Select Committee on International Development Minutes of Evidence

Examination of Witness (Questions 156 - 159)




  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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Prepared 29 March 2001