World AIDS Day 2003
The final item of business today is a members' business debate on motion S2M-564, in the name of Des McNulty, on world AIDS day 2003. The debate will be concluded without any question being put.
Motion debated,
That the Parliament acknowledges the importance of World AIDS Day, 1 December 2003, both for Scotland and for all those nations and peoples most affected by the spread of HIV/AIDS; notes the need to combat HIV/AIDS-related stigma and discrimination which is highlighted by this year's theme, "Do you have time?"; further notes that there are now over 42 million people living with HIV/AIDS, including 50,000 people in the UK and nearly 4,000 people in Scotland; recognises that women account for half of those infected with HIV/AIDS and there are more than 13.2 million AIDS orphans; notes the importance of practical assistance for the poorer countries devastated by HIV/AIDS; believes that pharmaceutical companies and governments should take the steps necessary to allow access to appropriate antiviral treatments to all those who need them; congratulates and applauds all of the agencies that work with those living with HIV/AIDS in Scotland, the UK and worldwide, and encourages each MSP to raise awareness about the disease and work towards its global eradication.
I begin by thanking my co-sponsor, Sarah Boyack, and the 47 other members who signed the motion. Similarly, thanks go to representatives from Aid International, the Church of Scotland and HIV Scotland, who are in the public gallery for today's debate.
This is the first world AIDS day debate in the Scottish Parliament. I firmly believe that putting the issue of HIV/AIDS on the political agenda is an essential step. We cannot conquer the virus by ignoring the threat that it presents worldwide, or by assuming that its impact here in Scotland is being contained.
The raw statistics regarding HIV/AIDS are well known. There were 3 million AIDS deaths in 2002, which is more than 8,000 deaths a day, or five people every minute. The estimated number of people who were living with HIV/AIDS at the end of 2002 was 42 million, including 57,000 in the UK and nearly 4,000 people here in Scotland. The cumulative total of AIDS deaths by the end of 2002 was 28.1 million, and 45 million more people will die by the end of this decade unless we take immediate and decisive action.
The number of people concerned is so huge and the scale of the crisis is so vast that there is a danger that we will fail to react appropriately at a time when it is vital that we respond urgently and effectively. The number of people worldwide who were newly infected with HIV last year was greater than the entire population of Scotland. There are more AIDS orphans than the combined population of the United Kingdom's 10 biggest cities—London, Birmingham, Leeds, Glasgow, Sheffield, Bradford, Liverpool, Edinburgh, Manchester and Bristol. There are 12 million people living in those cities, compared with 13.2 million AIDS orphans.
Although most HIV/AIDS victims live in the developing world, with a particular concentration in sub-Saharan Africa, HIV infection knows no boundaries. HIV infections acquired elsewhere in the world account for a significant share of new diagnoses in the Netherlands, Norway, Sweden and the UK. Next week, Professor David Goldberg, head of the blood-borne viruses and sexually transmitted infections section of the Scottish centre for infection and environmental health—SCIEH—will address the cross-party international development group of the Scottish Parliament on the topic of imported HIV infection.
There is a strong moral argument that we should do everything we can to assist poorer countries to prevent the spread of HIV/AIDS and to treat people who already have the infection. A series of issues affect us here in Scotland, too, and what happens elsewhere in the world is coming to us. It is important that everybody who is able to attend goes along to listen to what David Goldberg has to say. It is clear that HIV/AIDS is a global challenge, with implications for us all. None of us is immune from its effects or from the responsibility to fight it. It is a public health crisis everywhere. In South Africa, it is an economic crisis, as a consequence of one in 10 people having become infected. In parts of Kenya, Malawi and Uganda, between a quarter and a third of a whole generation of people are being lost.
However, we should not fall into the trap of thinking that HIV/AIDS is solely an African problem. The problem is growing right across Europe. According to the joint United Nations programme on HIV/AIDS—UNAIDS—among the 5 million people who became infected with HIV/AIDS in 2002 were 30,000 people living in western Europe. In Scotland, sexually transmitted infection rates are rising. They have risen by 870 per cent over the past six years. Despite the prevention work that has been carried out, significant increases in the number of HIV/AIDS cases have been recorded over the past two years. Two years ago, there was an 11 per cent increase in the number of HIV cases; last year, there was a 46 per cent jump.
The topic of this year's campaign for world AIDS day is "Do you have time?" The campaign hopes to increase awareness of the stigma and discrimination that are associated with HIV. HIV/AIDS threatens the welfare and well-being of people. Combating the stigma against people who are affected by HIV/AIDS is, in my view, as important as developing new types of treatment. We know that new types of treatment are available in our society, which enable people who are infected with AIDS to live full and—now—much longer lives. In that context, it is shameful that people who are living with HIV/AIDS are often treated as second-class citizens. The media has recently featured stories about insurance companies that have refused to issue policies to HIV-positive people or that have doubled their premiums; about funeral rights being denied to HIV-positive people; and about educational establishments apparently refusing to teach infected children. I hope that the Scottish Executive will do everything in its power to outlaw discrimination of that type.
As a result of fears about discrimination and prejudice, people may be driven to conceal their HIV diagnosis, for fear of the possible consequences. That can result in other problems, such as increased anxiety, difficulty in forming relationships, a lack of access to information services and even unexplained absences from work. Even more alarmingly, some people opt not to get tested at all because they fear the difficulties that a positive diagnosis might bring.
If today's debate helps to make people in Scotland more aware of the facts around HIV/AIDS transmission, non-transmission, prevention and care, then the Scottish Parliament will have achieved something worthwhile. I am glad that the Parliament's online discussion forum is contributing towards a better understanding of HIV/AIDS. Similarly, the BBC News website is hosting online debates. I congratulate those who work on both those websites on their work to date.
One of the questions that was asked on the Parliament's website was:
"Has the battle not largely been won in the developed world, where the combination of health education and medication has seen HIV and AIDS largely contained?"
Unfortunately, the answer is no. Increases in the number of people with HIV stem from a failure to take the risks seriously. About 50 per cent of young people worldwide do not know how to protect themselves from HIV infection, and too many young Scots are among them. Unless unfounded myths are dispelled, and unless stigma and discrimination are eliminated, infection rates will continue to rise.
What can we do? We can end discrimination and the fear and prejudice that lie at the core of HIV. We can tackle it at community and national levels. A key task in Scotland as much as anywhere else in the world is to confront fear-based messages and biased social attitudes in order to reduce the discrimination and stigma of people who are living with AIDS or HIV. By sharing and disseminating information about HIV and AIDS, we can all contribute to dispelling the myths and misinformation that feed stigma. By ending ignorance we will end prejudice.
On world AIDS day last year, Nelson Mandela said:
"We have to respond to the crisis that is threatening our communities. Through our involvement and leadership, a change in attitude towards the disease is possible."
I hope that not just the Scottish Executive but the whole Parliament will respond to the challenge by making the fight against HIV/AIDS one of our overriding and unifying goals.
I conclude by mentioning that one positive thing that came out of the recent state visit by United States President George Bush was the establishment of a UK-US task force to ensure that funds that are donated to the AIDS battle are spent according to the priorities of those who work in the countries that are most affected. The task force will initially target five African countries that have been seriously hit by HIV/AIDS: Ethiopia, Nigeria, Zambia, Kenya and Uganda. The Governments of the world's two biggest donor nations have signalled their willingness to listen to their African counterparts.
If HIV/AIDS is treated holistically and recognised as a poverty and justice issue as much as a health issue, that will be very welcome. We need to force a change. I very much welcome the opportunity that we have had to discuss the issue.
I congratulate Des McNulty on securing this important debate. The Parliament always shines when we add an international dimension to our debates, so let me begin by addressing the international dimension to the AIDS debate before returning to the Scottish situation.
Internationally, there is an inextricable link between poverty and the spread of HIV and AIDS. Only last week, the United Nations Food and Agriculture Organisation published a report that contrasted different countries. It showed that countries with economic growth have been able to reduce hunger, which, in turn, has led to slower population growth and lower levels of HIV infection.
We are in the 21st century—in 2003—but 850 million people in the world will go to bed hungry tonight. The world is perfectly capable of feeding itself, yet the number of people who are undernourished is increasing by 5 million a year and has done since the mid-1990s. We must tackle famine and world poverty if we are to tackle the spread of HIV.
AIDS is causing havoc in many developing countries by depriving them of their work forces. Families are losing their strongest and most productive members. Last year alone, an extra 5 million people were infected with HIV worldwide. One in five people in sub-Saharan Africa are infected by HIV. That is 40 million people in total. In the next decade, Botswana, which is one of the most developing countries, is set to lose a fifth of its agricultural work force through AIDS. That is an indication of how serious the situation is likely to remain in the next few years. Some UN reports indicate that teachers in some developing countries are dying at a faster rate than they can be trained. That gives another indication of how serious the situation is.
There is a vicious circle involving AIDS and poverty. Unless we tackle HIV infection, we cannot tackle poverty; unless we tackle poverty, we will not halt the spread of HIV. The west has a huge role to play in breaking that vicious circle. Recently, we have seen a welcome fall in the price of drugs for preventing the spread of HIV and for treating patients with HIV. Because of that, Britain's position is now that it will give cash towards treatment rather than just prevention. I believe that all of us in the chamber would share the view that the way in which the multinational pharmaceutical companies have held the developing world to ransom in recent years is absolutely despicable. Let us hope that we can put that behind us and allow affordable drugs to be supplied to the developing world.
In the past year alone, UN spending on HIV/AIDS has increased by 50 per cent, to £4.7 billion. That might seem to be quite a lot of money on the face of it, but it is just a fraction of what should be spent. During Bush's recent visit, he said that tackling AIDS is always on the agenda whenever global leaders meet these days. The difficulty is that they always have military spending and war on the same agenda, and those issues, unfortunately, are higher up the agenda than tackling AIDS is.
Before I sit down I want to make two points to the minister, which I hope he will address. First, there have been reports that the European Union is planning to cut the funding for the centres that monitor the progress of tuberculosis, AIDS and other sexually transmitted infections in 2004. That may be the plan, but at the same time, new states in which HIV rates are on the rise are entering the EU. I ask the minister to address that point. Perhaps he will investigate the matter and make representations to the EU if he thinks that that would be worthwhile. We have to find out more information about those worrying plans.
I also seek an update on plans to tackle HIV infection in Scotland. Lots of new initiatives have been adopted. One initiative is run by Grampian police who are now giving out clean needles to stop the spread of HIV among drug users in their custody. I look forward to the minister's responses on those issues.
I congratulate Des McNulty on getting the motion on to our agenda tonight. When I saw the terms of the motion, I was happy to co-sponsor it. Des McNulty put the global context of HIV and AIDS extremely effectively in his opening speech.
The motion mentions that around 4,000 people living in Scotland have HIV and AIDS. In my few minutes tonight, I want to focus on the situation of black African people who have the virus and who are living in Scotland. Recent estimates from the SCIEH show that, of those diagnosed with HIV, two thirds are presumed to be from Africa. Black Africans throughout the UK are the group that has the fastest-rising rate of new HIV diagnosis. It is perhaps not surprising that Des McNulty and Richard Lochhead mentioned the huge number of people in sub-Saharan Africa who live with HIV and AIDS. The overall number of people who live in sub-Saharan Africa is more than 28 million.
Black Africans living in Scotland are disproportionately affected by HIV. Many of them live in desperate circumstances. They not only face the stigma of the virus, but frequently experience racial abuse. The confusion that often arises in the press around terms such as "refugee" and "asylum seeker" adds further to the discrimination that those people experience. Many of them have been disowned by their families and abandoned by friends. Most of the African community in Scotland who live with HIV are here to study or to visit family members. They are not here as asylum seekers or refugees. Much of the anecdotal evidence shows that many are professionals such as teachers and nurses.
Many of the Africans whom we know about in our communities in Scotland find out that they are HIV positive only at the point when they become unwell. At that time, they face tremendously difficult human choices about whether to remain in the UK and receive treatment or return home where they will receive no treatment whatever. That is a horrendous choice to have to make. Their situation can be further compounded by changes in immigration status that can leave them unable to work or study, without entitlement to benefits and sometimes absolutely destitute. I ask the minister to work with UK ministers to try to take some of the simple measures that could help people who are living in such circumstances. For example, it would be possible to speed up the process by which people can apply to remain in the UK on humanitarian grounds so that they can receive treatment for their illness.
I want to highlight some of the superb and vital work that is being done in Edinburgh by Waverley Care's Solas centre, which is in my constituency. The centre offers support services, information and an informal meeting place for people who are living with HIV. An African outreach project has been set up to research the health needs of Africans living in Scotland who have been affected by HIV and AIDS. I hope that the project will provide better access to health services for African people and raise awareness among the African community. The African support worker is able to give practical and emotional support to black African people in the Lothians.
The growth in HIV, in Scotland and the rest of the UK, is part of the bigger picture that Des McNulty talked about. The mobility of many people nowadays is a feature of globalisation. We should not be surprised by the fact that many of the people in the UK who are HIV positive are black Africans. We need to ensure that a practical, effective and humane response can be made to their situation. We also need to ensure that people have support.
I congratulate Des McNulty on bringing the issue to the chamber tonight. I know that we will have a good debate and I hope that it will provide encouragement to people who are working in the voluntary sector. I hope that today's debate will help to tackle the stigma and prejudice that people are experiencing and to ensure that the services that are provided will be better in the future.
I add my thanks to Des McNulty for initiating the debate. It is nice—in fact, it is a joy—to have a debate with him that is consensual and non-confrontational.
I see that Patrick Harvie got dressed up for the occasion.
I did not dress up specifically for the debate.
As some members know, before I was elected to Parliament I spent a number of years working in a sexual health project with a remit to promote sexual health among gay and bisexual men—including, but not limited to, HIV prevention. As the newly published draft sexual health and relationships strategy makes clear, sexual health is not merely an absence of disease; rather, it includes social, emotional, physical and mental elements of well-being in relation to sex and sexuality. That holistic understanding was central to our work. I pay tribute to the organisation that I worked for, PHACE Scotland—Promoting Health and Challenging Exclusion—which still works hard and effectively on those issues.
World AIDS day always had an important place on our calendar. It was an opportunity to use methods—such as advertising, news coverage and television programmes—that were not always available to raise awareness of HIV and AIDS. We went out and did street stalls, put up posters and had social events. Many of those methods will be familiar to politicians from across the spectrum. World AIDS day gave us an opportunity to reach people whom we often did not reach at other times and to celebrate the lives and work of people in the HIV field, including those who were overcoming difficulties caused either by living with HIV or by the discrimination and prejudice that they faced because of their HIV status.
In recent years, one of the most predictable headlines around the time of world AIDS day was about heterosexually acquired HIV. Our job was continually to remind Scotland—the Scottish public and Scottish policymakers—that HIV prevalence among gay and bisexual men is still high and rising. Gay and bisexual men are still a key target group and a group that has never received a proportionate allocation of health promotion funding to reflect that prevalence. Funding should be available not only for specific health promotion projects, but to build equality and diversity training into all services and to tackle homophobia at root. That includes work in schools.
There is a need for other work that is targeted at men who have sex with men, who may not be gay or bisexual. That includes condom provision in prisons, and I am glad that some progress may be made on that shortly. We must also give the same high priority to support services and interventions for men selling sex as we do for women.
During my time working in the field, the proactive health activism that initiated gay and bisexual men's sexual health work largely gave way to a perception of voluntary organisations that were service providers for the statutory sector. Among the consequences of that change are insecure one-year funding and project funding without core funding. That has practical and emotional consequences for the people who work in the field. Tireless efforts are being made by hard-working, talented and professional individuals.
I have lodged a motion to bring to the attention of members the misinformation about sexual health that is spread around the world by several organisations. That issue is controversial because one of those organisations is a church, which spreads misinformation about the effectiveness of condoms as part of a sexual health strategy. That happens not only in developing countries, but has happened—and probably still happens—in Scotland. I have encountered it myself. There must be a clear, assertive response to such misinformation. I hope that that forms part of the Executive's response when it endorses—as I hope it will—the sexual health strategy.
I, too, am pleased that Des McNulty has secured the debate, four days in advance of world AIDS day on 1 December. World AIDS day is now an established mark on the calendar and it is appropriate that we in the Parliament should recognise it.
The revealing document that was published by the joint United Nations programme on HIV/AIDS and the World Health Organisation to coincide with world AIDS day contains some chilling statistics. I will not rehearse those statistics, because many of them were quoted by Des McNulty, but I am worried by the perception that AIDS is somehow yesterday's problem. The level of political activity of some of those who express that idea is surprising. The perception is that, although AIDS was a problem in the 1980s and the first half of the 1990s, drugs are now a bigger problem or that other issues have overtaken AIDS because things have moved on. Things have not moved on. How can they have moved on when every year many people die of AIDS or are infected with HIV, which leaves them, at best, with an uncertain future? One of the most chilling statistics in the document is about southern Africa. Sarah Boyack mentioned Africa, but southern Africa is home to about 30 per cent of people worldwide who live with HIV or AIDS, yet it accounts for less than 2 per cent of the world's population. That should give us pause for thought.
Des McNulty mentioned some organisations that campaign on the issue. I do not want to belittle or detract from them, but I will say a little about an organisation called Interact Worldwide, which has been lobbying MSPs strongly and effectively. Interact Worldwide is a human rights charity that provides sexual and reproductive health and rights services to millions of men, women and young people, locally, nationally and internationally. The charity works with partner organisations in developing countries to tackle reproductive health issues such as the rise of HIV/AIDS, which now affects more than 40 million people worldwide. Through the implementation of services including family planning, maternal health, education and information services, the organisation works to alleviate poverty in developing nations. I could not agree more with Richard Lochhead that the vicious circle of HIV and poverty must be broken and that we will not effectively alleviate one without doing likewise with the other.
I am concerned about the situation in the UK—50,000 people in Britain now have HIV, which is a 20 per cent increase on last year's figure. We must consider the fact that HIV/AIDS is most prevalent among young people. The Executive is active in many ways in assisting people, not least young people, with sexual health and the recently announced sexual health strategy is welcome. However, I—like other members, I suspect—have received information from Barnardo's Scotland, which has worked for a number of years with children who are affected by HIV/AIDS in Dundee, Edinburgh and Glasgow. Barnardo's experience is that the needs of children who are affected by HIV/AIDS are often overlooked. The information from Barnardo's states:
"We know the numbers of people infected by HIV/AIDS through the collection of national statistics. However, there is no standard method of recording and identifying those children who may be in need of additional support because they are affected by HIV/AIDS."
I urge the minister to take steps to ensure that those statistics are collected and that the extent of the need is identified.
There is a danger that we will simply repeat what has been said already and I have no intention of doing that. I will close by quoting from the UNAIDS and World Health Organisation publication. A box on the back of the document contains the following wording:
"These are some of the most painful symptoms of HIV/AIDS."
The symptoms are quotations:
"I'm not allowed to talk to you … You disgust me … I trusted you … How could you do this to me? … You brought shame on our family … You deserve it".
The document continues:
"Help us fight fear, shame, ignorance and injustice worldwide. Live and let live."
That is a suitable slogan for world AIDS day 2003.
In the time that the debate will take, approximately 300 people will die from AIDS. That is the background to our debate.
One puzzling and worrying figure is that a third of those who suffer in the UK remain undiagnosed. I back Mike Watson's point about the lack of information on young children who are affected. From July to September, there were 57 new cases of HIV in Scotland: 23 of them were a result of sex between men and 20 were in heterosexual couples. I back Patrick Harvie's comment on that issue—the fear is that we are not considering the problem fully.
Another five of those 57 cases were injecting drug users, which is an issue we have known about for years. In the 1980s I set up with the local health authority a needle exchange system that was based in some of my pharmacies. Although I received support from the local health authority, I did not get support from anywhere else and indeed was criticised by my own profession for encouraging drug abuse. That was not the purpose of the scheme. The kits in question contained needles, syringes and condoms and we had a registration system that allowed drug and social workers to have access to the people in the drugs arena. That in itself helped to contain the spread of these diseases within the drug-abusing community. I think that Richard Lochhead mentioned that very point with reference to the police in Aberdeen.
When I was dealing with drug addicts, I found that there was a huge stigma about these diseases. Because the addicts were terrified to talk about their problems, they went undiagnosed. In fact, early diagnosis is the most vital area of the debate in the UK. How do we persuade people to take the tests at an early stage? After all, the later they have treatment, the less chance they have of surviving. We also need to find out early on whether patients are liable to develop resistance to the drugs. It is a fact of life that not everyone benefits from the drugs that are used.
Members have mentioned AIDS orphans. That issue is part and parcel of other matters that are related to famine victims and so on that could be dealt with collectively by international organisations. However, poverty is not the only problem in some of these areas; we must also take into account the lack of education and certain cultural aspects such as the acceptance of promiscuity. It is not easy to change a culture. Indeed, it is very difficult for people from outside a culture to insist that a particular group of people should change their ways overnight.
We have our own problems. We now have international movement of people: people will move around, no matter whether we are talking about the oil industry going into Africa or whatever. Our own people must be aware of the risks of going on alcohol and drug-fuelled holidays without thinking about their role in the worldwide spread of the disease.
Richard Lochhead mentioned the drug industry. As that is my background, I assure him that without that industry's profits we would have neither research and development nor the ability to cut the costs of drugs to people. The same drug companies also invest hugely in charitable foundations that have been the main supporters of much of the activity that has been carried out to help such communities. We have to recognise that this is not a one-way street.
This debate is very important, because the issue in question is coming ever closer to home. We cannot ignore it forever.
I, too, congratulate Des McNulty on securing this important debate. I am pleased that the Parliament has this opportunity to address the international HIV/AIDS situation.
I am also pleased that we have had an opportunity to remind ourselves that this is a very real issue closer to home and in this city. It is worth remembering that, as of today, there are more than 1,500 cases of HIV in Edinburgh, which accounts for 42 per cent of Scotland's HIV population and 2.7 per cent of the total UK HIV population. Sadly, Edinburgh is still working through its dubious distinction of being a main HIV centre.
However, we must put that in a wider context. HIV is one of a number of sexually transmitted infections that are now on the increase. Chlamydia has reached almost epidemic proportions and syphilis and gonorrhoea infections, which many people thought were things of the past, are very much things of today. If cases of many other infections were to increase on such a scale and at such a pace, there would be a clamour for action, but the very nature of sexually transmitted infections means that we hear much less about them, although the problem is no less acute.
I am delighted that the draft health sexual strategy was published recently, because it provides us with an enormous opportunity to make a step change in our efforts in Scotland to tackle the spread of HIV and other sexually transmitted infections and to address a wide range of other issues that affect the sexual health of the population. It is worth reminding ourselves that the sexual health strategy has three key strands: the need to work to change culture; the need to provide people with knowledge, skills and appropriate education; and the need to ensure that we have in place access to all the services and support that people need.
People often wonder whether they can tackle all the problems and make a genuine difference. I believe firmly that if there is the will, the leadership and the investment, we can make that difference.
In the debate, which is by its nature depressing in some respects, it is worth holding on to the successes that there have been in living memory. It is only in the past 20 or so years that we have seen a genuine national effort to combat HIV. We saw the combination of major awareness campaigns and although the approach that was adopted might not have been to everybody's liking, those campaigns played their part.
We also saw efforts such as the needle exchanges—which David Davidson mentioned—to address the spread of HIV among intravenous drug users. We saw a tremendous effort in the gay community, including the examples that Patrick Harvie spoke about, as well as work in the media, in our churches, in our schools and an increase in the availability of condoms. Those things together had an impact on sexual behaviour in the 1980s and therefore had an impact on the spread of HIV at that time.
We need to learn the lessons of the past and to step up our efforts once again for the future. In implementing the sexual health strategy, I hope that ministers will be prepared to be bold and radical and to recognise the extent of the problem, but also the extent of the opportunity that we now have to make a difference.
I hope that the views of the most important people of all will be listened to: those who have been infected by HIV and other sexually transmitted infections and whose health and well-being are being affected as we speak. We can make a difference and I hope that the debate today will have played some small part in adding to our effort.
I offer my congratulations to Des McNulty on bringing this important debate to us. One reflection of the importance of the debate is that Interact Worldwide—which used to be called Population Concern—has now realised that it is, at the beginning of this century, most important to address the health issues around reproduction.
I will reflect briefly on my work and acquaintanceship with the problems of HIV and AIDS as a guidance teacher for 14 years before I came to Parliament and on my visit to South Africa. I thoroughly endorse what Susan Deacon and other members said about the fact that there is no place in school education for complacency about AIDS. The level of support for guidance teachers and departments in the late 1980s and early 1990s was excellent and that level of support must be kept up through the sexual health strategy. I remember that when 3rd and 4th-years were having their first detailed relationships instruction, they said to me, "We wish we'd heard this earlier."
Acquaintanceship with condoms is absolutely essential. Every child in every school in Scotland should have handled a condom in class before they leave school and preferably before they leave the 3rd and 4th years.
In several primary schools that I visited in South Africa, there were two signs on the walls. One of them addressed discrimination and stigma and it stated in capital letters, "MY FRIEND WITH AIDS IS STILL MY FRIEND". The other message was, "Use a condom". Occasionally there was a picture of a needle with a big cross on it. Let us not forget that those signs were in primary schools. Those three messages are being given out in South Africa from primary school onwards.
There is no reason for us to be complacent about AIDS in the population and say, "They have 30 per cent infection in South Africa." To add to that misery, 40 per cent of the armed forces in South Africa have HIV. Fifteen per cent of students and 20 per cent of teachers have HIV. If nothing is done to stop the spread of AIDS, it is predicted that by 2020 50 per cent of people under 15 will be infected through inheritance or sexual transmission. The country is in an absolutely appalling state.
Poverty is at the root of much of the problem in South Africa; it is almost impossible to imagine the extent of that poverty. When I visited Soweto, I found one hospital for over 2,000,000 people. There is no access to fresh water or to toilets, and people are living in shacks miles and miles away from health care facilities. What does South Africa get? It gets a President—Mbeki—who is not prepared to accept the real causes of AIDS. It gets the most appalling mystic beliefs; for instance, it is believed that if a man sleeps with a virgin he will not get AIDS, so the incidence of child rape in South Africa is beyond belief.
Cheap medicines are not enough; free medicines are needed. I am holding up a condom—100,000 of them arrived in South Africa a few years back. The one that I have in my hand I got at an AIDS campaign stall that carried the message, "More than this is needed." Why? It was because the condoms came from the United States and were all two years out of date when they arrived in South Africa.
I thank Des McNulty for bringing the debate to the chamber.
I point out that there was a problem with the clock, but you got the same four minutes as everyone else, Mr Harper.
I shall start as Robin Harper left off, with congratulations to Des McNulty on securing parliamentary time for this important debate. I am glad that some members have resisted the temptation of a certain other event that is beginning soon to attend the debate—I see that some are even preparing for that event as we speak. It is noticeable, however, that there is a party that is not represented in the chamber this evening. I hope that that party will not be represented at the dinner later this evening. This is an important debate that all parties should attend.
I shall not rehearse the eloquent description of the economic problems that have been caused by AIDS in Africa, with which Richard Lochhead began. I echo the views of Sarah Boyack on the personal experiences of those who are living with AIDS in Scotland but for whom Scotland is not their home. I shall direct my brief remarks towards Africa.
A number of years ago, I visited Malawi, a year after Malawi became a democracy after years under the corrupt dictator, Banda. I visited a village not far from Blantyre. If we consider connections between Scotland and Africa, there is no greater example than that of a city in Malawi having the same name as a town in Scotland and suffering many of the same problems. The village had never been visited by a white person before; I was the first white person to visit, only five or six years ago. When I arrived, a number of children crowded around me, curious to see this young but balding white man.
One of the Government officers who accompanied me on the visit explained to me that many of the children—roughly a quarter, in fact—had AIDS. The disease is cruel and it has affected a country that was being born into democratic enlightenment. If I were to visit that village now, I would see its population decimated by the kind of increase in the disease that Des McNulty talked about. Robin Harper talked about hospitals in South Africa; the situation is similar in Malawi, where hospitals have similar catchment areas to those in South Africa. There is a total lack of equipment and no visiting health workers. The problem is as acute as it could be.
It is important to stress, however, that Scotland has a role to play. In liaison with NHS Scotland, with our academic fraternity and with some of our churches, we can be extremely progressive in our relationship. This Parliament has had a visit from President Mbeki, and we have a role not only in educating other health professionals and workers in Africa, but in educating African leaders. I believe that the impact of President Mbeki's visit to this Parliament will be positive. I believe that our first visiting head of state was President Muluzi of Malawi, who took away many contacts with people in our health and educational communities.
I close with one observation that picks up on what Mike Watson said. AIDS is not yesterday's condition; it is very much tomorrow's. Although the media is not represented here today, I hope that world AIDS day will receive the media profile that it deserves.
Given the impact that severe acute respiratory syndrome—SARS—has had, over recent months, despite the very small number of people whom it affected in communities in the developed world, I hope that we do not give disproportionate consideration to a condition that affects the developed world less than HIV/AIDS affects the developing world.
I join other members in congratulating Des McNulty on securing a debate on a topic that concerns the well-being of millions of people throughout the world, whose lives are threatened by a virus for which there is, as yet, no cure. It is fitting that the Parliament should discuss this issue as world AIDS day 2003 approaches.
Along with the remarks that Des McNulty made at the start of the debate, the motion gives an insight into the scale of the problem. HIV/AIDS is one of the greatest ever public health challenges to confront mankind. Mention was made of the situation in sub-Saharan Africa, where the epidemic claimed 2.4 million lives in 2002 alone—equal to almost half the population of Scotland. That is such a sobering statistic that we might take a few moments to consider the enormity of it.
In Scotland, the cumulative number of HIV reports since the figures were first collected in the 1980s was 3,780 at 30 September, unfortunately including 1,300 deaths. The rise in the number of new reports in Scotland last year is a timely reminder that there is no room for complacency, as other members have rightly said.
The implications are much wider than sickness and death, tragic though those are. The motion refers to the existence of more than 13 million AIDS orphans throughout the world. That heart-rending figure highlights the hugeness of the task facing the caring and supporting agencies.
There are also economic problems. HIV, as it progresses, often means that men or women are unable to work to sustain their families. Employers have difficulties in recruiting staff to fill jobs. As a consequence, productivity drops and economic growth is impeded. That is a critical problem in many developing countries where HIV is rife. As Des McNulty rightly said, it is important that rigorous prevention programmes are put in place and that there is an adequate response to care and treatment needs.
Richard Lochhead raised the issue of on-going funding and research. I am happy to say that the United Kingdom is in the vanguard of the international response, both as an advocate for a concerted approach and as a practical contributor to the global effort. International funding for HIV/AIDS is now $1.8 billion annually, compared with around $400 million in 1998, and the UK is the second-largest bilateral donor of HIV/AIDS assistance in the world.
Would the minister be willing to investigate reports that the European Union is planning to cut funding for the HIV surveillance centres in Europe in 2004?
I noted that point earlier, and I will address it in a moment.
The United Kingdom was also instrumental in setting up the global fund to fight AIDS, tubercluosis and malaria and has committed $280 million over seven years to ensure that it has long-term stability of funding. In addition, on another subject that was referred to earlier, the United Kingdom Government is pursuing a number of approaches to make essential drugs—including those for the treatment of HIV/AIDS—available in developing countries at affordable prices. The United Kingdom's record is good.
I note the points that Richard Lochhead has made and I will make inquiries into that issue. However, there seems to be a determination, within the EU, to pursue research and there are still plans for an EU centre on communicable diseases.
The communication that was issued by President Bush and the Prime Minister last week affirms the fact that the US and the UK will work together to strengthen efforts in HIV/AIDS prevention, treatment, care and support, beginning in five African countries.
Does the minister accept that there are still concerns over the United States' policy of tying sexual health aid funding to abstinence-based programmes?
There will always be concerns. What I want to do tonight, and what the Prime Minister wants to do, is to concentrate on what is positive. If it can do nothing else, the United Kingdom can play a large part in influencing the United States' approach and attitude. I hope that we continue to do that on the matter to which Patrick Harvie referred.
As a result of events last week, a special joint task force will be established to focus our national efforts and enlist the support of others. A comprehensive approach will aim to expand the delivery of HIV/AIDS prevention, care and treatment and will include greater access to safe and effective medicines, better health system delivery and the building of a skilled force of health workers. All of that shows the UK's commitment and contribution to the international effort, which has the Executive's full support.
Of course the global effort must continue unabated, but we cannot afford to slacken our work on the domestic scene. On the Executive's behalf, I assure members that we will remain totally committed to responding to the diverse challenges that HIV/AIDS presents in Scotland.
The report of the HIV health promotion strategy review group, which was published in 1999, provided the strategic framework for our approach in Scotland and proposed an integrated response under which all the partners and stakeholders work together.
In the absence of a vaccine, prevention is of paramount importance, so we give NHS boards more than £8 million annually to engage in or commission activities to prevent the spread of HIV. The voluntary sector, whose tireless and dedicated contribution I applaud, has a critical role to play. Some of that NHS funding supports that sector's activities. It also supplements the £500,000 that the Executive gives directly to voluntary organisations each year. Patrick Harvie referred to funding. Each year, £150,000 goes directly to the Healthy Gay Scotland project.
Working together, NHS boards and voluntary organisations such as HIV Scotland and Healthy Gay Scotland deliver diverse and innovative initiatives to raise awareness, prevent the spread of HIV and provide succour to those who need it.
Susan Deacon was right to refer to the need to include sufferers. Two projects—Body Positive and Positive Voice—work to reduce stigma and discrimination and to deliver prevention messages.
Nationally, NHS Health Scotland continues to raise awareness. For example, it recently issued a booklet that gives HIV advice to travellers abroad. That is available at Scottish airports.
The motion refers to stigma and discrimination, which Des McNulty was right to address. Such practices are unacceptable in the inclusive Scotland that we are striving to create. We will not tolerate such behaviour and we will work with voluntary organisations and other interests to eliminate it. The sexual health strategy that is out to consultation has been mentioned. The strategy deals with barriers to HIV testing and the problems that people experience in securing insurance.
We have the support of the people of Scotland in working towards eliminating stigma and discrimination. In September, the Executive published the results of the 2002 Scottish social attitudes survey, which said that more than two thirds of Scots think that the country should do as much as it can to get rid of all kinds of prejudice.
Building a respectful society in which people can live their lives free from prejudice, stigma and abuse is a key element in the battle against AIDS. It is a cornerstone of the Executive's partnership agreement and I am certain that it is a principle that unites the Parliament.
Much is being done in Scotland and there are some signs of hope for the future. For example, last year, 10 new infections occurred from injecting drug misuse. That is the lowest annual figure in that group since records began. Measures to reduce the risk from drug misuse are clearly bearing fruit.
As expected, the debate has revealed a welcome consensus and determination to meet head on the real threat to world health and to reduce its impact domestically and on the international scene.
In Scotland and internationally, unity of mind and purpose is growing to address the challenging and complex issues to which HIV and AIDS give rise. We are committed to building on the solid foundation that exists. I am encouraged and delighted that the debate has reconfirmed the unity of purpose in Scotland and the shared commitment to the aims that we have all mentioned.
Meeting closed at 17:59.