testing and treatment. If, as happens in Ukraine and Russia, police officers patrol needle exchange points and arrest people, surprise, surprise, drug users do not go to use them. Some women will not get tested because they are terrified that if their husband or family finds out, they will be thrown out of the family home.

What we do know is that where there is greater openness and honesty about HIV, progress happens. That is the case for Brazil, Thailand, parts of India and Malawi, but it is not straightforward, because in Lesotho although less than 10 per cent. of women in their late teens are infected, the figure for those in their early 20s rises to 40 per cent. We must keep on the case everywhere. As I said a moment ago, many women and girls do not have control over what happens to them. They need to be able to say, “If we’re going to have sex, you’ve got to use a condom.” Men and boys need to respect women’s decisions and to understand that no means no.

This is about changing culture and attitudes, and we can do that only if we are honest about the nature of the disease and what the problem is. Also, we must be honest about what works and in giving people the information and services that they need to protect themselves. Not all societies and not everybody finds it easy to do that, because some people feel very embarrassed and we are not always good at talking about sex. However, that is as nothing compared with the shame that we should feel about the huge daily death toll. The truth is, as our experience teaches us, that we can do something about it, and we have to do something about it.

I am really grateful to the hon. Member for Ribble Valley for giving us the chance to debate the progress that we have made and what we have yet to do. Now is a good time to show that we are serious about doing something on this issue.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Six o’clock.