Examination of Witnesses (Questions 540
- 559)
TUESDAY 25 JULY 2000
RT HON
CLARE SHORT,
MR DAVID
CLARKE, DR
JULIAN LOB-LEVYT
AND MR
BOB GROSE
Mr Robathan
540. I will move on from that. I think I have
made my point. The second point is a very important one about
the Communique« from Okinawa. Something we have been discussing
the whole time is about how AIDS is a developmental issue, I think
the biggest developmental issue facing certainly sub-Saharan Africa
and possibly the world. It is not just a health issue, and I find
it distressing that in the Okinawa Communique« AIDS comes
under health. Would you like to comment on that?
(Clare Short) I agree with your preliminary remarks.
Most people are drawn to it first and see it as health, but if
you only see it as health we will not be as effective as we should
be in prevention. I have just been to Russia a couple of weeks
ago. There is a massive spread in the use of drugs amongst young
people, sharing needles, and serious HIV spread. The actions that
need to be taken are not just in the health sector to deal with
that, so you are right but I think the whole world has had a mind
lag here. It first presents itself as a health problem, so people
think health, but if you confine yourself to interventions in
the health sector you are not acting as powerfully as you should
to prevent and indeed to try to attend to the economic consequences
in terms of family poverty and so on that flow from people dying.
541. I think to stay in order with the Chair
I had better move on to the particular questions I was asked to
ask which relate to the expenditure of your Department, and this
ties very much in with the statement yesterday when we wanted
to know what the specific details of expenditure related to HIV/AIDS
were. Both Ronnie Campbell and Harry Cohen asked that question.
How would you define HIV/AIDS-related expenditure because, as
we have said, it is not just health, and to what extent should
donors simply increase sectoral programmes in response to HIV/AIDS,
and to what extent should they establish AIDS-specific programmes
both in prevention and impact mitigation?
(Clare Short) We were asked to prepare these figures.
Our spend has increased from £15 million in 1992-1993 to
£55 million in 1999-2000 and this includes sexual and reproductive
health and non-health activities in which HIV/AIDS is flagged
as a significant element, for example, in education and prevention
and so on. But the implication of your question is absolutely
right. The more we mainstream our efforts the less we will be
able to measure separately because it will be mainstreamed right
through our programme. It is like gender. If you have separate
money for spending on women's equality you can measure it, but
if you do the better work of taking that perspective right through
all your programmes, measuring your exact spend and disentangling
the bit that is relevant to HIV/AIDS as opposed to more broadly
education or improving primary health care, it becomes difficult.
I will ask, is it Bob who should come in on this? We have quite
a sophisticated way of trying to mark and track the way our spend
goes. The more we do good work and mainstream it, the less easy
it is going to be to just have separate crude figures for spending
on HIV/AIDS, you are absolutely right. Bob?
(Mr Grose) Coming back to your two questions, if I
have understood them correctly. How much should there be sectoral
spending and how much should there be HIV specific spending? I
think there needs to be both.
542. A politician's answer.
(Mr Grose) As we mainstream more then people who control
budgets for education or rural livelihood protection or transport
or a whole range of things will be spending money on HIV. That
goes back to what the Secretary of State was saying about the
difficulty of identifying that always as HIV money. At the same
time we do need to be spending money on HIV prevention, that is
the first priority, and increasingly on aspects of care. That
will be easily identifiable as HIV specific money. Having said
that, some of the money that goes into care, in fact, will go
into health sector or health service strengthening and then that
becomes difficult to identify necessarily as HIV specific. Even
some of the money that goes into improving people's access to
care when they become ill from HIV would not necessarily be identifiable
as HIV specific. That is why the answer is both.
(Clare Short) If you take reproductive health care,
which is one of our objectives anyway, and earlier treatment of
sexually transmitted diseases, that is important in its own right
but also massively slows the spread. If the Committee comes back
to this, we will just be very straight with you about our spending
and how we are tracking it. I do want to flag the fact that the
more we mainstream, the more difficult it is going to be to just
very accurately, separately, account for just HIV/AIDS spending.
Chairman
543. Can I intervene here because the evidence
taken by the Committee from the Department when Dr Lob-Levyt was
with us giving evidence, which was only less than two months ago,
the figure given to us was that we would be spending £20
to 30 million over the next three years per annum.
(Clare Short) Is that commitment or spend?
544. £100 million in total over three years
was the evidence given to us. Your figure today suggests £50
million I think.
(Clare Short) 55 in 1999-2000.
545. Yes.
(Clare Short) I will bring Julian in, and I know they
have been doing work on this, but we have always got commitment
figures and spend figures. They are always different.
546. I do not want to quibble about the figures
too much because, as you have just described, you can ascribe
parts of all sorts of programmes, quite rightly, to this. I am
not saying you are fiddling the figures but it is difficult to
know what to include, what not to and so on. What we are trying
to get at as a Committee is basically the question that this figure
of spend is actually far too low. We were surprised how low it
was. We wondered whether you would share our surprise at this
figure and whether you have plans to increase it?
(Clare Short) No. As I said earlier, our problem has
been willing governments, not our willingness to spend.
547. Right.
(Clare Short) We have been pushing and trying wherever
we are strong, wherever we could get in, to run programmes and
do the best.
548. Yes.
(Clare Short) Where governments will not move, to
be able to get to scale is then very difficult. You can fund the
odd little NGO and that is better than nothing but it is not the
kind of care. Can I ask Julian to clarify.
549. If you want to clarify the figures, I think
we should just leave that because you said in fact you were in
the process of refining them yourselves. If you could write to
us about the way in which you have made them up and what they
currently are so we can be absolutely accurate as to what your
evidence is.
(Clare Short) We are not trying to obfuscate or hide
in any way.
550. No, no.
(Clare Short) It is this problem of how do you count
good programmes for treatment of sexually transmitted diseases,
etc., and the availability of condoms. We subsidise a lot of condoms
that go to Africa and so on. We were doing reproductive health
care work anyway. It is all those kinds of questions.
551. I think the Committee very well understands
the difficulty. It is a matter of technically getting down to
how you made up the figures and what they are. If that could be
given to us in written form I think that is the best thing to
do.[1]
(Clare Short) Okay.
Mr Rowe
552. A supplementary to that. For example—and
one or two of our witnesses have told us how important this would
be—if DFID decided that one of the most useful things it
could do would be to enhance the income of families caring for
AIDS victims, quite apart from anything else to stop the children
being taken out of school in order to earn money, for example,
would that be HIV/AIDS expenditure in your budget again?
(Clare Short) We are doing more and more
on the livelihood enhancements. With the rural poor, who are still
the poorest of the world, not so much doing a maize programme
or a fishing programme but trying to build around people's lives
because rural people tend to do a bit of this and a bit of that.
They might have a market stall and do a bit of fishing and the
women folk might make clothing and so on. We have been trying
to do more and more of that rural livelihood, building up the
income levels of poor families. In families afflicted by people
dying or being sick that is highly relevant but it is not just
an HIV programme. As I understand we have this prism marker system
in the Department, how we measure, and we would make a judgment
attributing if we do a new livelihoods programme in, say, Zambia,
we would make a judgment about how much of that is helping families
affected by HIV and mark it in our statistical system. That is
the best we can do. In the end you cannot totally disentangle
because you want to help families whether they have HIV/AIDS or
not. That is how we do it, we could explain it more fully in this
letter.
Chairman: Yes, we do know about prisms
but that is an important point.
Mr Robathan
553. Could you explain to the Committee how
the money you are spending this year on HIV/AIDS is broken down
both regionally and in terms of type of activity? For instance,
is it still overwhelmingly devoted to prevention?
(Clare Short) I think the answer is yes but I cannot
really answer that.
(Mr Grose) The answer is that the overwhelming amount
is still for prevention.
(Clare Short) As I say, I do not apologise for that.
We must do more about care. Prevention is still the big thing
to pursue.
554. Regionally?
(Mr Grose) We would have to come back to you on that.[2]
Chairman: If we can get that in a statistical
answer. Tony Worthington, could you continue on this.
Mr Worthington
555. Can you talk to us a little bit about,
I suppose, ideal projects or activities over the next few years?
What is it that you are looking for? What is an ideal focus of
concern and activity?
(Clare Short) I think an ideal is that countries have
explicit and clear strategies and that the international community
is collaborating behind that, so the prevention, education, supplies,
treatment of sexually transmitted diseases, support for orphans.
The number of orphans and the lives they are leading is a real
worry, coherently so. The ideal is not separate, fine UK programmes,
it is countries leading and us collaborating. That is where we
want to be.
556. What are the characteristics of the good
prevention programme?
(Mr Grose) The first thing I would say is that they
must be targeted on people who have the highest levels of risk
of either transmitting or acquiring HIV infection. How you define
those groups varies hugely from country to country and within
countries. The group that is most often cited is commercial sex
workers and their clients. Now, in some countries you might find
that there are groups of males who have sex with males, all have
to be reached and take part. In some countries you might find
there are injecting drug users who also need to be reached and
take part in programmes. In general even where there are very
high levels of prevalence, as in some of the African countries,
targeting is still important, it is just that the target is much
bigger. It is particularly important in those countries to be
working with young people and enabling young people to reduce
the risks they take. Young people are important in all the countries
but they are particularly important in countries with high levels
of prevalence.
557. Can I tell you an impression I have. The
Secretary of State was talking about a mind lag we have had in
this area with regard to NGOs. I have the impression that the
NGOs have had a mind lag on AIDS related initiatives in that you
have on the one hand the very big Oxfams, Save the Children and
so on, and then you have specialist reproductive health NGOs,
such as Marie Stopes, Population Concern, and that neither have
really adjusted to the AIDS environment in terms of their project.
Would you feel that was true?
(Dr Lob-Levyt) I would say that many NGOs have contributed
substantially on the advocacy side, championing the rights of
women in particular, which has been very important, and have contributed
some important projects. I think what is more important is to
scale up this kind of intervention, to have the governments in
the lead and for NGOs to work to support those governments and
to move governments into the mindset of thinking where they should
take ownership/leadership and drive the partnerships which are
going to make a difference. I think moving away from small NGO
projects with limited impact and scaling up rapidly, that is where
the NGO should be thinking to facilitate that process.
(Clare Short) That is a real challenge to their way
of working. This opportunistic, getting in, helping early stages,
challenging people to face up to it is a very good act and then
when we move to the next stage that is the challenge to ways of
working and thinking.
(Mr Grose) If I could add that also I think NGOs are
facing the same kinds of challenges as the larger agencies, and
that is a shift from HIV as mainly health problems to HIV impact,
and that is a major development problem. They need to face the
challenge, as we all are, of making sure they are building the
response to HIV impact.
Chairman
558. Are there examples, other than Uganda,
of countries scaling up their programmes in HIV/AIDS?
(Clare Short) Thailand, where its commercial sex workers
went for a major push on condom use successfully. Senegal is the
other country that I know a lot about which went for public education
and has not seen the growth of prevalence.
559. Outside Uganda, Thailand and Senegal, are
there any new ones?
(Clare Short) Zambia?
(Dr Lob-Levyt) Yes, we are beginning to see the same
kind of increased political commitment and increased spending
in Zambia and also in Tanzania.
(Mr Grose) Brazil.
1 See Evidence p 265. Back
2
Ibid. Back
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