HIV/AIDS, conflict and security
118. As we stated earlier, there is good reason to
believe that one significant contributor to the spread of HIV/AIDS
is conflict. It is no coincidence that sub-Saharan Africa, disproportionately
plagued by conflict in recent decades, is also terribly afflicted
by HIV/AIDS. Speaking of Africa, Jacques du Guerny said, "It
is certain that various conflicts, which are there, are creating
the conditions for future epidemics ... One can see this in a
country like Rwanda or Ethiopia. We are now seeing increases in
the level of AIDS".
The reasons are clear. Families divided by war; the vulnerability
of civilian populations and refugees; the impoverishment of conflict
and the pressure for some to engage in sex work to make ends meet;
the prevalence of rape; the instability and uncertainty leading
to behaviour changes as past certainties no longer appear to apply.
119. But does it also work the other way round? A
report produced by the National Intelligence Council of the United
States entitled 'The Global Infectious Disease Threat and Its
Implications for the United States' predicts, amongst other things,
"- The infectious disease
burden will weaken the military capabilities of some countries
as well as international peacekeeping efforts as their
armies and recruitment pools experience HIV infection rates ranging
from 10 to 60 per cent. The cost will be highest among officers
and the more modernized militaries in sub-Saharan Africa and increasingly
among [former Soviet Union] states and possibly some rogue states.
- Infectious diseases are likely to slow socioeconomic
development in the hardest-hit developing and former communist
countries and regions. This will challenge democratic development
and transitions and possibly contribute to humanitarian emergencies
and civil countries."
120. Professor Alan Whiteside warned of "Potential
instability as middle ranking army officers, police and the security
forces face increased illness and death. Social instability if
there is not clear political leadership. Evidence suggests that
in societies facing economic crisis and lack of clear political
leadership the presence of AIDS with its associated stigma may
cause instability. The citizens are aware of the increase in illness
and death, the stigma associated with it; and the lack of leadership
leads to blame and anomie in society".
Mark Stirling from UNICEF cited the estimate that 50 per cent
of today's 15-year olds in Maputo, Mozambique, would be dead because
of AIDS by the time they were 45 and questioned, given that statistic,
whether "the leadership and economic progress, the security
and stability" of Mozambique could be maintained.
Dr Peter Piot also saw HIV/AIDS as a question of national security,
and indeed the very continuity of the nation, for many of these
121. It is obviously more difficult to demonstrate
clear causal links between HIV/AIDS on the one hand and greater
conflict and insecurity on the other. Our previous Report, however,
on Conflict Prevention and Post-Conflict Reconstruction identified
poverty as a major cause of conflict.
There is thus a prima facie argument, given all the evidence
we have received that HIV/AIDS increases poverty, that there
will be greater social insecurity and possibly conflict as a result
of the HIV/AIDS epidemic.
122. There are obviously implications for UNHCR and
refugee policy, for the deployment of peacekeeping forces, to
give just two examples, in the close linkage between conflict
and HIV/AIDS. There are also implications for those who think
strategically about sub-Saharan Africa. Moreover, anyone tracking
the epidemic in the region and concerned as to its spread can
only be horrified at current events in the Democratic Republic
of Congo, involving not only that country but nearly all its neighbours.
There can be no doubt that that conflict is going to have a drastic
and terrible effect on the prevalence of HIV/AIDS in central Africa.
We request information from DFID and UNAIDS as to what representations
have been made to all governments involved in the DRC conflict
on the spread of HIV/AIDS amongst soldiers, refugees and civilian
populations. We also wish to know what surveys of HIV/AIDS incidence
have taken place in the region affected by the conflict. The area
is obviously vast, difficult and extremely dangerous. But thought
must be given, even in such circumstances, as to how the donors
and NGOs can intervene and assist to limit the spread of HIV/AIDS.
123. In our Report on Conflict Prevention and Post-Conflict
Reconstruction we also welcomed work by DFID, the FCO and MoD
in security sector reform.
Discussion between the departments on security sector reform issues
takes place in the forum of the Whitehall Conflict Network. We
recommend that DFID, the FCO and MoD discuss the implications
of HIV/AIDS for their security sector reform activity. We would
expect any such discussion to include consideration of how to
establish good morale in forces with high HIV/AIDS prevalence;
the need for training in the rights and proper treatment of civilians,
and of women in particular; HIV/AIDS prevention in the armed and
security services, both in terms of sexual behaviour and also
other risky contacts such as open wounds; the training and 'skilling'
of personnel given the likelihood of high mortality and morbidity
The Impact of HIV/AIDS
124. We have looked at the impact of HIV/AIDS across
a number of sectors. There are other aspects to the impact of
the disease which we simply do not have space to go into. But
the main thrust of our findings has emerged clearly. HIV/AIDS
will further and profoundly impoverish those who are already poor.
In those countries, particularly in sub-Saharan Africa, with high
prevalence rates, its effect could well be to reverse past development
gains and destroy state, social and household systems which have
previously been extremely resilient to shocks. This means that
development may well have to be done in a different way. Donors
are now generally aware that HIV/AIDS is not merely a medical
problem but a developmental one and by this they mean
it is having a pervasive and destructive effect on the poor, thus
making its prevention one of the main developmental challenges.
What is still lacking amongst donors is a real and determined
attempt to examine how HIV/AIDS affects all aspects of development
activity. Support for education, the private sector, agriculture
extension and rural livelihoods, developing country government
departments, to give just a few examples, must not only be increased
but, more importantly, redesigned. We have on a number of occasions
in this Report commented on DFID publications which ignore the
impact of HIV/AIDS and how the epidemic should change the way
development is done. We single out DFID because it is the donor
we have a responsibility to scrutinise. But this failure is a
general one, and certainly not confined to DFID.
125. We have been impressed in this Parliament by
the role DFID has played internationally as an advocate for the
international development targets and for a development strategy
genuinely committed to the elimination of poverty. Does DFID have
a similar advocacy role with regard to HIV/AIDS? Evidence from
the Secretary of State at the conclusion of our inquiry gave no
hint that she saw DFID in such a role. She began her comments
by stating "that we at our very best are only part of an
international system. Sometimes when people get emotional about
things like AIDS they say, 'What is the United Kingdom do more?'
as though we can do it, and we cannot. We are not the whole of
the international system. We do not operate everywhere. We can
try to be a leading force both in influencing the international
system to operate better and to do good work from which we learn
and which drives forward our understanding of what can be done.
But sometimes the discussion is as though a Government like ours
can lead the whole world effort, and of course we cannot".
126. Clare Short's warning is true and important.
DFID is only one player in what must be an international and coordinated
effort, headed by the national governments of those countries
most severely affected by HIV/AIDS. We will return later in this
Report to the responsibilities of the various actors in combatting
the epidemic. However, we do believe that one aspect of an
effective HIV/AIDS strategy for DFID must be an identification
of its 'added value' on the international stage. We have no doubt
that one great asset of DFID is its intellectual capital and expertise.
It is in our view particularly well placed to do the sort of rethinking
and redesign necessary to ensure development programmes regain
their relevance and effectiveness in countries with severe HIV/AIDS
127. Mainstreaming HIV/AIDS is a two-way process.
It means ensuring that all aspects both of development policy,
and of government policy more generally, conspire to reduce the
incidence of HIV/AIDS and reduce its impact. But it also means
ensuring that HIV/AIDS is taken into account when working out
development policies which are genuinely going to tackle and reduce
poverty. We recommend that DFID conduct an audit of all aspects
of its development programmes, particularly as they are applied
in sub-Saharan Africa, to ascertain the extent to which they are
prepared to withstand current and likely future impacts of HIV/AIDS.
We also recommend that where they are found wanting, DFID should
research how best to redesign programmes, sharing conclusions
with other donors and developing country representatives.
128. Reducing the impact of HIV/AIDS through appropriate
development is, we must remember, itself a preventive measure
of fundamental importance. In the successful reduction of poverty
we target that environment in which HIV/AIDS thrives and devastates.
Conversely, if we do not act to reduce the impact of HIV/AIDS
we entrench further that poverty which fosters the epidemic and
we allow a vicious circle of poverty and infection to develop.
151 Q.124 Back
UNAIDS June 2000 Report pp.31-32 Back
UNAIDS June 2000 Report p.31 Back
UNAIDS June 2000 Report p.31 Back
DFID 'Better Health for Poor People' para.2.1.6 Back
challenge of universal primary education'75 Back
Evidence, p.268 Back
Global Infectious Disease Threat and Its Implications for the
United States' January 2000 Back
Evidence, p.75 Back
Sixth Report from the International Development Committee, Session
1998-99, Conflict Prevention and Post-Conflict reconstruction,
HC 55, paras.17-19 Back
Sixth Report from the International Development Committee, Session
1998-99, Conflict Prevention and Post-Conflict Reconstruction,
HC 55, pars.75-78 Back