[Lord Speaker] Private notice question
on the UK's contribution to eliminating HIV AIDS.
Lord Fowler.
[Lord Fowler] My Lords,
I beg leave to ask the question
of which I've given private notice.
Namely to ask His Majesty's Government in the light of World AIDS Day today
and the estimated 650,000
annual deaths worldwide from HIV AIDS,
what plans they have to increase their contribution to eliminating the disease?
My Lords, is not the tragedy
that although we
now have all the means to eliminate AIDS
unlike the time when I was a minister,
yet the annual figures still show
worldwide this figure of 650,000 deaths,
including very significantly over
200,000 deaths of women.
And worst of all, 100,000 deaths of children.
In the light of this continuing emergency,
how can it be justified that the government has cut back
the resources they are devoting to fighting this disease?
And will they now reconsider that policy?
[Lord Goldsmith of Richmond Park] My Lords, the UK is committed
to working in partnership to deliver on the global AIDS strategy
and ending the epidemic of AIDS by the end of this decade.
This is evidenced by our recent pledge of £1 billion to the Global Fund,
and this funding will help to provide
antiretroviral therapy for 1.8 million people.
The UK also provides substantial funding to the World Health Organization and
UNAIDS and supports countries to strengthen their health systems.
Together, we're working towards ensuring that all can access the prevention
and treatment services needed to make progress on HIV and AIDS.
[Lord Cashman] My Lords, I echo the words of the noble Lord, Lord Fowler.
38.4 million people globally
are living with HIV in 2021, and as we have seen
with other pandemics, an infection in one country ultimately affects us all.
So therefore it's in our national interest that we increase funding
to the global fund fighting AIDS, HIV and malaria.
But my Lords, globally and nationally, we have seen
incredible advances in tackling HIV.
Central to these benefits is empowering individuals to test, take control
and therefore live a healthy life with HIV positive status.
So I ask the noble Lord, the minister, will the government commit
to widening the prescribing of PrEP beyond sexual health clinics
to pharmacies, general practitioners, community and maternity services?
PrEP is part of the armory that prevents transmission.
My Lords, we have the tools, but
they are useless if they are not widely accessible.
[Lord Goldsmith of Richmond Park] My Lords, the UK met
the UNAIDS 95-95-95 targets for the first time
two years ago in 2020, 95%
of HIV positive individuals were diagnosed.
99% of those people who were diagnosed were receiving treatment
and 97% of those receiving treatment were being virally suppressed.
I very much note the suggestion by the noble Lord
about increasing availability of PrEP, and that is a message
which I’ll convey to the health service.
[Lord Allan of Hallam] My Lords, my Lords.
There are concerns that a fall in HIV testing
levels during the pandemic may hamper the government's efforts
to eliminate HIV transmission in England by 2030.
Does the minister share those concerns and will the government be
taking extra measures to increase testing levels again?
[Members] Hear, hear.
[Lord Goldsmith of Richmond Park]
My Lords, I don’t have specific figures in relation to the
rate of testing during the pandemic I’m afraid, if they exist, I'll certainly
make sure they are made available.
But I can absolutely say that the UK remains completely committed
to the global goal of achieving zero new HIV transmissions by 2030.
And as a nation we've made big progress, as I relayed in my previous answer
domestically, but internationally, we remain one of the main funders
and supporters of action to tackle HIV AIDS.
[Baroness Falkner of Margravine]
My Lord, will the noble Lord
take up the powerful point made by Lord Cashman.
That in the domestic UK context, women are losing out
on getting treatments, including PrEP, there's very low take up
and will he speak to his colleagues in the Department of Health about that?
[Lord Goldsmith of Richmond Park] It’s certainly the case globally
that women with HIV have some of the highest maternal death rates, which is why
our ending preventable deaths approach, which is a major focus of UK
ODA, has a strong rights and equality
focus and will remain a priority for the UK.
In the domestic and the UK context I'll certainly convey
that suggestion to the Department for Health.
[Lord Herbert of South Downs] My Lords, I welcome the governments
recent commitment of £1 billion to the Global Fund, which in the circumstances
fiscally here in the UK
is a remarkable and generous donation and makes us one of the best
contributors still in the world to this important fund.
Of these 650,000 deaths from AIDS every year globally, to which my noble
friend Lord Fowler referred some third are from tuberculosis.
Tuberculosis is the biggest single cause of death of people who have HIV
and co-infection of the two diseases remains a serious problem.
Does my noble friend recognise the importance of tackling both
major epidemics, tuberculosis and HIV together, and that that commitment
will continue to be important
if we are to have some chance of beating these diseases?
There is no chance of beating them, TB, by 2030,
but at least within the lifetime of a generation.
[Lord Goldsmith of Richmond Park] I first thank the noble
Lord for his comments about our contribution to the Global Fund.
And I agree with him.
I mean, in the face of the pressures that we're facing, the budgetary pressures,
I was very relieved and pleased that we were able to make that commitment
to the Global Fund, which is doing extraordinarily important work.
The noble Lord also makes an important point about TB.
And it is the case that until just a few years
ago, the trajectory for TB was very much downwards.
And it was one of those historic illnesses which we had almost got to grips with
and certainly believed we were getting to grips with.
And one of the problems
is that we are seeing the weakening of the effectiveness of antibiotics,
and there is a currently a limited supply of antibiotics
and if we continue to abuse them, as we are globally, well over
half of the world's antibiotics are used just to keep animals alive in factory
farm conditions, conditions in which they would not otherwise survive.
And it just seems to me to be the height of irresponsibility to be wasting this
globally, this treasure, antibiotics this miracle cure,
which our ancestors would have dreamt of in order
just to get animals a bit fatter, a bit quicker, and keep them alive
in conditions that we shouldn't be keeping them in any case.
So this is a priority.
The UK is leading this issue and is doing extraordinarily important work on it
and I don't think we can solve this problem that the noble Lord raised
unless we get to grips with our abuse of antibiotics.
[Baroness Thornton] I think the noble Lord the minister is allowing his
other passions to slip
into the answer here, and well done in doing that.
And can I also commend the noble Lord, Lord Fowler,
for his absolute consistency and championing of this issue?
My Lords, the role of UNAIDS is crucial for making progress in the global fight
against HIV and AIDS,
but they are now facing a severe shortfall in their operating budget.
So what steps will the government take to support UNAIDS in building its capacity?
And second, on the domestic front, my Lords, it seems that the law really
needs to keep up with the science, which I think has been referred to already.
And in recognition of this today, the Labour Party is supporting people
with HIV that they should have equal access to fertility treatments.
Does the noble Lord agree
that this is important and how can he help to take it forward?
[Lord Goldsmith of Richmond Park]
I echo the noble Baroness's remarks in relation to the noble Lord Fowler,
who has a long and distinguished record of championing this issue
and is widely respected for having done so.
The noble Baroness asked
about UNAIDS and of course
the UK is completely committed to UNAIDS.
We will continue to work to ensure that UNAIDS
leads the implementation of the ambitious new
global AIDS Strategy for 2021 to 2026.
At the UN high level meeting on HIV in June last year,
the UK was at the forefront of working to secure the highest level of commitment
from our global partners
so that the world has the best chance of meeting those 2030 goals to end AIDS.
And on the domestic question, I'm afraid I'm not qualified
to answer that question, but I instinctively agree with the premise
of the question put to me by the noble Baroness,
and I'll make sure that the Department for Health has a look at that.
[Bishop of Gloucester]
My Lords, in sub-Saharan Africa, adolescent girls and young women
are three times more likely to acquire HIV than adolescent boys and men.
Can the noble Lord, the minister say what's being done
to fund programs which help keep girls in education,
which we know reduces their vulnerability to HIV by up
to 50%?
[Lord Goldsmith of Richmond Park] The noble Baroness is right.
Sorry, the right reverend Prelate is right.
We continue to support stronger health systems around the world
more broadly because that in turn
helps end AIDS related deaths and prevent new HIV infections.
I said earlier that women with HIV have the highest maternal death rates,
which is why our ending the preventable deaths approach remains a priority
for the UK.
On education, education has been now for some years,
particularly education of women and girls, a top priority
as enshrined in the integrated review, but also the international
development strategy.
And it remains a priority and it will remain a priority.
[Lord Patel] My Lords, what are the key challenges for UK
to meet the target of eliminating transmission of HIV by 2030?
Is the elimination of
undiagnosed cases, which currently
out of the 107,000 total cases, probably are around 5,000.
How does the government intend to tackle that?
[Lord Goldsmith of Richmond Park] My Lords, much of our work
that we support is through the multilateral system.
We were talking earlier about the Global Funds
and increasing diagnosis rates remains a key priority
for not just the Global Fund but other multilateral organs as well.
So through our support for those institutions, we are in turn supporting
increased and escalated efforts
to boost diagnosis rates.
[Baroness Masham of Ilton] My Lords, would the government
give some new publicity on the importance
of prevention of HIV and AIDS?
Some people think it has gone away.
My Lords, we have heard clear and loud today
it has not gone away.
[Lord Goldsmith of Richmond Park] I think it’s certainly right that here
in the UK we have seen remarkable progress and I think people in the UK
can take
comfort from the figures that I cited right at the beginning of this exchange.
But that is not true internationally, as we heard from the noble Lord Fowler,
where the numbers are really shocking, 650,000 annual deaths.
So prevention has to be, as
it is with all preventable diseases, has to be a key priority.
And I hope my answer just two questions ago in relation
to prevention of early deaths, particularly among
women and girls, will have provided some reassurance
to the noble Baroness.
[Baroness Brinton] My Lords, I want to refer to your response to Lord
Cashman's question about the availability of PrEP beyond sexual health clinics.
It's really important, my Lords, that it is more universally available.
But I want to ask a second question.
Are we helping other countries to have access
to PrEP, particularly some of the women and children
in Africa that the right reverend Prelate referred to earlier on.
[Lord Goldsmith of Richmond Park]
The wider availability of PrEP is an issue that I know the government is working on.
I don't belong to the relevant department,
so I can't provide authoritative figures.
But the case is bulletproof.
And I know that is a view that's shared by colleagues across government.
But I'm going to have to provide via them a more updated
response to that, I'm afraid.
In terms of the international rollout and availability of PrEP,
I believe that is something that the Global Fund is also doing.
The Global Fund is the main vehicle that we use
and is therefore the main vehicle we support,
which is why our commitment of £1 billion is so welcome.
But all of that work is through those multilateral institutions.
[Lord Bruce of Bennachie] My Lords, will the minister
perhaps remind the current Chancellor of the Exchequer
that as a newly elected MP, and member of the International Development Committee
he led a campaign to ensure that the UK set annual targets,
monitored them and delivered retrovirals across the developing world.
Will he remind the Chancellor of the Exchequer of his commitment
and suggest he repeats it now.
[Lord Goldsmith of Richmond Park]
My honourable friend the Chancellor has long
been a champion of UK aid.
And I very much hope that as a consequence
in his current capacity he will be able to do more than that.
I hope he'll be able to return us as quickly as possible as soon as the
fiscal situation allows to the 0.7.
The 0.5 still makes us one of the most generous countries in the world,
but it also inhibits some of the areas where we showed
real leadership in the years up to that decrease.
So I have every confidence that the Chancellor
will wish to do everything he can in his current post to bolster
our position of global leadership through our deployment of aid and part of that,
of course, is having rigorous targets and ensuring that we have value for money.
[Lord Paddick] My Lords, isn’t one of the major issues around
HIV is the stigma attached to people who are HIV positive.
It's not widely understood that with effective treatment, viral load
can be undetectable and those people cannot transmit the virus to other people.
What is the government doing both in the UK and globally
to reduce the stigma associated with HIV?
[Lord Goldsmith of Richmond Park]
The noble Lord makes an important point and he too
has been a vocal champion,
both in the domestic context and beyond.
The UK itself as a country is a champion of human rights around the world
and we are committed to the principle of nondiscrimination on any grounds,
including on the basis of sexual orientation or gender identity
the issues which are often conflated with the issue that we're discussing today.
And the noble Lord
is absolutely right to point to the stigma associated with HIV AIDS.
But his point will have been recorded for posterity
around the fact of the issue, the facts of the efficacy
of current treatments and the
removal of danger that that results in.