Tackling the Global Spread of HIV-Aids and TB

16th November 2004

I, too, congratulate the right hon. Member for Edinburgh, East and Musselburgh (Dr. Strang) on securing the debate. I could not disagree with anything he said. Neither could I disagree with anything said by the Chairman of the Select Committee on International Development, whom I congratulate on distributing the new international development magazine. I am sure that its next edition will include an article on the subject of our debate.

I am pleased that the hon. Member for Brighton, Pavilion (Mr. Lepper) mentioned several issues in Ukraine. I worked there some years ago and know that it suffered badly after the Chernobyl disaster.

I will try not to repeat what has been said, but some figures are so stark that I may repeat them. As the right hon. Member for Edinburgh, East and Musselburgh said, the United Nations Secretary-General issued a call to action in April 2001 to battle malaria, TB and HIV/AIDS, to mobilise, manage and disburse funds with the Global Fund and to try to reverse the spread and reduce the consequences of those infectious diseases and others between now and 2010. The Global Fund was created to finance a dramatic turnaround in the fight against those diseases, which kill more than 6 million people a year.

I hope that the Under-Secretary will detail the financial commitments and proposed disbursements for the year ahead, now that we have heard from the right hon. Member for Edinburgh, East and Musselburgh about what has already been committed and disbursed. To date, the Global Fund has committed $3 billion in 128 countries to support aggressive intervention against AIDS, TB and malaria. It is vital.

The fund is truly an international project, with a global impact, fighting three of the deadliest problems that the world faces. The statistics about what it is doing and what it is hoped it will do are impressive. As has been said, TB kills about 2 million people a year—an estimated one third of the world's population may be infected. It is estimated that, in the next 15 years, it could claim 35 million lives and that 200 million may become sick with it. Out of that 200 million, 250,000 children die each year of TB.

Poverty and TB go together. It costs only $10 for a full treatment course to cure infectious patients. The Global Fund is helping to detect 3.5 million additional cases of infectious TB. It is also hoped that it will cure 2 million people through the directly observed therapy strategy. The fund is also fighting the new scourge—multi-drug-resistant TB—with more than 12,000 new treatments.

We have heard that an estimated 45 million people are infected with HIV worldwide; 95 per cent. of those live in the poorest countries, in what we call the developing world, but more than 20 million have been killed worldwide, and the virus is now the leading cause of   death in Africa. Again, children suffer. More than 15 million children have been orphaned by AIDS and that figure is projected to double in the not-too-distant future. Over the next five years, the fund should provide 1.6 million people with anti-retroviral treatment, reach 52 million people with counselling and testing for HIV prevention, and support more than 1 million orphans with medical services, community care and education.
 
Malaria kills at least 1 million people per year and   could cause more than 300 million clinical cases. More than 40 per cent. of the world's population is at risk from malaria. That figure is increasing—in the 21st century, when we should be winning the battle—because of poor health systems, drug resistance, climate change, war and poverty. It is the poorest, and children, who are most vulnerable. Ninety per cent. of malaria deaths occur in sub-Saharan Africa and approximately 3,000 people die of it each day in that region—many of them children. The fund is providing finance for 108 million treated bed nets to protect families from transmission and is delivering 145 million treatments for resistant malaria.

AIDS, TB and malaria are the most lethal combination that one could imagine. That combination is hitting the world's poorest people hard, in Africa. The most vulnerable group, as I have said, are children, many of whom are already orphans. The effect of orphanhood on children in Africa is terrifying. For most people, the death of their child is the worst thing that could ever happen; but what happens to children who are orphaned in some countries seems like a fate worse than death.

In Zambia, 65 per cent. of child prostitutes are orphans. In Addis Ababa, 75 per cent. of child domestic workers are orphans. Such children are more vulnerable to sexual abuse than any other sector of society. There are orphan gangs and orphan delinquents—bewildered, lonely and angry children. Never having known love, they reach adulthood and have their own children. That growing band of potential orphan parents will be one of the highest-risk groups. If they die, their children will have no grandparents to look after them. That is a time bomb that is ready to explode, if it is not already doing so.

Many of those orphans are also the carers for their siblings. I met a young boy in Addis Ababa who told me his story. He was 14, with a 12-year-old brother. His mother and father had died. They lived together in what   was basically a cardboard-box and plastic slum dwelling. They spent their days shoe shining and going to school. They earned enough money to buy food to eat. If they earned more, the older boys would steal the   money. That is how they existed—and they are vulnerable; one fears for their future.

An objective observer of what is unfolding would be forgiven for thinking that the world had gone mad. At a   time when starvation and disease grip parts of our planet, obesity and over-consumption are major problems in the west.
The Global Fund provides some salvation, and its resources give hope to the millions who suffer TB, malaria or AIDS. What can the fund do? Previous speakers told us about what has happened and spoke of its potential, but we must look to the future.

The statistics seem bleak, but only last week I heard at first hand of one case in which the battle against TB had been won and the war against AIDS was being fought with determination. A gentleman called Winston Zulu came to visit me in Parliament. He is from Zambia and is one of 13 children. He had been treated for TB and had recovered, but he has been living with AIDS since 1990. He had four brothers, all of whom died of TB or HIV. The last one passed away in March because of lack of access to anti-TB drugs. I feel for him as I am one of four brothers; he said that he was the only survivor. He was cured of TB in 1997 and he is now an advocate for the changes that can be delivered by the Global Fund.

Winston Zulu is now married and an inspiration to many. I met him not only at Westminster but in Edinburgh, where he was speaking to a group that included another person who deserves mention. Sir John Crofton, a 92-year-old inspirational individual, developed the first co-ordinated drug resistance programme. I think that it provided the foundation for the DOTS programme that the Select Committee saw being delivered so effectively in India, in one of the successes in the battle against TB. It was good to see that the man who developed the treatment 50 years ago is still battling on today.

The Select Committee visited India, but I went there in March to see at first hand how DOTS was unfolding. While there, I spoke to mothers and children who would have been orphans but for the investment of a relatively small amount—$10 per head for a life saved.

I met the Under-Secretary and the Secretary of State after that visit, and I spoke of the concern that the funding of TB programmes might end in the not-too-distant future. I was pleased to receive a letter from the Under-Secretary. The hon. Member for Leicester, East (Keith Vaz) and I had raised with him the question of future funding for anti-malaria programmes in India. He wrote:

"The Government have also told us that the Global Fund for   AIDS, TB and Malaria, to which DFID has committed £180 million, has made a grant to India for TB control in Andhra Pradesh and Orissa. They have therefore decided not to ask for DFID assistance for TB in those states, which means that our programme in Andhra Pradesh will end in 2005 as planned."

Credit where credit is due: not only did the Under-Secretary stay in touch and keep me up to date, but DFID is playing its part. I say, "Well done."

Sadly, the opposite was the case in Malawi at the Bottom hospital in Llongwe. There, we saw TB sufferers and AIDS victims being treated in a medical system that appeared to be falling apart. The health workers were falling victim to the same diseases, and 50 per cent. of poor households were affected by AIDS. Although every bed was full in the children's ward, we were told that it was a quiet time—at busy times, there are two or three children to each bed.

The Global Fund can invest in education to ensure prevention and reduce the spread of those diseases that have been mentioned. Again, that is likely to help the most vulnerable—the children, and especially young girls, many of whom miss their education because of the pressure to leave school to become carers when their families need their help.

One statistic on the education of children in Malawi   sticks in my mind. We were told that of every 1,000 children who start primary school, two would graduate and one would die of AIDS. That cycle must be broken, and the Global Fund can help. However, the fund is no good without the political will of donors and recipients. We must continue to say that what is happening is unacceptable; the tide of devastation must be turned.
 
We have just remembered the dead of two world wars, during which resources were made available to defeat the enemy and the political will was unbending. We are now at war in Iraq and spending hundreds of millions of pounds to enable Iraqis to experience democracy. However, at the same time, people are dying by the million of preventable diseases—1 million a year of malaria; 2 million a year of TB, and possibly 3 million a year of AIDS. Those are the real weapons of mass destruction in today's world; they are the killers that we should focus on.

The holocaust that is unfolding is made all the worse by the fact that we know what is required to bring it to   an end—resources and political will. The resources must be made available, whatever the mechanism. The Global Fund is needed and our attention should not be diverted from the war that we should be fighting—against poverty and disease. Many people, including me, have expressed their concerns about what is going on in Iraq, but few have seen it as a diversion from a much greater problem: the death toll from malaria, TB and AIDS this week could exceed the total number killed in Iraq since the war began. We cannot go on like that.

I hope that the Under-Secretary will address a number of issues: the future funding of the Global Fund and the proposed International Financing Facility; what we can do to play our part in that when the UK Government chairs both the EU and the G8 in the year ahead, and how we can work in partnerships—no individual country can make progress on its own. Partnership is needed, and ways of ensuring that future disbursement means that money that has been pledged gets through to those who need it most. Most of all, we must play our part in the world to ensure the political will to end this tragedy.