SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS
THE NATURE OF THE EPIDEMIC
1. In 1999, 2.7 million people worldwide died
with AIDS. More than three times the combined deaths from war,
murder and violence. The catastrophe of HIV/AIDS must be the priority
for action by the international community (paragraph 1).
HIV/AIDS — a medical account
2. We must state unequivocally at the outset of
this Report that AIDS is caused by HIV infection (paragraph 6).
3. HIV/AIDS is currently the greatest humanitarian
crisis facing our planet. That is why we need to act. Added to
that, in a world ever more interdependent, the implications of
the pandemic and its appalling statistics in the South for the
health, economies and security of the North are most serious (paragraph
7).
HIV/AIDS — a disease of poverty
4. HIV/AIDS is not just about health. It is also
about wealth (paragraph 12).
HIV/AIDS is exacerbated by poor health systems
5. Recent work by the European Commission and
the G7 have linked HIV/AIDS with TB and Malaria in a single communicable
disease strategy. This is commendable and necessary. All these
diseases are diseases of poverty. The relief of poverty and the
provision of health care for the poor will have a fundamental
impact on all three diseases (paragraph 20).
HIV/AIDS is exacerbated by the denial of human
rights
6. We are convinced that an essential part of
any effort to tackle HIV/AIDS must be the ending of gender-based
discrimination and violence, the promotion of women's rights and
development, and the protection of the rights of widows and of
children, girls in particular (paragraph 26).
To fight HIV/AIDS it is essential to fight poverty
and promote human rights
7. The fight against HIV/AIDS can only be won
through progress in the elimination of poverty. It is poverty
which spreads HIV, with all its terrible consequences, and it
is only the reduction of poverty which constitutes a sustainable
basis for the control of the disease (paragraph 28).
8. We consider the declining amounts given in
official development assistance to be a worrying indication of
a failure of will by the international community to eliminate
poverty. This decline must be reversed immediately ... Increasing
amounts spent on HIV/AIDS will be limited in their effect if poverty
itself is allowed to continue and deepen (paragraph 29).
Why consider HIV/AIDS separately?
9. We consider that a distinct HIV/AIDS strategy
is essential for all donors of official development assistance
and for all countries affected by the epidemic (paragraph 37).
Two crises, not one
10. The levels of HIV infection are so high in
many sub-Saharan African countries that there is a real danger
of the collapse of systems and infrastructures, the erosion of
the state, and the reversal of all recent gains made in development.
Such deterioration would make effective action against the epidemic
almost impossible. We do not believe that the international community
has as yet fully grasped the scale and seriousness of this African
HIV/AIDS crisis, nor that they are agreed on how to address it
(paragraph 38).
The Impact of HIV/AIDS on the International Development
Targets
11. The region most severely affected by HIV/AIDS,
sub-Saharan Africa, is both the poorest (in terms of the proportion
of those living in poverty) and also the region making least developmental
progress (paragraph 43).
12. The infant mortality target is particularly
affected by HIV/AIDS. By 2005-2010 infant mortality in South Africa
will be 60 per cent higher than it would have been without HIV/AIDS.
In Zambia and Zimbabwe 25 per cent more infants are already dying
than would be the case without HIV/AIDS. By 2010 infant and child
mortality rates in these two countries will have doubled (paragraph
44).
13. It is important to bear in mind that a large
proportion of the world's poor live in two countries, India and
China. Neither is as yet as severely affected by the HIV/AIDS
epidemic as sub-Saharan Africa. Thus there is greater room for
progress against the IDTs. If these two countries succeed in making
significant inroads into poverty the global figures for the IDTs
will look healthy, obscuring the fact that at a regional and country
level the epidemic is condemning a continent to remain in extreme
poverty, if not decline even further (paragraph 46).
14. It is clear that the HIV/AIDS epidemic has
made the international development targets impossible to achieve
in those countries where it has taken hold, and that past developmental
achievements have been reversed. Any responsible development policy
must take account of HIV/AIDS in every aspect of its approach
(paragraph 48).
15. HIV/AIDS has made many of the international
development targets irrelevant to sub-Saharan Africa. The targets
were agreed before the full extent of the epidemic was known.
This fact needs to be acknowledged by the international community
and seriously addressed. We recommend that the Special Session
of the UN General Assembly on HIV/AIDS, to take place in June
this year, consider how to reinvigorate efforts in sub-Saharan
Africa to meet the international development targets, assessing
current prospects in the region and what progress can be made,
perhaps setting additional regional targets (paragraph 50).
HIV/AIDS, the economy and the private sector
16. We are sure that many large, multinational
companies have yet to assess the likely impact of HIV/AIDS on
their activities, are missing vital opportunities to reduce HIV/AIDS
incidence, and are thus going to see their productivity and profitability
seriously impaired (paragraph 58).
Business and the private sector
17. The impact of HIV/AIDS on small and medium-sized
enterprises, particularly in sub-Saharan Africa, must be addressed
as a priority. We expect development programmes to be reconsidering
such issues as the provision of credit and management of debt,
linkages with larger businesses, employment and training practices
in the light of the illness and absences which HIV/AIDS produces
at work (paragraph 59).
18. We consider that multinational companies have
an obligation to assist, both directly and through Business Councils,
small and medium-sized enterprises in countries affected by HIV/AIDS.
This should include the sharing of best practice and perhaps of
certain courses and facilities. It is also necessary for national
governments and donors to have a strategy as to how to support
the informal sector and SMEs through the HIV/AIDS epidemic
(paragraph 60).
19. We believe that serious international consideration
must be given as to how to respond to the growing skills shortage
in countries with high HIV/AIDS prevalence. We believe systems
need to be put in place both to ensure that such skills can be
brought in readily but also that such interventions are considered
temporary and accompanied by greater investment in the education
and training of local people (paragraph 3).
20. We do not as yet see much evidence of a diversion
or reduction of investment flows as a result of HIV/AIDS. We fear,
however, this is not a product of reflection by the financial
and business community, but rather a failure to reflect. Impacts
will of course vary according to the nature of the industry. Those
highly dependent on local raw materials will no doubt continue
where they are and cope in other ways. The concern is over the
impact of a shortage of skilled labour on any attempt by countries
in sub-Saharan Africa to enhance their productive capacity and
develop their industrial base (paragraph 4).
21. More investment in sub-Saharan Africa is desperately
needed. We must emphasise that such investment can take place
successfully and profitably, even with an HIV/AIDS epidemic. What
is needed is an intelligent assessment by business of the environment
and investment to be accompanied by effective prevention and care
programmes in the workplace (paragraph 5).
Macroeconomic impact
22. We recommend that the World Bank, the IMF
and other donors commission further research into the macroeconomic
impact of HIV/AIDS so as to establish a consensus as to impact
which can then be applied to particular countries (paragraph 1).
23. Structural adjustment policies, and in particular
the World Bank and the IMF requirements for public sector and
macroeconomic reforms, cannot continue unaffected by the impact
of HIV/AIDS. We recommend that the Government request the World
Bank and IMF to provide information on how they are changing their
approach to civil service reform and macreconomic policy in response
to HIV/AIDS (paragraph 73).
24. We recommend that in new and revised country
strategy papers DFID include comment on how HIV/AIDS is expected
to affect future economic performance, explaining how both the
country's economic strategy and DFID's approach are taking such
economic impacts into account (paragraph 4).
HIV/AIDS and Agriculture
25. We recommend that UNAIDS coordinate surveys
of HIV incidence and prevalence in rural areas to improve understanding
of the rural aspects of the epidemic (paragraph 82).
26. We recommend that DFID comment on the claim
that HIV/AIDS interventions have been too urban-based to date
and give details of those rural and agricultural projects currently
supported by DFID which have the tackling of HIV/AIDS as a primary
component (paragraph 83).
27. We recommend that MAFF advocate a clear mandate
for the FAO in combatting HIV/AIDS and assist the FAO in consideration
of how best to support Ministries of Agriculture faced with high
HIV/AIDS prevalence (paragraph 85).
28. We would also bring a number of other matters
to the attention of DFID, recommending their inclusion in DFID's
HIV/AIDS strategy and their promotion in dealings with other donors
and national governments:
- education policies should be reviewed to provide
rural children at a younger age with marketable skills, agricultural
knowledge, survival and income-generating skills for city life
- human resources in Ministries of Agriculture
should be reviewed urgently to minimise the impact of the loss
of skilled workers to HIV/AIDS. Adaptable civil service systems
will be necessary to adapt and shorten chains of command and technical
assistance may well be needed
- rural credit should be developed to prevent
destitution and there should be consideration of land tenure systems
- the legal and human rights of women, children
and the HIV-positive require attention and protection in rural
communities (paragraph 85).
HIV/AIDS and the elderly
29. As in many other policy areas, the needs of
the elderly with regard to HIV/AIDS have been ignored for far
too long. We recommend:
- that more research be conducted into the incidence
of HIV/AIDS amongst the over 50s
- that there be greater provision of HIV/AIDS
information and education for older people
- that there be greater provision of counselling
both for older people who are HIV-positive and for those caring
for the ill or those bereaved
- that income-generation opportunities and other
forms of economic and social support be provided for older people
affected by HIV/AIDS and those elderly involved in caring for
dependents
- that all HIV/AIDS strategies include explicit
policies and action plans to meet the needs of the elderly (paragraph
86).
30. We recommend that DFID promote such an approach
in its own HIV/AIDS strategy and internationally (paragraph 90).
HIV/AIDS, children, education and household survival
31. The strategy paper 'The challenge of universal
primary education' is an encouraging example of how DFID can design
its development approach to take account of the impact of HIV/AIDS.
Even within the last few months, there has clearly been progress
and further thought in the Department on this issue (paragraph
98).
32. We consider that all donors must agree on
an education strategy which both aims to achieve the international
development target of universal primary education by 2015 and
which also takes account of the new realities caused by HIV/AIDS.
Priorities in such a strategy must include:
- the provision of education for those unable
to attend formal schooling, in particular for those having to
work to provide for households;
- the protection of children stigmatised by
association with HIV/AIDS; and
- measures to maintain the supply of teachers,
perhaps involving the community, volunteers and the private sector,
as well as those formally trained and employed (paragraph 99).
33. Support to households caring for vulnerable
children needs to be extended and replicated on a national scale
in high-prevalence countries. This is a significant challenge,
particularly for public sectors already weakened by poverty. It
requires determined coordination amongst national governments,
donors and civil society. Consideration should be given as to
whether cash payments or other forms of support are most appropriate.
We recommend DFID in its response to this Report provide further
details of how it plans to support the identification and care
of vulnerable children in the community (paragraph 110).
HIV/AIDS and the health sector
34. We would welcome information from DFID on
how best to remedy the staffing crisis in certain developing country
health sectors. In general, we consider that 'Better Health for
Poor People' could usefully have spelled out in more detail how
health sector reform and development can be pursued in the context
of high HIV/AIDS prevalence (paragraph 114).
35. A decline in the efficiency of government
departments in countries severely affected by HIV/AIDS will have
a whole host of implications for development. Putting aside the
examples given already from agriculture, education and health,
one can think of the difficulties that might be experienced in,
say, revenue collection, the management of the country's debt,
the efficient regulation of industry, the preparation of necessary
legislation. We have noted that DFID is involved in an inter-agency
group on education matters, looking amongst other things at human
resource issues in education. Such consideration needs to be extended
so as to encompass human resource issues across the public service
(paragraph 117).
HIV/AIDS, conflict and security
36. There will be greater social insecurity and
possibly conflict as a result of the HIV/AIDS epidemic (paragraph
121).
37. 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 (paragraph 122).
38. 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
rates (paragraph 123).
The Impact of HIV/AIDS — Some Conclusions
39. 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 (paragraph
124).
40. 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
epidemics (paragraph 126).
41. 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
(paragraph 127).
42. 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
(paragraph 128).
PREVENTION AND CARE
43. We must emphasise that the fight against HIV/AIDS
is not a hopeless one. Even in the absence of a vaccine, and with
limited resources, successful prevention is possible (paragraph
135).
44. Evidence raised a number of aspects of prevention
which required support and further work. One important area is
work amongst young people both within the school curriculum and
through peer education. Many witnesses stressed the need to establish
effective primary health care, sexually transmitted disease services
and testing and counselling facilities. It is also vital at early
stages of an epidemic to take prompt action amongst high-risk
groups. We do not intend to expand on these points in this Report.
We stress that this is not because they are unimportant —
on the contrary they form the bedrock of any effective and meaningful
prevention. As such, there is already a significant amount of
literature and experience on which donors can draw. We certainly
expect DFID to be advocating and supporting such interventions
as a central part of its HIV/AIDS strategy and welcome the prevention
work DFID has engaged in to date (paragraph 136).
45. Were the sub-Saharan Africa prevalence rate
to be replicated in Asia, there would be a further 285 million
HIV-positive people in the world. The consequences for the global
economy and security, as well as the scale of the resulting humanitarian
disaster, are unimaginable. The prevention of a high-prevalence
HIV/AIDS epidemic in Asia must be a priority for the international
community (paragraph 137).
Material interventions
Male Condoms
46. We are appalled that at such late and grave
stage of the epidemic there remain condom shortages in sub-Saharan
Africa. One aspect of this shortage could well be cost. There
is also, however, a question of effective logistical planning
by government health departments. DFID has recently given £25
million to UNFPA for the purchase of condoms for developing countries.
We welcome this intervention and believe bilateral and multilateral
donors have a vital role in this area. We would also encourage
the provision of technical assistance to developing countries
in the purchase both of condoms and of drugs and other medical
supplies to ensure consistent and sustainable supply over time
(paragraph 141).
47. We recommend that DFID take colour into account
when considering the provision of condoms to the developing world
and that market testing should identify whether colour could make
any difference to the acceptability and use of condoms (paragraph
142).
Female-controlled protection
48. Alongside moves to develop other female-controlled
prevention tools such as microbicides, the female condom clearly
has an important role to play and DFID is to be congratulated
for its early support. The female condom is not invisible or inconspicuous;
women who currently find it impossible to get a male partner to
wear a condom will not be spared the need to negotiate. However,
there are situations where it will have an advantage, especially
for sex workers. We recommend that DFID continue to support the
promotion of the female condom (paragraph 147).
Microbicides
49. The Department of International Development
has previously directed some funds to research into microbicide
development. As the area has been relatively neglected internationally,
there is clearly potential for greater investment. Investment
by the UK Government would could play an important part in developing
a product with the potential to reduce dramatically incidence
of HIV infection. In its HIV/AIDS strategy, the Department for
International Development should prioritise microbicide research
alongside research for a vaccine and act as an advocate internationally
to encourage other donors to give microbicides a higher priority
(paragraph 150).
Vaccines against HIV
50. We believe that vaccine development partnerships
and investors should take steps to ensure that research prioritises
sub-types of the HIV virus found in developing and worst-affected
countries as least as highly as those more commonly found in the
developed world (paragraph 151).
51. We believe that the Department for International
Development should continue to support the search for a vaccine.
We believe that all spending on HIV prevention should be carefully
monitored to ensure that there is a balance between searching
for prevention technologies such as vaccines and microbicides
and work aiming to achieve behavioural and social change and to
promote the use of condoms. The latter will clearly remain the
only proven effective means of prevention for the foreseeable
future and therefore a careful balance of priorities needs to
be maintained so that this work does not get neglected (paragraph
153).
52. We hope that the EUROVAC programme, and other
similar initiatives, will take steps to ensure that public money
is only used to fund the development of products which will be
affordable in developing countries (paragraph 154).
53. We welcome the initiatives of the United Kingdom
Government in attempting to secure better availability of drugs
to prevent and treat HIV/AIDS, malaria and TB in the developing
world (paragraph 155).
Injecting drug use
54. We look forward to DFID making clear how it
is promoting harm reduction strategies amongst injecting drug
users. This is a sensitive area where stigma and legal sanctions
have meant it has been difficult to see progress in areas such
as safe needle exchange. Nevertheless, injecting drug use is in
a number of regions the main mode of transmission of HIV/AIDS
and an internationally agreed approach is urgently needed (paragraph
165).
Behavioural interventions
Prevention and human rights
55. To change behaviour, people need to have a
stake in their own futures. Such an outlook is difficult for the
abjectly poor. The human rights to health, to education, to food
and water are crucial to any change in behaviour to prevent HIV/AIDS.
DFID's poverty-focussed approach, which is explicitly rights-based,
is thus a vital foundation for all HIV/AIDS work (paragraph 167).
56. We would encourage DFID to include explicitly
gender rights in its HIV/AIDS programmes. Such an approach must
include the education of men in less exploitative models of masculinity,
the rights of women and children. Programmes need to educate young
women and girls in how to negotiate sexual relations and how to
be able to refuse sex with those older or more powerful than themselves.
A properly designed HIV/AIDS strategy will also prioritise the
protection of women from domestic violence and rape through community
pressure, effective policing and a gender-sensitive courts and
legal system ... We request information from DFID on how many
programmes it is funding which are explicitly designed to tackle
HIV/AIDS and which also include such 'women's rights' components
(paragraph 168).
57. A responsible HIV/AIDS strategy must counteract
stigma, acknowledge the human rights of such stigmatised groups,
provide information and access to prevention and treatment, survey
prevalence amongst such groups and adopt strategies to reduce
their vulnerability to infection (paragraph 169).
58. Those living with HIV/AIDS must enjoy the
full protection of the law, access to employment, education and
appropriate care. It is a duty of donors to advocate the rights
of those living with HIV/AIDS, monitor and support those rights,
and argue against their abuse (paragraph 170).
59. We welcome the work done by the FCO to promote
human rights in the context of HIV/AIDS and its inclusion in the
Annual Human Rights Report ... If DFID is no longer to have an
involvement in the Annual Human Rights Report we think it is still
necessary for it to report to Parliament on what it is doing to
promote human rights within its work on HIV/AIDS and we recommend
that there be a section to that effect in future Departmental
Annual Reports (paragraph 171).
Prevention and the media
60. We welcome the work done by DFID and the BBC
World Service (and the BBC World Service Trust in particular)
in promoting HIV/AIDS awareness through the media ... We believe
that the media should not simply disseminate factual information
on HIV/AIDS but also encourage community debate and engagement.
In other words, any HIV/AIDS media strategy must have a clear
human rights dimension. One component should be the encouragement
by DFID and the FCO of a plural, independent and healthy media
in developing countries. Another must be the use of the media
to generate grassroots involvement and activity in the fight against
the disease (paragraph 174).
Prevention and the workplace
61. We are convinced that the opportunities of
the workplace provide some of the most important means of prevention,
and indeed care, in the developing world (paragraph 175).
62. We wish to stress the important role that
DFID and other donors can play as catalysts to such workplace
prevention and care. This can involve initial funding of programmes
(though companies should take over beyond the experimental stage)
and the provision of technical assistance (paragraph 177).
63. DFID should also be involved in advocacy of
workplace interventions ... We recommend that DFID engage in discussions
with British industry, in particular such bodies as Chambers of
Commerce and the Confederation of British Industry, to promote
the importance of HIV/AIDS prevention and care when operating
in developing countries with high HIV/AIDS prevalence (paragraph
178).
64. We recommend that ECGD only support projects
where consideration has been given to the vulnerability of the
workforce to HIV/AIDS and what can be done to prevent infection
... Ethical Trading Initiative members should take HIV/AIDS
into account when vetting overseas suppliers ... We also recommend
that DTI in promoting investment and trading opportunities overseas
discuss HIV/AIDS, making clear that it does not preclude profitability
but that it is vital to take the epidemic into account in workplace
policies, including prevention, care and employment rights (paragraph
179).
Priorities for treatment and care
65. All HIV/AIDS strategies must include an emphasis
on the care of HIV-infected persons. This is not only a humanitarian
imperative but also an indispensable component in any effective
reduction in infection rates. We welcome the recent acceptance
by DFID of the need to put more resources into care (paragraph
181).
66. The Committee agrees that basic healthcare
is a necessary pre-requisite for the medical care and treatment
of people with HIV. DFID's identification of this as a priority
is clearly appropriate. Primary healthcare for all would immediately
markedly and improve the health of people living with HIV through
access to basic palliative and other essential medicines, effective
treatment of tuberculosis and STDs, and would offer the potential
for expanding access to drugs to treat common opportunistic infections
(paragraph 185).
67. We strongly endorse the approach of UNAIDS
in producing a clear set of priorities to inform multilateral
agencies, bilateral donors and governments of developing countries.
We believe that this model should determine the priorities of
DFID and other agencies and that action should concentrate first
on provision of essential care interventions before consideration
of access to anti-retroviral drugs (paragraph 186).
Community involvement
68. It is hoped that DFID considers the way in
which people living with HIV have been involved in the planning
and consultation of programmes, and the ways in which they will
be involved in overseeing the delivery and monitoring of all programmes
it is funding. This principle needs to be constantly re-affirmed
and would go a long way to change the invisibility of people with
HIV in developing countries, to challenge the silence and stigma
attached to HIV infection and to affirm a rights-based approach
that does not simply consider people with HIV to be passive recipients
of care (paragraph 188).
Access to anti-retroviral drugs
69. The provision of anti-retroviral treatments
to people with HIV in the poorest developing world is clearly
not a practical or sustainable development intervention. Donor
funds and activities should concentrate on prevention of further
infections, development of basic healthcare systems, provision
of palliative drugs and basic treatments of opportunistic infections
(paragraph 192).
70. In its Globalisation White Paper, DFID announced
that it will set up a Commission on Intellectual Property Rights
to look at how rules can be designed to benefit developing countries
and in particular access to generic resources. We welcome this
important step in the consideration of how both to ensure appropriate
respect for patents and the encouragement of further research
and development, whilst also aiming to maximise the access of
the developing world to affordable drugs. It has been striking
how the pharmaceutical companies, faced with mounting discontent
at their pricing policies in poorer countries, have begun at last
to offer significantly discounted prices for their products. Preferential
pricing agreements, particularly for drugs to treat opportunistic
infections, need to be agreed and implemented without delay. We
criticise the slow progress being made under the Accelerated Access
Initiative (paragraph 197).
71. The provisions of TRIPs under which a country
can use parallel importing or compulsory licensing in a national
emergency were put in for a purpose. Progress in agreeing concessional
prices with the pharmaceutical companies is to be encouraged.
This should not be at the expense of developing countries also
pursuing alternative solutions permissible under WTO rules. We
do not believe the United Kingdom Government, the European Union
or any other developed country should put pressure on developing
countries not to make use of available TRIPs provisions. Technical
assistance should rather be given both to identify what can be
done within the WTO agreement, how affordable any cheaper drugs
are to the health department budget, and whether they will genuinely
reach the poor, rather than an elite (paragraph 198).
RESPONSES AND RESPONSIBILITIES
Some thoughts on funding
72. We request assurance from DFID that sexual
and reproductive health expenditure is only accounted for as an
aspect of HIV/AIDS spending when HIV/AIDS is explicitly and specifically
addressed in the programme design (paragraph 204).
73. We recommend that UNAIDS and donors reach
agreement as soon as possible on how to calculate levels of expenditure
on HIV/AIDS. We would expect such an agreed basis for calculation
to specify, on the basis of research, the conditions necessary
for mainstreamed interventions to have a real impact on HIV/AIDS
(paragraph 210).
74. The figures both on the decline in ODA overall
to sub-Saharan Africa and of spending per HIV-positive person
make appalling reading. We seem as far away as ever from the UN
target of 0.7 per cent of donor countries' GNP being spent on
development assistance. And we must add that the 0.7 per cent
target was agreed to in an AIDS-free world. We share the Secretary
of State's cynicism over headline-grabbing announcements of cash.
But this fact at least is clear — not enough money is actually
being spent in the response to HIV/AIDS. It is often difficult
to spend wisely and effectively, that is true. Donors must as
a matter of urgency devise ways of spending significant sums in
less than perfect environments, at the same time strengthening
national governments' policy frameworks. We believe this should
be a priority for the International Partnership Against AIDS in
Africa (paragraph 214).
75. We welcome the introduction of Poverty Reduction
Strategy Papers and in particular the insistence that HIV/AIDS
is included in the strategies of all countries affected by the
epidemic. The PRSP process requires adequate consultation with
civil society...Every PRSP should have been preceded by consultations
with community groups and NGOs working on HIV/AIDS, and, most
importantly, with people living with the disease. Any strategy,
to be acceptable, must take account of their views and include
community participation (paragraph 217).
76. We recommend that UNAIDS monitor the extent
to which debt relief results in the mobilization of resources
by national government for HIV/AIDS and reports back to the international
community (paragraph 218).
77. We would encourage the World Bank and donors
to ensure that as much as possible of the US$500 million committed
by the World Bank to HIV/AIDS in sub-Saharan Africa is in grant
rather than loan form (paragraph 223).
78. We are concerned that funding of HIV/AIDS
is done responsibly and recommend that UNAIDS be closely involved
in the provision of technical advice to the World Bank in its
funding decisions (paragraph 224).
79. We are concerned that certain countries are
not as yet spending enough of their own resources in the fight
against HIV/AIDS. Dependence solely on donors not only limits
the resources available but also demonstrates the lack of real
national commitment to halting the epidemic (paragraph 227).
80. We recommend that DFID inform us of how they
plan to encourage community involvement in the prevention of HIV/AIDS
and in the care of those who are HIV-positive. We are particularly
interested in how much DFID expenditure is directed at such community
activity, how long-term and sustained such expenditure is, and
what technical assistance is given to national governments in
the funding of a community response and its replication nationwide
(paragraph 228).
National Political Leadership
81. Whatever the policies on HIV/AIDS, their effectiveness
relies on the public believing and acting on safe sex messages.
Even without the sort of doubts expressed by President Mbeki,
it is difficult enough to change people's sexual behaviour. To
encourage doubts as to whether the HIV virus causes AIDS is grievously
irresponsible and can only undermine whatever good work is being
done elsewhere on HIV/AIDS (paragraph 233).
82. We would encourage the setting up of parliamentary
AIDS groups in all countries significantly affected by the epidemic
and suggest that UNAIDS and the InterParliamentary Union act together
to promote such groups. An IPU Committee on HIV/AIDS might be
usefully set up to promote the establishment of such groups as
well as support Members of Parliament who declare publicly their
HIV-positive status (paragraph 238).
83. The response to the HIV/AIDS epidemic, particularly
in sub-Saharan Africa, has been a culpable and serious failure
in political leadership and governance. At relatively low cost
there are certain basic interventions which all governments must
introduce — a sustained, comprehensive and effective information
campaign on HIV/AIDS; ensuring the widespread availability of
condoms; National AIDS Commissions located in the office of the
head of state with independent budgets and real authority in their
relations with government departments; the reorientation of the
current health budget to take account of the epidemic. But they
have all too rarely occurred. Donors should consider carefully,
and target effectively, before providing funds to any government
which has not attempted these basic interventions (paragraph 239).
The European Community
84. We recommend that the EC consider increasing
the number of HIV/AIDS experts in Brussels, and in particular
that certain officials be charged with examining the HIV/AIDS
sensitivity of all EC policies relating to the developing world.
There must also, on the lines recommended earlier in this Report,
be an audit of how development planning and implementation in-country
is taking account of the new realities arising from the HIV/AIDS
epidemic (we were disappointed to hear of neglect of the toolkit
devised by Professor Alan Whiteside). We also request information
from DFID on how the EC is coordinating its HIV/AIDS strategy
and activities with those of member states, and other multilateral
donors (paragraph 245).
The United Nations
85. We welcome the work of UNAIDS and consider
it to be making an impressive contribution to the fight against
HIV/AIDS. We trust that its work will at no point be constrained
by under-resourcing. We remain concerned that there is still some
way to go in coordination amongst UN bodies on HIV/AIDS and believe
UNAIDS should be prepared to be publicly forthright on problems
and failures, if necessary shaming organisations into improvement
(paragraph 248).
86. We recommend that the forthcoming Special
Session of the UN General Assembly specify the action necessary
to meet the HIV/AIDS international development target. We were
pleased to learn that UNAIDS is preparing a Global Strategy for
the fight against HIV/AIDS. We look forward to its publication
and hope it will address the main conclusions and recommendations
of this Report (paragraph 249).
Regional and Multilateral Organisations
87. We look forward to an analysis of HIV/AIDS
coordination to date, and recommendations for the future, to be
included in the forthcoming UNAIDS Global Strategy (paragraph
251).
88. We are pleased to see the CHOGM declaration
of 1999 where the heads of government committed themselves personally
to lead the national commitment against HIV/AIDS in their countries.
The Commonwealth Medical Association are also active in this area.
We believe the Commonwealth Parliamentary Association is also
well-placed to educate and mobilise Members of Parliament in the
support and advocacy of effective HIV/AIDS strategies and we look
forward to greater involvement by the CPA in HIV/AIDS work (paragraph
252).
The Department for International Development
89. The lack of an explicit HIV/AIDS strategy
in DFID must be remedied as soon as possible. 'Better Health for
Poor People' is not adequate on its own as a framework for DFID's
HIV/AIDS activities. We know that a strategy has been in preparation
within DFID for considerable time and we understand its agreement
is now imminent. We look forward to the publication of DFID's
HIV/AIDS strategy — it is long overdue (paragraph 254).
90. We trust that in the final stages of preparing
their HIV/AIDS strategy DFID take full account of the recommendations
and conclusions contained in this Report. We also believe that
the strategy should be 'owned' by all United Kingdom government
departments. To the extent that the activities of a department
of state have an impact on the developing world that department
should take account of how such activities impinge on the epidemic
(paragraph 255).
91. We welcome the prevention work being supported
by DFID in Asia (paragraph 260).
92. For DFID expenditure on HIV/AIDS to decline
to sub-Saharan Africa is unacceptable (paragraph 261).
93. We recommend that DFID reverse the recent
decline in its HIV/AIDS expenditure to sub-Saharan Africa and
include in its HIV/AIDS strategy an account of how it plans to
confront the epidemic in the region (paragraph 262).
94. We have already made detailed recommendations
to DFID in this Report. We have, for example, recommended that
DFID continue to increase its expenditure on HIV/AIDS. We have
recommended that DFID review how HIV/AIDS is affecting all its
development activity, particularly in sub-Saharan Africa, and
consider how development work might need to be redesigned to meet
the new realities created by the epidemic. In this section we
would redirect DFID's attention to sub-Saharan Africa, encouraging
its new interest in the care of those living with HIV. We are
pleased to note the growing seriousness with which DFID claims
to be taking the HIV/AIDS epidemic. The Department should not,
of course, overestimate what it can do — as Clare Short
said, they are only one player in the international community.
On the other hand, nor should they underestimate the impact they
can have once they apply the same intellectual rigour and energy
to HIV/AIDS that they have to other development issues (paragraph
264).
Conclusion
95. We are concerned that the current and legitimate
debate over drug pricing might distract from consideration of
the real crisis — the crisis of poverty. It is the denial
of resources, services and rights which has done so much to exacerbate
the spread of HIV/AIDS and control of the epidemic will only be
secured when such poverty issues are addressed. With inroads into
poverty we would expect to see progress in the reduction of infection
rates and standards of care (paragraph 265).
96. HIV/AIDS is not only a result of poverty —
it also entrenches poverty still further. We have concluded that
development programmes, including those of DFID, have much work
to do in assessing the impact of HIV/AIDS on the whole spectrum
of development activity. There is an urgent need to redesign development
programmes, policies and approaches, particularly in sub-Saharan
Africa, to take account of the new realities caused by HIV/AIDS
(paragraph 266).
97. Are we doing enough? The answer is clearly
not. More resources are in our view necessary, especially for
sub-Saharan Africa. It is not, however, only a question of resources
but of political determination, solidarity, and effective organisation
of a response. DFID has done much good but also has the potential
to do much more. We look forward to the forthcoming DFID strategy
paper on HIV/AIDS refocusing the efforts of the United Kingdom
Government on a successful response to the epidemic (paragraph
267).
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