Cookies: We use cookies to give you the best possible experience on our site. By continuing to use the site you agree to our use of cookies. Find out more
House of Commons Hansard
x
HIV: Women and Girls
12 April 2016
Volume 608

[Ms Karen Buck in the Chair]

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a pleasure to serve under your chairmanship for the first time, Ms Buck, and to follow the hon. Member for Finchley and Golders Green (Mike Freer), who gave a measured and constructive speech. I will try to continue that tone.

This debate is a timely opportunity to ask whether the Secretary of State and her ministerial colleagues have, perhaps inadvertently, downgraded the Department’s work on HIV and AIDS. Ministers rarely mention HIV and AIDS unless pushed. There is—granted, my exploration of DFID’s website was only cursory—no record of a serious ministerial speech on this issue unprompted by Parliament for a very long time. There is no sign of a push to signal Britain’s continued interest in the major international efforts to tackle the factors that still drive the spread of HIV and AIDS. Given the urgency of the investment that is needed if we are to achieve the 90-90-90 targets, which the hon. Gentleman spoke about, it is disappointing that the Secretary of State does not appear—unless the Minister has news for us—to have a major plan to do the advocacy work that is needed at an international level.

The 10 countries that had the most people living with HIV in 2014—the last year for which figures are available—are South Africa, Nigeria, Zimbabwe, Mozambique, Uganda, Tanzania, Kenya, Zambia, Malawi and Ethiopia. They are all countries in which DFID has a significant bilateral programme or with which our Government have a long history and good connections. Britain’s continued influence with the countries that have the most people living with HIV is unlike that of any other country in the G7 or globally. It is therefore all the more important that Britain continues to show leadership on this issue.

Similarly, the slightly different list of the countries with the highest incidence of HIV among adults, as opposed to the general population, comprises countries with which Britain has a close relationship at Government level or, with one exception, where DFID has significant programmes. Again, that highlights the importance of Britain’s role in galvanising further investment in antiretroviral programmes and in championing the legal and cultural changes that are necessary to improve the response to HIV and AIDS.

The Department’s work focusing on girls and women is important and very welcome, and it is strongly supported on both sides of the House and among the non-governmental organisation community. I commend the Secretary of State for that work. However, I continue to be surprised by the apparent lack of interest in the impact on women and girls of being HIV positive. HIV and AIDS continue to be the biggest single killer of women of reproductive age globally. Despite that fact, the impact of HIV on women as a priority group is not frequently discussed or reflected in ministerial policy.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

The hon. Gentleman is making very important points about women and girls, but does he agree that they should be included as decision makers, not simply as victims and recipients of aid?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Absolutely. Britain’s international leadership on this issue is important because one of the things that we, as a country, should be championing is the cultural change that is needed in countries so that, as the hon. Lady says, women and girls become more active decision makers. At the moment, in too many cases, they are not. I gently bring her back to the important point she made about the strong support given by Britain to the global fund. I welcome that investment, but it is not enough to outsource leadership on HIV and AIDS from ministerial offices to the global fund. Political change is needed in countries as much as investment in health services, with which the fund helps. I fear that that is the important missing link in Britain’s response at the moment.

On 16 March, at International Development questions, I asked the Secretary of State specifically whether her Department’s spending on HIV and AIDS would be rising or falling over the comprehensive spending review period. In her reply, she said that the Department was planning shortly to publish the results of its bilateral aid review. Will the Minister set out for us whether he expects bilateral HIV-specific programmes to be rising, when up to now they have been in decline?

I am told by some of the NGOs that follow the Department’s work on HIV and AIDS closely that no mention of any such work seems to be in the aid strategy published by the Department last November. It would be good to hear from the Minister why that omission has happened. Furthermore, the sexual and reproductive health team, which has responsibility for HIV and AIDS work—certainly on the basis of ministerial answers to written questions—appears to be prioritising a series of other issues. They are very important issues, granted, but they are issues other than HIV and AIDS. Again, it would be good if the Minister explained that choice to downgrade the work on HIV and AIDS by the sexual and reproductive health team in DFID.

I come back to the first intervention that I made on the hon. Member for Finchley and Golders Green. He mentioned the Durban meeting, but I gently suggest that the UN General Assembly’s high-level meeting on ending AIDS, which is to take place in New York in June, is equally important. That is surely the perfect opportunity for the Secretary of State to set out Britain’s continuing commitment to and willingness to play a significant leadership role in tackling AIDS.

In addition, Britain could ask the new Commonwealth secretary-general to prioritise a discussion of the work needed in Commonwealth countries to tackle the HIV and AIDS epidemic. Foreign Office ambassadors and senior staff could perfectly reasonably be tasked to talk to senior figures about what more might be done in countries with particular challenges in tackling AIDS.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I thank the hon. Gentleman for his generosity in giving way. At those various international meetings, global ministerial commitments to tackle issues such as forced marriage and early marriage are also key factors in fighting HIV and AIDS.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

The hon. Lady is absolutely right. A series of factors drive the spread of HIV and AIDS. A health response is needed—we have rightly talked about the need to invest more in antiretroviral AIDS therapy and to improve health services more generally. A series of cultural practices need challenging and gender empowerment issues need addressing.

The only way that such things can happen is if political leaders are willing to step up to the mark. The challenge needs to come from a country such as Britain that has shown great leadership on the issue in the past; we will work with and support them, but we want things to change. I hope that the Minister will reassure me that the Secretary of State is willing to show that kind of leadership in future.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a pleasure to speak in the debate and to serve under your chairmanship, Ms Buck.

We are discussing HIV, which curses the lives of people in all walks of life across the globe. Yet many of the women who are infected are unaware of the status of their condition and are unable to access the treatment that they rightly need to go on to live a long and sustained life. I thank the hon. Member for Finchley and Golders Green (Mike Freer) for securing this debate on tackling HIV and AIDS specifically in women and girls.

Perhaps due to the lingering stigma attached to HIV since the time of the virus’s discovery more than 30 years ago, its impact on women is often disregarded in policy. Recognising that the barriers, stigmas and issues of access to services and treatment all require further consideration, let us use today’s debate to turn the trend on its head—we must recognise that, globally, HIV is the No. 1 killer of women of reproductive age.

We must also recognise the UNAIDS 90-90-90 target, which we heard about from the hon. Gentleman: the ambition by 2020 to have 90% of all people living with HIV knowing their HIV status; 90% of all people with diagnosed HIV infection receiving sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy having viral suppression. That should be not only an ambition but a reality, and we must ensure that we do all that we can to make that the case.

There are, without doubt, issues of HIV infection among women in the UK, but the heaviest concentrations of HIV infection are in the developing world. In such places, women are most affected. In sub-Saharan Africa, the region with the highest burden of HIV, 57% of people living with HIV are women, and figures from 2014 show that, among women of all ages, there were 12,500 new HIV infections every week. Those figures are huge. The effect of infection on each life is devastating; the lives of young girls, future women, will be devastated unless we do more to act. We must ensure that the UK plays a prominent role in securing a future for them. It is vital to consider how aid programmes funded by the UK and the devolved Governments can help to change that deadly trend.

There is a correlation between disproportionate rates of HIV infection among women and gender inequality. Gender inequalities have far-reaching consequences for women living with, and at risk of, HIV. To name but a few, issues include domestic violence, the role of sexual violence and the lack of access to income and property. Only last month, with the Women and Equalities Committee, I visited the UN Commission on the Status of Women, which focuses primarily on women’s economic empowerment. We must ensure that we unpick such gender issues and learn how best to tackle them. I ask the Minister how DFID intends to monitor and track the progress of sexually transmitted disease and to set targets for achieving those goals. The disease will not disappear by itself, and ultimately we must do all that we can to end the epidemic.

Advances have been made to improve access to antiretroviral treatment, but socioeconomic barriers for women to overcome remain. In particular, UNAIDS research identifies food insecurity as a barrier to adherence to antiretroviral therapy. Without adequate dietary intake, people undergoing antiretroviral therapy cannot experience the full benefits of treatment. That can create a vicious cycle. Women are usually those involved in producing, purchasing and preparing food. When a woman is HIV-positive, household food security is impacted as responsibilities shift to the younger women in that household, often raising additional issues of food insecurity for their families.

It is believed that 90% of HIV-positive children contract the virus from their mother during pregnancy, delivery or breastfeeding. Inadequate nutritional status may increase the risk of HIV transmission, and women therefore need access to information and replacement feeding options to minimise the risk of transmission during breastfeeding. It is unacceptable that the number of women and girls contracting HIV infections continues to be a growing trend, especially in developing countries. Young women aged between 15 and 24 are five times more likely to be affected than young men of the same age. The problem of HIV in Africa is complicated and there is no magic bullet. However, we must do more to educate men and boys about how they can prevent this disease, so that we prevent such harrowing statistics. Adolescents between 15 and 19 make up 74% of the new HIV infections that affect young girls and women.

The Scottish National party believes firmly that the empowerment of women is key to tackling and battling global poverty, and we are not alone. The First Minister is quoted as saying that the SNP sees the empowerment of women as the key in battling global poverty. Scotland’s First Minister has said:

“For virtually every nation, fully empowering women is probably the single simplest way, in which they can sustainably increase their productive potential. Gender equality can help to transform the global economy.”

The World Bank has said:

“Putting resources into poor women’s hands while promoting gender inequality in the household and in society results in large development payoffs.”

The UN General Secretary has said that

“removing the barriers that keep women and girls on the margins of economic, social, cultural and political life must be a top priority for us all—businesses, governments, the United Nations and civil society.”

The Scottish Government have taken action where possible to help the world’s most vulnerable people through their small grants programme. This programme supports NGOs to make a big impact and reduce poverty worldwide. The grant also includes using community sport to educate young people about HIV and using technology for a mobile phone app to improve emergency care in Zambia.

The HIV crisis is impacting developing nations, but it can be stopped. In order to best contribute, UK aid must focus on education about HIV transmission and on empowering women who are at most risk of infection. I urge the Minister to consider the effects of HIV on women and girls. How does the Department intend to monitor and track its progress in achieving the sustainable development goals? It is the responsibility of all Governments wherever possible to provide leadership in this debate. I hope the Minister will be able to respond to my questions.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a pleasure to speak in this debate and I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing it. Many of us have an interest in this issue. I suspect that many more would be here if it was not for other duties and debates elsewhere, because the issue certainly resonates with us. We are here today because we want to highlight the issue for those in other parts of the world. We are taking steps here in the United Kingdom of Great Britain and Northern Ireland, but we need to encourage countries and Governments to take steps elsewhere.

Worldwide there are some 900 million adolescent girls and young women in the 15 to 24 age group. Despite being 12% of the entire population of the world, too often for cultural or political reasons those young women are left without a voice or any say or control over their own bodies. We are all aware of the issues across the world and the violence against women. Rape seems to be a method of violence and war that some soldiers inflict on women wherever they have the opportunity to do so. We have had many debates in Westminster Hall that have highlighted the rape of women and girls and the brutal, horrible violent acts that take place against them. We recently had a debate on Burma and the Rohingya people.

Across the Sahara and across Africa, rape seems to be a weapon of war and we must highlight this issue. I often say we have to be a voice for the voiceless, and so we do. In this House we have to be a voice for those who have no voice, who do not have anyone to speak up for them, and the debate today is an opportunity to do just that.

Women have limited access to healthcare in developing nations and little or no access to education. Systems and policies skewed against them in some of the more gender-oppressive nations combine to create obstacles that block adolescent girls and young women from knowing how to and being able to protect themselves against HIV. We need a loud awakening of some of the Governments across the world so that they understand what is going on.

Despite the fact that the world is becoming more global, there are still regions in the world where young women and adolescent girls remain at a much higher risk of HIV infection than their male counterparts. It is shocking that, despite this fact being known, there seems to be no real progress, and girls in the age group I referred to still account for a disproportionate number of new infections among the young people living with the infection. There are an estimated 340,000 to 440,000 new HIV infections among young women aged 15 to 24 each year. If that does not shock us, I do not know what does. Despite making up only 12% of the population, they accounted for 60% of all new infections.

Poverty plays a big role, but the elephant in the room, as so often, is that although it is a global issue, there are clear issues in particular regions that exacerbate the case. It is true that some cannot afford access to care, treatment and preventive measures, but more often than not it is the cultural or political treatment of women that means they are unable to access the treatment, care and preventive measures that they need. Fifteen per cent. of women living with HIV are aged 15 to 24, a shocking 80% of whom live in sub-Saharan Africa. We know that that is an extremely impoverished area of the world, but we also know that the culture and policy towards women there is a far cry from the relative gender equality we enjoy here in the west.

Indeed, up to 45% of adolescent girls in those poor regions reported their first sexual experience to be forced. That is another shocking statistic. It is estimated that around 120 million girls worldwide have experienced rape or other forced sexual acts at some point in their life. The magnitude of those figures should shock us all. They remind each and every one of us exactly what the issues are and it is why this debate is so important. From a collection of more than 45 studies from sub-Saharan Africa, it was revealed that such relationships were common between younger women and older male partners, and relationships with large differences in age are associated with unsafe sexual behaviour and the low use of condoms.

Women who experienced violence from a partner were 50% more likely to have contracted HIV than women who had not experienced such violence. In fact, of all the age groups, even married girls and women in the 15 to 24 age group are most affected by spousal physical or sexual violence. Some of the Members who have spoken already, including the hon. Member for Lanark and Hamilton East (Angela Crawley), who spoke just before me, mentioned DFID. Again, the background notes supplied for this debate are very helpful. I want to put this note on the record:

“DFID has committed to putting girls and women at the heart of its development assistance. As well as continuing a focus on women and girls in DFID’s bilateral HIV programmes, more work is required to capture, measure and maximise the HIV related benefits of DFID’s wider work with women and girls.”

Hon. Members who have spoken have expressed some disquiet over the DFID policy in relation to its ever being successful. The Minister always responds in an energetic and knowledgeable way, so I am sure he will be able to indicate and reaffirm DFID’s response. If there is a shortcoming—I perceive that there is—DFID must address that as well.

The note continues:

“Global progress on reducing new infections in women and girls remains a priority for DFID.”

I hope that that is the case. Negative gender stereotypes and harmful norms are equally damaging. Adolescent girls and young women face significant barriers in accessing health services or protecting their own health. Lack of access to comprehensive and accurate information on sexual and reproductive health means that adolescent girls and young women are not equipped to manage their sexual health or to reduce potential health risks. Furthermore, they are less able to negotiate condom use. They have limited access to HIV testing, modern contraception and family planning, and are less able to adhere to HIV treatment. Those facts cannot be ignored.

Queen Nana Adwoa Awindor of Ghana, who chairs the African Queens and Women Cultural Leaders Network, has underscored the important role that cultural and traditional leaders have to play in the fight against HIV and AIDS, saying:

“It is our responsibility to ensure that harmful traditional practices that promote the spread of HIV such as early marriages and female genital mutilation are eradicated”.

What she is saying is, “Change traditions and protect the people.” I hope that today’s debate will in some way do that.

ln sub-Saharan Africa, only 26% of adolescent girls possess comprehensive and correct knowledge about HIV, compared with 36% of adolescent boys. In that context, according to UNICEF, among girls aged 15 to 19 who reported having multiple sexual partners in the previous 12 months, only 36% reported that they used a condom the last time they had sex. There are basic, simple issues that must be addressed by DFID and through the Minister’s Department, but also by the Governments responsible for the countries where HIV and AIDS are epidemic. There is a need for relentless pressure to be exerted, using the international bodies at hand, such as the UN, on the Governments of the countries in question. The things I have talked about are not acceptable in the UK, and we are addressing them; they should not be tolerated anywhere else in the world.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing what has been a considered and useful debate on tackling HIV and AIDS in women and girls. I congratulate him too on his work as chair of the all-party group on HIV and AIDS, of which I am a member. There were useful contributions from the hon. Member for Harrow West (Mr Thomas), who brings considerable experience to the debate, my hon. Friend the Member for Lanark and Hamilton East (Angela Crawley)—I shall reflect in particular on some of what she said—and the hon. Member for Strangford (Jim Shannon), who spoke of being a voice for the voiceless. I do not think there is any question of his voice not being heard. He spoke with his usual commitment and passion.

This debate is timely, as has been mentioned, taking place as it does in the context of the adoption of the sustainable development goals. Indeed, some of us will be back tomorrow for a debate on the implementation of those goals in the round. However, today’s debate is a useful opportunity to reflect on the particular issue of tackling HIV and AIDS, for all the reasons that we have heard, in particular the need to make rapid progress now that the goals are agreed. The number of people around the world living with HIV and AIDS continues to rise, despite the progress being made, and indeed partly as a result of it, given the enhanced longevity from treatment—an HIV infection need not be a death sentence per se. Nevertheless, transmission continues to increase and, as we have heard, in particular parts of the world that may affect women and girls disproportionately.

Three themes arise from what we have heard in the debate: general issues and challenges, such as those I have touched on; the steps and strategies needed to tackle those challenges; and the ways in which we fund and prioritise those steps. I will reflect briefly on those, making sure, of course, that the Minister has plenty of time to respond to all the questions that have been asked.

We have heard that HIV/AIDS is the No. 1 killer of women of reproductive age around the world. In our part of the world it is sometimes difficult to comprehend that, because it is not necessarily true in every individual country, or in developed countries such as ours. However, in developing parts of the world it is of particular concern. During the recess I was in Zambia with the Westminster Foundation for Democracy. The overall prevalence of HIV/AIDS in the country is 12.4% of the population—some 500,000 women. Yesterday I welcomed Jacqueline Kouwenhoven, who is Dutch born but is a Member of the National Assembly of Malawi. She is the Member of Parliament for the Rumphi West constituency. In Malawi the prevalence of HIV/AIDS among men is 8.1%, but among women it is 12.9%. That is a pretty stark demonstration of the disparity, and the disproportionate impact that HIV/AIDS has on women, which is reflected in other statistics we have heard in the debate. I think others have discussed how 74% of new HIV infections in 2014 among adolescents in Africa were among girls and women. That is 12,500 new infections every week, and it gives us a sense of the scale of the challenge.

There is a challenge in two respects. First, there is a challenge for the individuals, as HIV/AIDS limits their life chances and lowers their life expectancy, limiting their ability to work, contribute to society and live flourishing, dignified lives of their own. However, there is also a broader development challenge, in the form of a barrier to societal and economic development, starting at household level, because younger children may be taken out of school to provide care or take up income-generating activities. That has a knock-on effect on whole societies. My hon. Friend the Member for Lanark and Hamilton East quoted Scotland’s First Minister, Nicola Sturgeon, on the importance of empowering women fully, as the simplest way for countries to increase their productive potential sustainably. Interestingly enough, the quotation came from a speech given to the Chinese Friendship Association in Beijing in July 2015. As we have come to expect, Nicola Sturgeon is not afraid to be a voice for the voiceless and to speak out, without fear or favour, around the world on issues of gender equality. That goes to the heart of the point made about the need for political leadership—both an holistic response to a holistic challenge, and political leadership to drive that response forward.

The steps needed to tackle the spread of HIV and AIDS among women and girls in particular fall into two key areas. The first is prevention, in its broadest sense. We have heard a lot in the debate about education, including education specifically for awareness—of status, safe practices and cultural barriers. All those things are important, and we have heard about some of the support that the Scottish Government are providing. A particularly interesting example came about through the small grants scheme, which allows the funding of small, innovative programmes. The Yes! Tanzania programme conducted a feasibility study on using its sports facilities to educate young people about the transmission of HIV and AIDS, and used the study to put the lessons into practice. It will deliver both sport and sexual health training to more than 60 community sports coaches, teachers and peer leaders, and through that method will reach more than 2,000 young people in Arusha in Tanzania. Hopefully it will go on to measure the impact of the work.

Using small grant funding can be a useful and innovative way to try out new techniques and to reach young women and men in particular, through forums where they might not traditionally have expected to receive such education. It would be useful to hear the Minister reflect on whether there any lessons he can learn from that kind of thing.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I would like to reiterate what the hon. Gentleman has said. The Elim Church in my constituency—to give just one example—does fantastic work in Swaziland with young boys and girls who have HIV/AIDS. Some of the good work that the hon. Gentleman has been discussing, and that he asks DFID to do, is also being done by church groups throughout the United Kingdom. I mentioned the Elim Church, but the Presbyterian Church, the Church of Ireland, the Methodists, the Baptists and the Roman Catholic Church all do it as well. It is good to recognise some of the good work that other groups do.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I am sure we can all give examples from our constituencies or broader areas of interest of specific projects or programmes that have made a difference. An issue relating to some of the broader questions that have been asked about DFID is to do with its different priorities: the way in which it is leveraging the 0.7%, which we all welcome, and how that can be done as effectively and as holistically as possible. Having some flexibility to try to innovate in new areas and support small, dynamic projects is definitely one area for consideration.

There is the important question of education specifically about HIV/AIDS, which we have heard about, but there is a broader question of education as well. Although it is true that, as I have said a number of times—my hon. Friend the Member for Lanark and Hamilton East said it too—there is no silver bullet to global development, educating women and girls is about as close as we can get. Broader access to education—not just education on HIV/AIDS but, more broadly, education that trains and empowers women with the skills they need to take into society—can reverse the negative spiral that I spoke about at the beginning of my remarks. That economic empowerment is crucial.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I want to highlight again the need to educate men and boys on their role as community leaders, partners, fathers and brothers, because they also have a role to play in education.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Indeed. Speaking from my 36 years’ experience as a man, I entirely agree about the need to tackle all these issues. Education, in a range of different forums and of both men and women, is important.

Access to treatment is also crucial. It has been interesting to read in some of the documents supplied in preparation for the debate about the progress made in terms of prophylactic and preventive treatment such as the dipivirine ring trials and various other medical advances, which are incredibly encouraging. It is important that they are invested in and supported. That is why the points made, especially by the hon. Member for Finchley and Golders Green, about intellectual property in the development of pharmaceuticals is key. That has come up in numerous Westminster Hall debates on international development, in particular on tackling preventable disease. It would be interesting to hear from the Minister how the Government intend to take forward those proposals—I was interested to hear that movement in that direction appeared in the Conservative manifesto.

Just as with education, where specific education and improvements in education across society as a whole is needed, the same is true in treatment. We need to be able to treat the specific symptoms, effects and infections and boost the overall level of wellbeing of society as a whole. That is where questions of food security and so on come in.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

In addition to a medical model, does my hon. Friend agree that it is extremely important that couples counselling is also offered to help in coming to terms with HIV diagnosis, reducing stigma and the risk of violence and desertion by a partner, and ensuring that adaptive coping strategies are applied?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

That is a useful point. My hon. Friend brings considerable experience of those issues to the debate, so it is useful to have her contribution.

That brings us to funding and prioritisation. I generally echo all the questions directed at the Minister so far. On the prioritisation that DFID is prepared to give to the sustainable development goals, every credit is due to the Government for the role they played in the negotiation and establishment of those goals, which are a hugely comprehensive framework for global development. We now have a road map that can take us to the kind of world that we know is possible, which will allow us to reach other targets such as the 90-90-90 target, which has been referred to. However, I do not think I am alone, even in the Chamber, in being slightly disappointed by the lack of emphasis given to the sustainable development goals in the Command Paper, for example, or the lack so far of a joined-up Government approach or even of information about that. Indeed, my hon. Friend the Member for Lanark and Hamilton East raised questions about monitoring.

Other mechanisms also need to be considered. The Global Fund is due for replenishment, so it would be interesting to hear a timetable from the Minister for the Government’s commitment. They have said repeatedly that they are prepared to give up to £1 billion, so my question has repeatedly been: if they are prepared to give up to £1 billion, why not just give £1 billion? The Global Fund knows how much money it needs and the UK has an opportunity to show global leadership by committing as much as it can to that replenishment.

Finally, the point about middle-income countries is crucial. I spoke about Zambia earlier on, and the definition of a middle-income country stretches from a GDP per head of something like—I do not have the figure in front of me—$1,500 to $13,000. In that vast range, a country can suddenly become a middle-income country and find itself less able to access the resources and support that helped it to attain that status. It would be interesting to know how the Government intend to support countries as they transition to middle-income status to reduce the risk of back-sliding in so many areas, not least HIV/AIDS transmission.

HIV is a preventable and treatable disease and we have the knowledge and ability to reduce transmission and improve access to treatment, especially with regard to women and girls. If we do that, we boost development, help to build stable societies and grow economies. Everyone benefits, but we must have the political leadership and willingness to invest effectively.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Let me first say what a pleasure it is to serve under your chairmanship, Ms Buck. When we first met 30 years ago, giving out leaflets on the streets of Paddington, who would have guessed that I would be my party’s spokesperson on development, but you would be a member of the august Panel of Chairs?

Let me congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing this important debate. Let me say a word about the position of women and girls in the UK and remind the House that the part of the population with the most disproportionate incidence of HIV/AIDS is African women. The reason they have that level of infection is because if people think the level of stigma in the population as a whole against HIV and AIDS is bad, for men who have sex with men in the African community it is so much worse. It is all about stigma, so anything we can do in this Chamber to break down that stigma will save lives not just in the global south, but in communities in some of our constituencies.

As we have heard, the number of women and girls living with HIV continues to increase in every region of the world. As a group of politicians, we should pause and think about what that means to people’s lives and hopes. This is not just abstraction and about position papers; it is actual people’s lives. Last year I was privileged to visit Uganda on a wonderful trip, organised by the Aids Alliance and Stop Aids, to meet the men and women working on Uganda’s HIV/AIDS response at Government level, at non-governmental organisation level and at grassroots level. It was an amazing trip.

I visited 10 different projects in all during my time in Uganda, but three stand out. One was a project involving the Lady Mermaid Bureau and Crested Crane Lighters. This was a project for female sex workers—actually, we could not consider those women victims. We went to the market where they plied their trade. They spoke to us about their fears, their experience of police harassment, their hopes, their efforts to get information and protection to younger sex workers, and their hopes for their children. This is the sort of grassroots project among a marginalised community that is so important to fund and support if we really are to roll back HIV/AIDS in those communities.

I also met the Uganda Youth Development Link, which is a genuinely young persons-led project—the chair was 28 years of age. It is a network of young people from 10 to 30 living with HIV/AIDS, and they pointed out that one of the problems with HIV response in the global south is that it does not reach young people: it is not reaching under-18s; the work is not being done in schools. In what are very young societies, if we are not focusing on under-18s or doing the work in schools, we are not doing what we need to do to reach the goal of eradicating HIV/AIDS.

I saw many projects in Uganda, and my trip brought it home to me that, in the end, it is not about what we say here in this House. It is not even about what the big NGOs and the UN can do. It is about communities and empowering people—particularly women and those in marginal communities—to offer leadership and to roll back this scourge.

We have made a great deal of progress on HIV/AIDS, but it is important that we do not roll back on that progress now that our goal of eradicating altogether is within sight. I hope the House will forgive me if I remind it of Labour’s record on this issue. We have continued to be a champion in the AIDS response, leading the first global promise to deliver universal access to HIV treatment, care and support by 2010 at the 2007 Gleneagles G8 summit.

The Government are to be applauded for their contribution to the Global Fund, which has disbursed $27 billion on programmes for HIV, TB and malaria, and programmes supported by the Global Fund had saved 17 million lives by the end of 2014. However, there is a concern about bilateral spending and the absence in the Government’s programmes and policy of a specific commitment on HIV/AIDS. Commendable as the Global Fund and the Government’s support for it are, bilateral aid for HIV continues to be important to meet the gaps that the Global Fund cannot fill and to equip affected communities—whether it is the young people or the brave and vibrant sex workers I met in Uganda—with the skills, tools and information they need to help the Global Fund to meet its goals.

Sadly, it would appear—I am content to be put right by the Minister—that UK bilateral funding for HIV has been decreasing, and many are concerned that it may come to a complete end. I would stress to the Minister that we cannot end aid dependency or stop thousands of lives being lost to AIDS month by month in regions of the world if we do not equip communities, including marginalised ones, with the tools to tackle and treat HIV/AIDS.

We need to build the capacity of communities to demand their rights. Ending AIDS by 2030 requires investment in communities and support to demand their rights, and the evolution of the Global Fund clearly demonstrates the value of such investments. There are still challenges in ensuring that key populations—for example, LGBT populations or sex workers—have a voice, but the Global Fund has developed strong human rights principles and places a value on the inclusion of those populations in governance structures. That evolution is driven by the affected communities, but it needs strategic bilateral funding.

As colleagues have said, the sustainable development goals have committed to ensuring that no one is left behind. The UK Government, in their new aid strategy, have committed to leading those efforts. Delivering on that promise, however, will require ensuring that those who are most marginalised, vulnerable and excluded can benefit from efforts to deliver the SDGs, including the goal on ending AIDS. The Global Fund cannot achieve that alone.

We have to consider the practicalities. I saw in Uganda last year that condom use—which is not a high-tech medical intervention, but a vital one—in the global south has gone down. There has been an increase in new infections, and under-18s are not yet a target group. Forty per cent of the Ugandan population are under 30 years of age. That very high proportion of young people is true across the global south, and one challenge faced by groups seeking to work on HIV/AIDS is the rise of vicious anti-human rights legislation on homosexuality and the LGBT population. In Uganda, we found that that was a major obstacle in the communities that needed to be reached.

I will mention one more group that I met in Uganda. Icebreakers Uganda is a youth-led LGBTI organisation that we visited in Kampala. Think what it means to be an LGBTI organisation in a country that has passed legislation that could end up with people losing their lives for admitting to being LGBTI. Despite the challenges, the organisation offers services in 14 districts in Uganda, runs a 24-hour service and has a house and centre for men who have sex with men. Due to the punitive legislation and criminalisation, the organisation has to be very careful about how it works, but it continues to work.

I commend the Government for their contribution to the Global Fund. It is unfortunate, as we have heard, that we have only promised 80%, not 100%, of what we should be providing. I stress the importance of making HIV/AIDS a specific goal and a specific issue in relation to women and girls. The Government cannot expect to be taken seriously in their concern for women and girls if the issue of HIV/AIDS is not only high up the agenda, but explicitly so in the speeches that are made, on the Department’s website and in the availability of funding.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a great pleasure to follow the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who spoke with infectious enthusiasm about her experiences in Uganda, the programmes she saw there and the genuine commitment to community empowerment.

I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for focusing his forensic intellect and our attention on this vital life-and-death question, on the eve of the replenishment of the Global Fund, with the UN’s high-level meeting on ending AIDS and this year’s AIDS conference coming shortly thereafter. This is a year in which we must make a change in the trajectory of this disease with respect to women and girls.

I clearly have to reassure my hon. Friend. I do not believe that this is the best forum in which to take him through the Department’s website, but I am confident that we can arrange a time to do so, perhaps when there is a screen in front of us. On the goal that he found absent, the high-level departmental goals will not specify every disease upon which we want to make an impact. I put it to Members this way: we put our money where our mouth is—follow the money. We are the second largest donor in the world in response to the AIDS epidemic.

In 2014-15, we spent some £374 million on our response to AIDS. In the current cycle, we have committed £1 billion, subject to the 10% burden share, to the Global Fund. We support UNAIDS, UNITAID, the Clinton Health Access Initiative and the Robert Carr network for outreach to civil society. All those things are vital, and they have had an impact. The response to the AIDS epidemic has seen in the past five years 15 million adults being treated for the disease, 1 million babies of infected mothers being able to avoid infection themselves and a two-thirds reduction in the number of new infections—and yet, as my hon. Friend pointed out, in sub-Saharan Africa 50% of the people who are infected do not know it, and among young women, only 15% know they are infected. Clearly, this has to be our main effort if there is any prospect of us getting to zero: to zero new infections, zero—

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

rose—

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I am sorry. The hon. Lady has rather thrown me—I give way to her, if she must.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I apologise for interrupting the Minister’s flow, because he is making a very important speech. I have listened carefully to the debate, which I commend the hon. Member for Finchley and Golders Green (Mike Freer) for securing. I agree with my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), the shadow Secretary of State, that because of what the Minister is saying, the Government should be very clear that that is their aim. I still do not understand why they have not explicitly stated it in their information. I hope he is coming to that point.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I hope that I will be given the chance to get there, and that my statement today will be regarded as something of an explicit statement in lieu of what Members have not been able to find on the website, but that is a question we might come back to.

As I was saying, this has to be our main effort if we are going to have any prospect of getting to zero: to zero new cases, zero deaths and, as the hon. Member for Hackney North and Stoke Newington and my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) pointed out so importantly, to zero stigma and discrimination—a vital part of the equation.

How are we going to achieve that? I believe that the proper principle is to deploy our resources where the need is greatest, where the burden is greatest and where the resources are fewest. I have to reassure my hon. Friend the Member for Finchley and Golders Green in respect of his perfectly proper concern about middle-income status countries. The reality is that the Global Fund deploys half its resources in middle-income countries and specifically has programmes to deal with neglected, vulnerable populations in high middle-income countries. We have given £9 million to the Robert Carr fund specifically to address some of those issues.

I put it to hon. Members that as countries develop and become wealthier—I accept entirely that, as the hon. Member for Glasgow North (Patrick Grady) pointed out, there is a question of what defines a middle-income country, and there is a wide spread—there has to be an expectation and a challenge to them to start deploying more of their resources to deal with the problems of healthcare and AIDS in particular. It is very much part of the Addis agenda that countries deploy their own resources, and part of the challenge to us and to the Global Fund is to hold them to account for doing so.

My hon. Friend the Member for Finchley and Golders Green was right to challenge me on the issue of research and development. I do have concerns, but we are the leading investor in product development partnerships, which delink the market incentives for research and development and replace them with the prioritisation of public health objectives. Some 11 new products are now on the market in low-income countries as a consequence of the partnerships that we have developed. In addition, we have invested. We are the fifth largest funder of UNITAID and have put €60 million into its programme for developing diagnostics and treatments. Indeed, there is also its groundbreaking development in the treatment of paediatrics, with some 750,000 treatment regimes for children.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I agree with the Minister that as countries get wealthier, in principle they should take responsibility for their own HIV/AIDS programmes. However, when there are allegedly middle-income countries that are members of the Commonwealth but which, to all intents and purposes, are going backwards on LGBT rights, does Her Majesty’s Government not have a responsibility to intervene with the type of projects that would make it easier to access marginalised communities?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I accept entirely that there is a challenge to all the developed world and all right-thinking countries to hold those regimes to account for their treatment of human rights and respect for human rights. Nobody should be left behind—that is the principle that we have to abide by—and we must find programmes and measures to deal with that. I accept that the hon. Lady is right on this issue.

On the issue of research and development, we are alive to this problem, but let us consider it a work in progress. I accept entirely that there are still problems, but I am glad that the World Health Organisation is now implementing what it calls an observatory on research and development, and that a working group will be set up to drive the matter forward.

The issue of condoms was raised by the hon. Lady and by the hon. Member for Strangford (Jim Shannon). I am very much in favour of the distribution of high-quality male and female condoms. What is more, I want to see much wider distribution of the benefits of microbicides, which were raised by the hon. Member for Glasgow North with respect to the rings and gels that are being used and in which we have invested some £20 million. I believe that that is essential.

The hon. Member for Strangford raised a key point—I think his words were that AIDS is being used as “a weapon of war.” He is right about that, and I want to see reproductive and sexual health as a key part of our response to any humanitarian emergency.

Of course, I want to see a successful replenishment of the Global Fund. That is essential—[Interruption.] The hon. Member for Glasgow North is signalling that he wants a commitment to be made now, but I am going to have to disappoint hon. Members over a figure and commitment now. That has to be left to the Secretary of State and it can only be done once the bilateral aid review and the multilateral aid review have been published. However, I am impressed by the way in which the Global Fund has attempted to address our preoccupation with women and girls and to make its response to women and girls central to its strategy. We now want to see how that changes things on the ground, because women’s needs are highly complex and our response has to be correspondingly comprehensive.

My hon. Friend the Member for Finchley and Golders Green asked me on a number of occasions how we were going to address the needs of women and girls, and it is a response that goes well beyond what we can do specifically to address the issue of AIDS. It is a question of changing culture and of changing law. It is a question of changing the perception of human rights. It is a question of changing economic development and of giving women the power to protect themselves. It is about empowering women and giving them information and access to family planning services. It is about giving them an education and a livelihood. All these things will empower women to ensure that they are enabled to negotiate the terms under which sexual intercourse takes place. However, I tell my hon. Friend this: a world free of AIDS—one in which absolutely no one is left behind—is one in which the rights of a girl are promoted and protected from the minute she is born.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

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.