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HIV/AIDS: Children

Volume 691: debated on Tuesday 24 April 2007

rose to ask Her Majesty’s Government what action they are taking to combat AIDS across the world and its effect on children.

The noble Baroness said: My Lords, I am very grateful to have such an array of distinguished speakers with long commitments to the fight against AIDS speaking in this short debate. It is a mark of the importance of the subject. I often think that, if HIV/AIDS were at the same level in Britain as it is in southern Africa, we would have nothing else on the agenda. In some places in southern Africa, two-thirds of the adult population are infected. A whole generation is being decimated. How can that not be seen as catastrophic?

I want to focus on the long-term implications of HIV/AIDS and, in particular, on the impact of the epidemic on children and the future of those countries that are already badly hit by HIV/AIDS or where the full impact is fast coming down the track. As UNICEF points out, the AIDS epidemic puts children at risk physically, emotionally and economically. Children may themselves be infected with AIDS; they may live with a chronically ill parent and be required to work or to abandon their schooling while they look after that parent or earn money. Many also become orphans. There are already 12 million orphans in sub-Saharan Africa alone. They may live with a grandparent, often in extreme poverty and deprivation, and be rendered even more vulnerable on that grandparent’s death.

Then there are the even wider implications of societies being undermined as large numbers in the working population die, of culture not being passed on and of working practices, such as those in agriculture, not being taught to children because their parents are sick and dying. One can draw a parallel—I have done so before, but it is worth emphasising—with the plague that struck 14th-century Britain, when enormous economic and social change followed. Some of that change was positive—it sounded the death knell for the oppressive feudal system—but villages died, people moved and rebellions occurred. The social and economic impact of AIDS cannot be overestimated. Surely it is a greater threat to peace and security than terrorism.

There was a time when the emphasis was on prevention. It was felt that those who were affected were beyond help because of the cost of drugs and the lack of infrastructure in countries to deliver treatment. It was laudable and extremely significant that the G8 at Gleneagles made the commitment that everyone who needed it should be on treatment by 2010. That recognised the injustice of not doing everything possible to get the kind of treatment to people that in the West has meant that AIDS is something you can live with, not die of. But it also recognised the need to look after communities, and children in particular, whose lives and futures were being shattered by this disease.

I gather that DfID is about to open a consultation on AIDS, and there is a question mark over whether children should continue to be a focus of its aid. I ask the Minister for her views on that. It seems to me that it is vital to look at their particular needs, and I hope that DfID will continue to do so.

Children, too, are infected with HIV, of course. Globally, there are 2.3 million children with HIV, the majority of whom live in sub-Saharan Africa. Over 90 per cent of paediatric infections are the result of mother-to-child transmission. For most children infected with HIV, the chances of survival are slim. More than half of those babies will die before their second birthday, yet paediatric HIV is almost entirely preventable.

In high-income countries, such as our own, where ARV drugs are given to women during pregnancy and labour and to infants, and where there are safe delivery and feeding practices, mother-to-child transmission rates are less than 2 per cent. There is a global commitment to offer appropriate services to 80 per cent of women who need this by 2010, but in developing countries in 2005 the figure stood at just 11 per cent. What can the Minister tell us about progress on that? Will Angela Merkel, leading the G8, put effort behind this project, as is rumoured?

When I went to South Africa last year, I was told that the cost of treating children had not been factored into the costings of providing mother-to-child treatment, yet the costs are considerable. When I visited a paediatric hospital in Mozambique, I could see not only the cost of treating the child but also the cost to the family, as parents often nurse sick children, thus being unable to work or to look after their other children. Prevention of mother-to-child transmission is known about, is extremely urgent, and must be properly funded and supported. Where a child is infected, treatment is still rarely available and is a blunt instrument, although there have been some welcome developments through the Indian generic drugs industry. But I was told by one UNICEF worker in southern Africa that drugs companies do not see investment in treatments for children as being worth while financially because they see the market as time-limited once mother-to-child prevention is widespread. What are we doing to ensure that research in this area is undertaken if the drugs companies are reluctant to undertake it?

There are enormous challenges in this area. There is the problem of accessibility, especially in rural areas and among women. There is the need to extend testing. In Lesotho and Botswana, people have to opt out of testing rather than opt in, which is surely welcome, but easier tests are required. Social and financial support needs to be given to vulnerable children, who suffer the effect of diminishing household income. Widows’ and orphans’ rights to land are rarely protected. Sometimes children are taken into households and used as little more than slaves, and any property rights that they had are taken from them. Orphans are less likely to be enrolled in schools than other children and they have poor nutritional status. More orphans end up in female-headed households; some end up in child-headed households; and some, of course, end up with grandparents, who may die before the children are 18.

It is very clear that children are likely to flourish better with relatives or in communities. There are difficulties with those situations, but they are much better than having the children live in institutions. There are many reasons for not wanting residential facilities for orphans, including high staff turnover, care deficits, lack of high standards and clearly worse physical and mental outcomes. Much more therefore needs to be done to give financial help to carers. I note that the global fund is supporting one such scheme to help grandparents in Swaziland, which is welcome.

The provision of cash transfers to older people has a positive effect on the well-being of children. In Namibia and South Africa, many older people spend the greatest proportion of their pension on food, clothing, education and healthcare for their grandchildren. A southern African study found that receipt of pensions by older women had a significant impact on the growth of the girls whom they looked after. In Zambia, a cash transfer scheme to older people caring for orphans has resulted in better school attendance. What plans do the Government have to extend these sorts of schemes?

We must not forget the enormous difficulty of getting help to children who fall outside these arrangements. Street children are especially vulnerable to HIV and AIDS. They live a transitory lifestyle, are unsupervised by adults and have little access to health, education or social services. Can the Minister comment on this particularly vulnerable group?

As UNICEF observes, in recent years there has been a surge in leadership and resources in the fight against AIDS. The UK has played its part. UNICEF says:

“This influx of funds has great potential for improving the lives of millions affected by the disease, but the impact on children has yet to receive the priority attention it deserves”.

I am therefore glad that we are having this debate tonight and that it happens to come at the beginning of an extensive consultation on the matter. I hope that the enormous implications for children of this appalling disease will be recognised and that even greater efforts will be made to improve their life chances.

My Lords, the noble Baroness, Lady Northover, is to be congratulated on again raising the urgent matter of dealing with the global scourge of AIDS. I see four main attributes of effective programmes: enabling willingness to talk about the problem; educational campaigns, particularly for young people; mechanisms for delivery of treatment; and the medicines themselves.

I was impressed by one programme in rural Namibia, where people became too weak to farm and feed themselves. The project got communities to discuss easier farming and other ways of earning a living at the same time as dealing with AIDS. So the illness was discussed in the context of income generation, with plans to support widows and orphans built in as the issues were examined. As people began to talk, more felt able to go for testing, which helped to remove stigma. The upshot was 50 income-generating activities in operation across two regions, combined with increased capacity to reduce HIV/AIDS. This model has now been taken up for the whole of Namibia. For an outlay of just under £2 million over four years, DfID has helped to change culture, nutrition, health and economic productivity, and, most effectively, it has helped to get people to talk.

I also heard about a television drama series for east Africa, “Makutano Junction”, produced with advice from the “EastEnders” people, which reached 5 million viewers in Kenya alone and inserts into the story—rather as “The Archers” does for farming techniques—educational information about safe sex. DfID is now funding research on the impact of the programme.

In Malawi, out of £100 million invested in the health service over five years, we have put £45 million into AIDS-related services. For this to work, however, the Government had to stop the doctors and nurses leaving and replace those dying of AIDS. So in an innovative programme, funds also go to improve pay and conditions. The number of nurses has doubled, that of doctors has tripled and 700 nurses who left the health service have now returned. The number of people tested for HIV more than doubled last year to 440,000, and the number of people on ART has increased from 4,000 in 2003 to over 80,000. Malawi’s former high infection level has now stabilised at 12 per cent.

Declaring an interest as a trustee of UNICEF UK, I saw an effective UNICEF campaign in Uganda to prevent mother-to-child transmission of HIV, which causes 90 per cent of child infection. The campaign minimises stigma by testing mothers as part of routine antenatal care and making treatment available during the birth. The cost of medicine was a huge barrier. DfID therefore backed a new international drug-purchasing facility, UNITAID, to help to lower drug prices through predictable and long-term funding. This has contributed to over $61 million for paediatric anti-retroviral therapy, previously scarce because research went on the needs of the developed world and adults at risk.

Are these strategies making a difference? There are some striking improvements. However, children still represent 15 per cent of AIDS deaths worldwide, while only 6 per cent of those get treated. So we must keep the focus. We must be sure what the decisive factors are. Can my noble friend tell us how work on evaluating impact is developing?

My Lords, I congratulate the noble Baroness, Lady Northover, on raising this important subject. My only regret, rather like hers, is that it does not have a more prominent position in the debates organised by the House. I am sure that she is right that, if this were raging in the United Kingdom and Europe as it is raging in Africa, it would have more prominence.

Let us remember that we are dealing with a situation in which there are, globally, 2.3 million children with HIV. Every day, almost 1,500 children under the age of 15 become infected. Last year, almost 400,000 children died of AIDS-related illnesses. By any standard, that should touch the conscience of the developed world. One factor makes the situation even more acute. In years past, we became accustomed in debates on HIV/AIDS to saying that action was difficult, even impossible, because we did not have the knowledge or medicine. It is true that there is still no cure or vaccine for HIV/AIDS, but today there are drugs for preserving and prolonging life. Medical science has achieved wonders, although, tragically, those drugs are still unavailable for millions living in the developing world as opposed to in developed countries.

We have made progress in treating illness. We have generally failed, however, in preventing the transmission of HIV. We can treat; prevention has not proved so easy. That is why mother-to-child transmission is so important. We can prevent paediatric HIV almost entirely. Anti-retroviral drugs given to women in pregnancy and labour and to infants in their first weeks of life, combined with safe delivery and feeding practices, have reduced mother-to-child transmission to less than 2 per cent in the richer countries. The knowledge is there and the means are there. All that is required is the will to do something about it. There is an international pledge that mother and child services will be available by 2010. According to UNICEF, however, that target will simply,

“not be met unless more money is urgently made available and the barriers that prevent money from reaching children in need are addressed. Existing and predicted financing levels for a comprehensive response to the AIDS pandemic fall drastically short of global needs”.

That is the challenge. It involves not only helping to finance the provision of drugs but also improving weak health systems so that women and children can access adequate healthcare; it involves helping to train and build up the number of health workers in countries that urgently need them and not taking them from those countries to work in other countries, as, regrettably, we have sometimes done here. The challenge is profound, but we are talking of newly born babies being protected from HIV. I hope that the Government will recognise and respond to that challenge. If we fail to give help to children when such help is available, future generations will not forgive us.

My Lords, I thank the noble Baroness, Lady Northover, for this debate on the overwhelming catastrophe affecting so many children across the world. Some years ago, a young child stood up on a stage in South Africa explaining that he had HIV/AIDS as did many other people in his country, and that something had to be done about it. The Government and president of South Africa had denied that fact time after time.

I am a founder member of the All-Party Group on AIDS, which goes back to the early days of 1985-86, when this terrible infection was presenting. That young boy in South Africa who stood up to be counted opened the eyes of many people and had my greatest admiration. I am sure that he touched the hearts of many people across the world.

I once heard a missionary nun say that she knew of a grandmother who had buried 17 members of her family who had died of AIDS. So often, the working members of the family die, leaving orphan children and the very elderly.

I have met children who had haemophilia and had been given infected factor 8 imported from America. One father told us at a meeting that he had promised his affected son and his friend, aged about seven, a trip to Disneyland but, because the children had HIV, they were denied entry. How do you think the father felt trying to explain that to the disappointed children?

The noble Lord, Lord Fowler, and I attended a United Nations luncheon a few weeks ago, here in London, which brought together people from many countries interested in trying to do something to combat AIDS. I was fortunate to sit next to a most enthusiastic Minister from Barbados who is running successful music campaigns, getting the message of the dangers of AIDS across through calypsos and songs.

In his Question of Monday, 16 April, the noble Lord, Lord Fowler, said that the number of new diagnoses of HIV had risen by 165 per cent since 1998. I wonder how many of those affected are children. We need a Minister like my luncheon companion who will run dynamic campaigns across Britain to alert those at risk that the problem has not gone away.

Over the years, progress in the treatment of HIV/AIDS has been remarkable, and the dedication and humane treatment of the specialists working in this field of medicine have been outstanding. The many research projects in the USA for HIV are very impressive. It is important that progress is shared across the world.

Preventing a mother from passing HIV on to her baby is so important. She can pass it on during pregnancy or delivery, or by breastfeeding. Anti-HIV treatment can, however, greatly, reduce the risk of a woman passing HIV to her baby. Having a caesarean rather than a vaginal delivery can reduce the risks even further. The aim of HIV treatment is to get and keep the viral load below 50. Once the baby is born, it will need to take AZT syrup for four to six weeks. A high viral load and low CD4 cell count will damage the immune system of the mother, who will be vulnerable to infection. They will need a combination of three anti-HIV drugs. The drugs can rapidly pass across the placenta, into the baby, protecting it. With so many mothers being HIV positive across the world, these drugs need to be available to prevent babies from becoming AIDS children.

Children across the world who are at risk of HIV/AIDS, TB and malaria are being helped by the Global Fund, and I am pleased that we are one of the countries taking the lead in supporting that important work. I hope that other countries that have not been as generous will follow this example.

My Lords, the noble Baroness, Lady Northover, has, as usual, put the case very concisely and clearly—so clearly in fact that it is not easy to find an area that she and others have not already covered in four minutes.

I shall make some use of the excellent briefings by UNICEF and the UK Consortium on AIDS and International Development. I am sure that my noble friend on the Front Bench and her department are fully aware of the strong case that they make, but I do not have time to develop that in four minutes.

Obviously, prevention is better than cure, particularly when there is not a cure and long-term, continuous treatment of HIV infection is the only option but, as every noble Lord who has spoken so far has pointed out, the treatment of pregnant mothers with anti-retroviral drugs, particularly nevirapine, can successfully prevent transmission to the unborn child in 98 per cent of cases. Unfortunately, that is not as simple as giving one or two injections in an immunisation campaign against diseases such as smallpox, polio or measles. In those cases, a team with the appropriate vaccines can visit a local community and, with suitable planning, immunise a high proportion of the child population before moving on to the next village. However, to prevent mother-to-child transmission of HIV infection, mothers need to have an HIV test, and counselling and health education should be part of the package. That requires the participation of one or more health workers with suitable training. The minimum necessary training, however, can be given to community workers who have not obtained formal professional qualifications. I will say a bit more about that if time permits.

As all the noble Lords who have spoken have pointed out, the unacceptable fact is that, although the knowledge and ability to prevent mother-to-child infection exists, only 9 per cent of pregnant women with HIV in low-to-middle-income countries with a high prevalence of HIV received the necessary care in 2005. UNICEF found that, of 81 million pregnant women, only 8.4 million, about 10 per cent, were told about the prevention of mother-to-child transmission of the HIV virus, and only 9.5 per cent opted to be tested. Those disturbing findings represent starkly the inadequacy of the health infrastructure in much of the developing world, and plans to boost that in many developing countries are seriously handicapped by a chronic shortage of health workers, particularly doctors and nurses.

On a recent visit to Malawi and Ethiopia, sponsored by UNICEF, to look at how malaria—the other major African scourge—is being tackled, we were told that around 60 per cent of established posts for medical officers and nurses were vacant. The major reason for that was not inadequate output from nursing or medical schools but the loss of personnel through emigration to the first world, where conditions of work were much better and salaries considerably higher. In Malawi, the problem, as my noble friend Lady Whitaker said, was being tackled by a series of incentives to retain would-be emigrants through the provision of housing and salary bonuses. Whether that will stem the flow or attract emigrants back remains to be seen.

I would like to ask my noble friend how far the Government are responding to this difficult situation. When the NHS needs nurses, it is difficult to stop recruiting from some countries and not others. Can we assist by improving salaries for health staff when and if they return to their own countries? I recognise that this is a difficult area, but I would be interested in the thoughts of my noble friend and DfID on this subject.

A more down-to-earth policy is to train health workers to a level that would be helpful in a local context but not to the level of an internationally recognised qualification. I saw this in action in Kenya when I observed the work of a small faith-based NGO, ICROSS, led by an energetic Irish priest, Mike Megan, who has lived in Kenya for many years. He has trained a team of dedicated community-based health workers who are trusted by their neighbours and care at home for many AIDS patients, thus saving beds in hard-pressed hospitals. I will not be able to develop that theme because I see that my time has run out. However, I think DfID should follow that model because it is economical and effective and popular in local communities.

My Lords, I declare an interest. I have visited Angola twice: first with the assistance of UNICEF and then with the assistance of Tearfund and Save the Children.

Angola has the lowest prevalence of HIV/AIDS of any sub-Saharan nation. I would like now to consider how that state might be maintained and Angolan children protected from infection, from becoming orphaned and from losing their teachers, doctors and nurses to HIV/AIDS. Angola has experienced 40 years of an armed conflict, including a 24-year civil war that was resolved in 2002. It has great wealth, yet needs assistance now as it recovers from its long trauma. It is the conflict that has broken communications within and without the country and has stemmed the spread of HIV/AIDS. But as displaced people return from without and within, the risk of the spread of HIV rises steeply. While statistics are somewhat unreliable, it appears that the rate of HIV in the capital, Luanda, is about 3.8 per cent, while in the region bordering Namibia it stands at about 9 per cent.

The risk of spread is great. Children represent around 60 per cent of the population in Angola. The country has the second highest fertility rate in the world. When surveyed, only 55 per cent of men admitted to using condoms with their last casual partners. The 40 years of conflict have damaged families and communities, leaving many young men without experience of stable family relationships. Lack of female autonomy and low levels of education are also significant risk factors. I hope that the Minister will be able to say that every opportunity is taken to recognise the Angolan Government’s positive efforts in this area and that encouragement is given to the president and senior political leadership to dispel any stigma attached to HIV/AIDS status.

The Department for International Development has most helpfully provided UNICEF with £3 million of unearmarked money for work in Angola. This is making a huge difference, I am told, mostly spent at local community level in training for staff in health centres and in support for mothers. As the noble Lord, Lord Rea, said, this is not high-level training and they are not going to be poached. Building HIV/AIDS awareness must be an important means of protecting children from its fallout. The national football team played its part during the World Cup. Recently, all schools took part in a national competition to compose and perform an AIDS song, and within schools there are AIDS clubs.

The quantity of provision has rapidly increased. For instance, antenatal testing was available only in two areas in 2004; in 2007 it is available in 27. Now there needs to be greater emphasis in developing the quality of provision, and here attention to capacity-building by the Department for International Development could make a significant improvement in children’s lives. The noble Lord, Lord Fowler, referred to the importance of preventing mother-to-child transmission. It is a complex task and people need to be trained to do the job effectively. We have the quantity of care and now we need the quality. What role might the Minister’s department play in developing capacity for these interventions with parents and children?

To conclude, HIV/AIDS might be the main barrier to Angola’s successful recovery from the trauma of conflict. UNICEF certainly holds it to be so. DfID already plays an important role in capacity development. If the Minister’s department can build on this, we will play an important part in preventing at least one sub-Saharan state from succumbing to the full scourge of HIV/AIDS and thus protect many children from the experience of being orphaned.

Are Her Majesty's Government carefully monitoring the situation in Angola with regard to AIDS? I look forward to the Minister’s response and understand that she may prefer to write to me in answer to those questions.

My Lords, last week we briefly debated Zimbabwe, where progressive droughts and food shortages, combined with political failure, have led to destitution, hunger and the vulnerability of ill health. These are the conditions in which the body’s resistance breaks down. Zimbabwe’s HIV/AIDS epidemic, although prevalence may have fallen below 20 per cent, remains one of the worst in the world. Some 3,500 die every week from HIV and the vast majority live beyond proper care and treatment. There are 1.3 million orphans and an estimated 350,000 child-headed households due to HIV. DfID has quite rightly made AIDS a top priority and we are told that it is having a significant impact. I want to ask our Government whether their strategy favours the national and international at the expense of the local. Why, for example, are they spending as much as £20 million on one vast US-based programme in Zimbabwe, Population Services International, which already has USAID funding?

Here I declare an interest as a former board member of Christian Aid and a patron of Trust for Africa’s Orphans. I saw the holistic work of both organisations in Uganda and was especially impressed by the community’s participation in each project. One partner organisation of Christian Aid, while active in AIDS prevention, also excelled in community education and awareness-building, ensuring that there was not stigma attached to its work. While it was church-based, there was no question of evangelical work and it was obviously highly successful, as many church projects have been in Uganda, spreading the ABC messages and combating the HIV virus. The Trust for Africa’s Orphans programme, founded by Mrs Janet Museveni, helps AIDS orphans and is supported by a range of agricultural projects: goat and pig farming, bee-keeping, savings and credit schemes, the provision of seeds,; and other forms of poverty alleviation.

The message for me was that the best healthcare goes hand in hand with community development and the participation of local people. Dependence on traditional healing and cultural and sexual patterns that encourage epidemics such as AIDS will change only when people understand and take part in that change. All this is in contrast to the work of many larger aid agencies in Africa, including some UN agencies and global public/private partnerships. I am not saying that larger organisations are incapable of a holistic approach, but they often assume that they can impose external solutions in spite of the cultural differences between them and the local communities. These agencies, most of which we are supporting as taxpayers, spend considerable sums of money, much of which goes to their own overblown organisations and lifestyles. It is an example of corruption that can be very well disguised by moral superiority.

I have questions, of which I have already advised the Minister, broadly on whether DfID will reconsider its approach to smaller community-based NGOs that are tackling HIV/AIDS in Africa. For example, I wonder whether DfID is biased towards national strategies in the name of better governance. Zimbabwe is obviously one country where this doctrine does not apply, but we still have to work with its Government. Generally in Africa, DfID has tried to provide budget support to ministries of health, thereby perhaps neglecting some very good small NGO programmes. I suggest that when it comes to defeating the AIDS virus, good practice makes a lot more sense than good governance.

At the same time, I recognise that countries such as Uganda and Mozambique have made huge strides in eradicating poverty and ill health. Perhaps DfID is too concerned with good impact assessments and statistics. Would it like to see more data collection to ensure faster progress towards the MDGs? Where Governments are corrupt and ineffective, what is DfID doing to shift its emphasis away from Governments and towards the community? Christian Aid is supporting some 250 such partners working on HIV/AIDS worldwide. Save the Children has had great success in Malawi and is extending its work across Africa and the Caribbean, benefiting hundreds of thousands of children. In my experience, smaller organisations pay at least as much attention to data collection—sometimes their funding depends upon it—and they are ready to share research with UNAIDS and the national networks. Being more familiar with the areas and the people where they work, with few exceptions, they provide much better value for money and still achieve the necessary results.

My Lords, I appreciate the opportunity to take part in this short debate, and thank my noble friend Lady Northover for keeping our minds concentrated on this problem consistently and in depth over many months.

I was told a true story about a pastor in the Kampala region of Uganda. He was taken to a village about 100 kilometres north of Kampala and, after his service, he was taken to see an old lady of 79. She had given birth to seven children. Six had already died of AIDS and the seventh was dying of AIDS. She said that she had sole care of 23 grandchildren. She was trying to care for them all by herself out of her own resources. She said, “I am an old woman, and I can no longer dig. One day soon I too will die, and then who will look after my grandchildren?”. That story can be repeated so many times. It is not only the disease itself, but the stress and anxiety for those who are in that situation. We hear of children who, when their parents die, lose not only their carers but also the homes in which they were brought up. Children are abandoned on the streets; babies have been saved from rubbish tips in parts of Africa. We all know that the situation for millions of children, women and men is a nightmare. Imagine the lost potential of the people who could be contributing to the future of their countries in that part of the world.

We must appreciate the vast amount of work that has been carried out by voluntary organisations that care and rescue. I know of the Christian Watoto Child Care Ministries. North of Kampala, they have now set up a village that already cares for 1,500 orphans of AIDS victims and about 17 of them are already going to university. It is a tremendous success story. There is already a new babies’ home. They have undertaken water projects. The work is carried out by volunteers. They have been visited by 60 short-term teams to assist with building and development. People have been moved by compassion to do something themselves. We must appreciate the work of the voluntary organisations. It does not cost us a penny; it is just encouraging.

The Government propose to bring forth some immigration regulations. I ask that there will be no restrictions to impede the work and the visits of people from here to the needy areas of Africa and other parts of the world, and that nothing will stop people from those places coming here to take advantage of any education or training opportunities we might be able to offer them. I ask the Minister for an assurance that any new immigration regulations will not impede that. These are simple requests, but they mean that we would be seen as a caring and compassionate country.

However, that is only treating the victims of AIDS and not attacking the disease itself. I am told, and this is where I begin to fantasise, that £12 billion would be a massive step forward to eradicate AIDS in the whole of the world—not £12 billion from ourselves, but globally. Is that not possible? It is just the amount that we are possibly going to spend on the Olympic Games—although I am a great supporter of the Olympic Games of 2012.

Finally, the World Health Organisation was able to announce some years ago that smallpox had been eradicated. Could we not now, as the United Kingdom, make it our main aim to be able to say that AIDS also, if it has not been eradicated, is at least only a fraction of what it is at present?

My Lords, I add my thanks to the noble Baroness, Lady Northover, for tabling this important Question. All the speakers today have made clear that there are no illusions about the severity of the AIDS crisis that affects so many children across the world.

Unfortunately, we have seen over the past few decades that knowledge of this crisis does not necessarily translate into effective action. Without constant efforts to keep the issue in the public eye, it is far too easy to continue with projects of uncertain efficacy merely because of inertia. We need, instead, to re-evaluate continually our approaches in the light of new evidence, new technology and new research.

Currently, the huge majority of retroviral research and provision of medication is based on adult patients; current donor methods and priorities are completely failing to help children in developing countries.

In researching this topic, I came upon the terrifying statistic that there are more AIDS orphans in Africa than there are children in the United Kingdom. Yet only one in 20 children in a developing country is receiving treatment. When 90 per cent of these children have been infected because of a lack of treatment to their infected pregnant mothers, it is clear their health must be moved further up the public agenda, as we have heard from my noble friend Lord Fowler.

As other speakers have made clear, recent reports have highlighted funding targets and, while they have been effective at improving donor countries’ commitment, they are not the measure we need to use. My honourable friend Andrew Mitchell has so rightly stressed that the emphasis should be on the number of patients treated, not the number of pounds donated.

With these new targets, I hope it is possible that significant attention will finally be given to reducing the cost of these treatments.

Patent law of course needs to be studied, but the considerable reduction in the cost of patented treatments, from $12,000 to $700 a year, due to certain pressures shows what advances can be made in this area. What are the Government doing to increase the supply of cheap, legal and reliable drugs to developing countries? The Government could look carefully at the example of Dr Yusef Hamied, nominated for the Nobel prize for peace for his efforts to eradicate AIDS. His Indian pharmaceutical company, Cipla, has been a major incentive for the recent fall in the price of AIDS medication by producing generic drugs that were legal under Indian patent laws, and sell far cheaper in developing countries. He said:

“What’s the use of developing life-saving medicines, if you can’t make them affordable to the patient?”.

Obviously, care must be taken to respect patent laws in the countries where the drugs are produced and delivered; but can the Government explain what they are doing to enforce the WTO rules which allow generic medicines to be used in a health crisis? The Government’s target for universal access to anti-retroviral treatment by 2010 is extremely ambitious, but we are unfortunately not on track to meet it.

I hope the Minister will reassure us that the Government are continuing to look at new ways of targeting aid effectively and making sure that much needed money is not being wasted.

My Lords, I, too, congratulate the noble Baroness, Lady Northover, on securing this timely debate and on re-focusing our minds. It is such an important global issue, and we have had a truly well informed exchange of views. A mixture of despair and hope has been expressed. Like the noble Lord, Lord Fowler, who has such a long and proud record in this area, I wish that more time could be spent in this House on this issue.

The AIDS epidemic is having a devastating effect on communities throughout the world. UNAIDS’s latest estimates show that 40 million people worldwide were living with HIV or AIDS at the end of 2006, and that 4 million people became newly infected with HIV—40 per cent of them young people between the ages of 15 and 24. The challenge is enormous, and this Government are responding, although we have no illusions about the efforts that need to be made. Strengthening health services is, of course, the most sustainable way to improve poor people’s health and to address the health aspects of HIV and AIDS, including for children.

Developing countries need to demonstrate their commitment by increasing their own health budgets and investing in the health of their own citizens. The UK has been working actively with Governments and the international community to support such a scaling-up. As my noble friend Lady Whitaker said, we are helping Malawi with a £100 million emergency programme over six years, part of which aims to double the number of nurses and triple the number of doctors, and to retain them through better pay and conditions, with a salary increase of 50 per cent. Early signs suggest that this support is helping to stop the outflow of health workers, and recruitment has dramatically improved.

We also provided Malawi with £20 million in 2005-06 to fund AIDS-specific projects. In response to my noble friend Lord Rea, our investment in Malawi is clearly one answer to doctors and nurses coming out of the country when they are needed in that country, but we also implement a code of conduct on recruiting health workers from other countries to work in the NHS. We are currently in the early stages of designing a new long-term health programme for Sierra Leone that is similar to the one that we have in Malawi.

We have quite rightly heard this evening that children are among those most affected by the epidemic, and I assure the noble Baroness, Lady Northover, that young children will continue to be the main focus of our new strategy. In Africa, 15 million children have lost at least one parent to AIDS. Without the guidance and protection of their primary care givers, these children are particularly at risk of abuse, exploitation, trafficking, discrimination and other abuses. Other members of the community and the family, especially grandparents, and grandmothers in particular, are hugely overburdened. The Government are working to help to ensure that support is provided where it is most urgently needed. That is why Taking Action, the UK Strategy for Tackling HIV and AIDS in the Developing World, gives a high priority to the rights of children and orphans. Between 2005 and 2008, DfID will spend £150 million, from an overall commitment of £1.5 billion, to meet the needs of children affected by AIDS, including street children. Expenditure on street children will be part of this commitment. The UK also supports programmes and organisations that work directly with street children. In Burma, for example, DfID is contributing £450,000 to the street and working children programme. One element of the programme is HIV and AIDS education.

Of course, additional funding is vital for a sustained response to HIV and AIDS, but political leadership is also crucial, and I take this opportunity to pay tribute to my right honourable friend Hilary Benn and his Parliamentary Under-Secretary of State for International Development for the leadership that they have shown in tackling these epidemics. In February 2006, the UK hosted, with UNICEF, the Global Partners Forum on Children Affected by HIV and AIDS to identify concrete actions to improve access to the prevention, treatment, care and support for children affected by HIV and AIDS. I spoke at this conference, and I assure noble Lords that it was truly action-focused. The forum made several recommendations, including long-term financial support for community action, integrated HIV and AIDS prevention and treatment services for children, the elimination of school fees and regular, predictable cash transfers to reduce the impact of AIDS. These recommendations fed into the UN General Assembly High Level Meeting on HIV/AIDS in June 2006 and were reflected in the General Assembly’s political declaration for achieving universal access to HIV prevention, treatment, care and support by 2010.

We are pushing for increased action through the inter-agency task team on children and AIDS which was set up to accelerate co-ordinated action and build consensus on priority topics. Indeed, today in Washington DfID officials are participating in a meeting of the inter-agency task team to scale up the response for children affected by AIDS. The UK was also the second largest donor to UNICEF in 2006, providing a total of £105 million. This helped to fund child protection programmes that ensure that children and adolescents vulnerable to HIV infection can access and use prevention information, skills and services. I note the remarks of the noble Baroness, Lady Rawlings, that perhaps we should be talking about outcomes and the number of people we help rather than the number of pounds we spend. However, there is a direct correlation between the number of pounds spent and the people affected in a good way. DfID is also working with UNICEF to support national action plans for children affected by AIDS in six countries in Africa, and we are providing an additional £5 million specifically for advocacy and capacity development behind the objectives of the campaign, Unite for Children, Unite against AIDS.

Many noble Lords rightly raised the matter of mother-to-child transmission. DfID is increasing its focus on the prevention of mother-to-child transmission and is working hard to make paediatric treatment more available. The UK was a founder member of UNITAID, the new drugs purchase facility established in 2006. Last year we pledged €20 million, a figure that will rise to €60 million annually by 2010 if performance justifies it as part of a 20-year commitment. One of UNITAID’s first decisions was to approve a $61 million investment in anti-retroviral treatment for up to 100,000 children in 2007. I believe that these strategies are making a difference.

The noble Baroness, Lady Northover, asked what the Government thought Chancellor Merkel would do in the G8 under the German presidency this year. There is a focus on the feminisation of the AIDS epidemic. This provides an opportunity to explore how the global community, and the G8 in particular, can place more emphasis on meeting the needs of women and girls, including mother-to-child transmission. The UK is actively engaging in these discussions, which will lead up to the G8 summit in Germany.

The noble Baroness, Lady Rawlings, raised various issues on medicines. The UK Government are working with the Medicines Transparency Alliance and with country, multilateral and civil society partners to build support for transparency in medicines procurement and supply and to help drive out corruption, excessive mark-ups and inefficiencies. Hilary Benn opened the first stakeholder meeting in London on 18 April.

DfID’s bilateral programmes also directly support children affected by AIDS. For example, in Kenya we are working with the ministry of health to provide home-based care to over 60,000 people living with AIDS and over 100,000 orphans and vulnerable children. In Zimbabwe, DfID is providing £25 million to non-governmental organisations and their community partners to protect orphans and other vulnerable children from all forms of abuse and increase their access to basic social services. The noble Earl, Lord Sandwich, spoke of the dreadful situation in Zimbabwe and asked if our national strategy is being exercised at the expense of local strategies. DfID’s approach to AIDS employs a range of instruments. Poverty reduction budget support is one of these, but the most recent assessments suggest that it is only a small proportion of total AIDS spending. It is important that funds get through to the organisations that provide direct support to those living with and affected by AIDS. Community-based organisations clearly have a very important role and an important contribution to make.

A key modality of DfID support to major NGO activities in the area of AIDS is through strategic partnership programme agreements. Under those agreements, partners such as Christian Aid and Oxfam work through local organisations at the country level. DfID also supports community-based organisations through its bilateral programmes, often through multi-donor pooled funds behind national AIDS councils or challenge funds, to develop good practice and encourage voice and accountability, as in the case of Zimbabwe.

The UK is tackling the wider issues that make girls and young women particularly vulnerable to HIV by supporting, in countries from Bangladesh to Zimbabwe and Uganda to Bolivia, programmes that empower girls and young women to control key aspects of their lives, including sexual matters. As noble Lords will know, the UK will spend £8.5 billion in support of education over the next 10 years, and education, especially for girls, is like a social vaccine against HIV.

DfID supports the work of the International Community of Women Living with HIV/AIDS, and I pay tribute to that excellent organisation for its work in empowering and maintaining contact with women living with HIV all over the world, sharing lifesaving information about their health and rights and influencing policies and attitude. Its work is especially important in countering the dreadful stigma mentioned by the noble Baroness, Lady Masham of Ilton, which prevents people getting the support and the help that they need. Many noble Lords have spoken of the need for pregnant mothers to be tested for HIV and AIDS, but too many pregnant mothers do not want to be tested for HIV because of the stigma that a positive result could bring, not to mention something like domestic violence. These are difficult issues that have to be addressed.

The noble Lord, Lord Roberts of Llandudno, spoke of the concerns of grandparents. Predictable, regular cash transfers to households looking after children affected by AIDS can be a simple and cost-effective way to ensure that children stay in a family environment and get the protection, nutrition, education and healthcare that they need. DfID is supporting that approach in seven African countries, and we hope we will build on that.

My noble friend Lady Whitaker and the noble Baroness, Lady Masham, rightly mentioned the importance of research and the need to evaluate the impact. The UK has been active in developing innovative financing to encourage R&D investment into treatments and vaccines for diseases such as HIV and AIDS. Among others, DfID provides financial support for research to the London School of Hygiene and Tropical Medicine and the Joint Learning Initiative on children and HIV/AIDS, whose goal is to protect and fulfil the rights of children affected by HIV/AIDS by mobilising the scientific evidence base and producing actionable recommendations for policy and practice. Like the noble Lord, Lord Roberts, I pay tribute to the many voluntary organisations that are working with people with AIDS, especially with children with HIV and AIDS. In response to his question, I do not expect that the Home Office points system for immigration will affect people coming to this country for training, but if I am wrong I will certainly write to noble Lords. That is something I must explore further.

The noble Earl, Lord Listowel, spoke about Angola. Yes, we recognise the activities to support HIV and AIDS awareness in that country. DfID’s main support for HIV/AIDS in Angola is provided through two grants to UNICEF. One is a general grant of £3.5 million over two years, and the other is a regional grant of £18 million for UNICEF’s work on HIV/AIDS with orphans and vulnerable children in southern Africa, from which Angola stands to benefit. In response to the noble Earl’s questions about monitoring, several agencies are monitoring the HIV situation in Angola, including the WHO, UNAIDS, UNICEF and the Centers for Disease Control and Prevention.

DfID is fully committed to leading international efforts to tackle HIV and AIDS. Much work is under way, but of course I understand and agree that more needs to be done to ensure that children have access to HIV prevention, treatment, care and support. International leadership is crucial for that. We look to the 2007 G8 summit, with its focus on Africa and strengthening health systems, to signal the international community’s renewed commitment to combating AIDS and to achieving the target of universal access to AIDS services by 2010. Working together, we must turn that commitment into action so that we can combat AIDS and its profound effect across the world, especially on our children.