Examination of Witness (Questions 156
- 159)
TUESDAY 20 JUNE 2000
MR JEFF
O'MALLEY
Chairman
156. Welcome to the Committee. Some of us were
at the South African High Commission meeting on HIV/AIDS so we
had the pleasure of hearing you speak there. We also have your
very useful written evidence. We want to explore that and other
issues with you this morning. I shall ask Mr Robathan to start
us off on the subject of community involvement in HIV/AIDS. Perhaps
you would like to make a short opening statement.
(Mr O'Malley) If I may, I would like
to do that. Like Alan, I want to thank you for holding these hearings
and for inviting me. I particularly want to draw the attention
of the Committee to the fact that I have been working in the area
of AIDS for about 15 years, mostly from the perspective of an
NGO. I worked for a couple of years in the UN system and a couple
of years at a university, but today my remarks will come from
the perspective of someone working within an NGO and the strengths
and weaknesses of my perspective will come from that. In relation
to the letter that I submitted, the International HIV/AIDS Alliance
is a UNAIDS collaborating centre. I want to underline that I speak
to you today as the director of the Alliance. I do not speak on
behalf of UNAIDS. I wanted to make that clear for the record.
Mr Robathan
157. Mr O'Malley, thank you for your contribution
which I have in front of me. I apologise because I shall have
to leave shortly, which is a pity because I would like to discuss
with you the remarkable Healthy Highways projects, which I have
seen in Hyderabad. I thought it was marvellous because it was
curiously ineffective. I do not want to go down that line at the
moment. Your first principal point was that "Successful responses
to HIV/AIDS require community involvement and commitment, especially
from people living with HIV/AIDS". How can communities intervene
effectively both to prevent the transmission of HIV/AIDS and to
provide care to those living with HIV/AIDS?
(Mr O'Malley) I was aware of your comments on Healthy
Highways from the testimony of last week. It is a shame that we
shall not have a chance to discuss it further. To answer your
question, I do not know whether any of you have MBAs, but I start
by saying that I firmly believe that we cannot market our way
out of this epidemic. There is a role for marketing, for service
provision and for political leadership, but it is also important
to look at places like Senegal, the Philippines and Thailand,
where they have either averted epidemics where everyone thought
they were coming, or turned around epidemics at much lower levels
than that that was turned around in Uganda. That never happened
simply through marketing information and services. That always
happened because there was a ground-swell of community action
and concern about AIDS. If you look at Uganda as a concrete example,
I completely agree with Alan in that President Museveni is an
exemplary example of leadership in Africa, but that has happened
only in the past six or seven years. The response to AIDS in Uganda
did not start six or seven years ago. An organisation which many
of you have heard of, TASO, was at the forefront of the response
to AIDS in Uganda. The story of TASO says a lot. Noreine Kaleeba
was here with her husband who was a student; her husband fell
ill and the Terence Higgins Trust provided him with "buddy"
services. He passed away and Noreine learned about volunteers
and "buddying" from being served from a London-based
AIDS voluntary organisation. She went home to Uganda and tried
to replicate that model. TASO has changed in many positive ways
over the years. I shall not go into that at length. The fact that
there were activists who got together and started doing something
to raise the profile of AIDS in Uganda helped to catalyse and
make it possible for President Museveni to come out and speak
so forcefully.
158. When you talk about effectively preventing
transmission, are you really talking about changing behaviour
patterns?
(Mr O'Malley) Absolutely. It is demand and supply.
The supply matters: that is the supply of the condoms, the supply
of the sexually transmitted disease services and the supply of
care. All of the supply in the world will not help if people do
not demand condoms, if people's individual community norms do
not change, either to having sex later in life—that is particularly
important for teenage girls—to starting to use condoms or
sticking to one mutually faithful partner. If that demand is not
there, the services will not help. My argument is that advertising
alone helps—it is important—but advertising alone
will not create that demand. It is a process in which people feel
that AIDS is part of their lives and that it is connected to other
issues that they care about. There is a whole variety of activities
in which communities start to feel that sense of control that
Alan talked about; that sense not only that AIDS is real but that
there is something that they can do about it. If one does not
have that sense of hope and that sense of there being something
that one can do about it, nothing else will help.
159. Apart from Uganda and TASO, what empirical
evidence is there that such interventions make a significant difference?
(Mr O'Malley) There is a huge problem with empirical
evidence about any intervention in response to the epidemic. In
terms of broad, national level or significant sub-national changes
of behaviour, we can look at the package of conditions and interventions,
but it is difficult to associate a particular intervention with
the change. The evidence that exists is intuitive and that is
where you see epidemics being turned around or averted, there
is a package of conditions that always includes community action
on AIDS. Where you do not see community action AIDS, even where
there has been quite considerable investment in other activities,
you do not see that turn around. If you look back to 1986, 1987
and 1988 and look to see where the first community responses to
AIDS were happening in developing countries—I think I mentioned
this at South Africa House—you will see that the community
action on AIDS started in places like Uganda, Senegal, the Philippines
and Thailand. Until very recently, South Africa had a remarkable
absence, not just of government action, but of community action
on AIDS. The people of South Africa, quite rightly, were wrapped
up in battling against apartheid and rebuilding their society
and AIDS was not even on the agenda. There is not empirical evidence,
but there is a strong association.
Chairman: I turn to Tony Worthington
to continue the questioning on stigma.
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