Examination of Witnesses (Questions 40-54)
4 MAY 2004
GARETH THOMAS
MP, MS ROBIN
GORNA AND
MR DAVID
CLARKE
Q40 Chairman: Minister, as you know senior
advisers from your Department were witnesses—in fact Robin
is here today—at the recent APPG group hearings on the integration
of HIV and reproductive health services, and they gave a submission.
"It is widely accepted that the reproductive health and HIV/AIDS
communities need to work together on both policies and practice
to ensure that they are both complementary and not competitive.
Many of the innovations and strengths of the reproductive health
and rights field have significant potential for enhancing HIV/AIDS
work", so clearly DFID are looking very carefully at the
linkages between what are currently two parallel services. Our
witnesses from the earlier session mentioned the Three Ones—one
plan, one co-ordinating mechanism, and one monitoring evaluation
service. How is DFID supporting the Three Ones framework? Will
you be providing technical assistance to help national governments
develop strategies that use established reproductive health frameworks
and monitoring systems?
Gareth Thomas: Sure. We provide
technical assistance on occasion to the National AIDS Commissions,
to country governments to help them develop HIV/AIDS strategies
and to develop the appropriate monitoring and evaluation framework
in line with Three Ones, and we will seek to make available to
governments the full range of research into linkages between reproductive
health and HIV/AIDS as they so need. What I would say more generally
on the link between HIV/AIDS and reproductive health is that I
agree that there are differences and nuanced approaches that one
needs to take in these areas but fundamentally the two are extremely
close together and if an intervention were to be suggested in
terms of reproductive health that was not also addressing the
issue of HIV/AIDS it would be a pretty strange intervention that
was being suggested, so I think the linkages are very clear and
explicit and we need to continue to make sure that the two issues
are addressed together.
Q41 Chairman: At the very beginning of
the session you were very clear that—and I think this was
the term you used—DFID's response needs to be "jacked
up". You were very clear that more needed to be done, that
the problem was identified, and the response needed to be improved.
So you know that the problem is there and you have endorsed UNICEF's
strategic framework. How are you planning to "jack up"
your response quite specifically?
Gareth Thomas: I think I used
"scaled up", for the record, and I do think we have
already scaled up our response significantly in the period since
1997, I just think we need to do more, but it is not just us that
needs to do more, it is the international community more generally,
and that was the reason for our publishing the United Kingdom
Call for Action on 1 December; it is the reason why HIV/AIDS
will be a key feature of our Presidency of the G8 and the European
Union; and it is why we are working on a revised and more detailed
HIV/AIDS strategy. I obviously cannot at this stage tell the Committee
exactly what it is going to look like but we have published a
consultation document on that strategy and I think we have sent
a copy of that to every member of the Committee and a range of
other MPs, and I genuinely would welcome responses from members
of the Committee, particularly those that were able to contribute
to the debate we had in Westminster Hall before Christmas.
Chairman: Can I just say that I agree
with the comments my colleague made earlier? I think DFID has
a great deal to be proud of, not just in this area but in the
whole area of international development. It was not an implied
criticism: I am simply very interested in how you plan to "jack
up"—I do love that expression—the system.
Q42 Tony Baldry: The second part of the
UNICEF strategy is mobilising and supporting community-based responses.
How is DFID going to do that at a time when, for perfectly understandable
policy reasons, the Department is moving more and more to budgetary
support? Are you going to do this by setting targets for recipient
governments to meet, or in those countries where there is quite
a large DFID presence like Ethiopia or Kenya where you have a
semi autonomous DFID office, are you going to expect a member
of the DFID team to be responsible there for helping to encourage
best practice in community-based responses?
Gareth Thomas: We can try and
achieve more effective community-based responses in a number of
ways, both through the contribution that our staff in particular
DFID offices make in terms of advice and technical assistance
they are able to offer AIDS commissions and country governments,
but we are also working to help organisations such as UNICEF scale
up their response in Africa to meet particular needs, and we are
working at a regional level with the South African development
community to help them scale up their response too, and that in
a provision of better community-based responses will not just
be done through technical assistance or through multilateral assistance
or regional programmes, but we also work with a range of NGOs.
For example in South Africa we are supporting Christian Aid to
work across the country with the Anglican church, putting £3.4
million behind that programme to try and reach every district
to provide a more effective community-based response, and the
make-up of that response might be to try and make sure that local
leaders in our community are sensitised to the impact of HIV/AIDS,
to try and encourage them to bring together people within the
community to work out what is most needed; it might be around
making sure that the community gets orphans to school; it will
be essentially for that local community to work out what it needs
to do. What we need to do is make sure those communities have
access to the skills, the training—the support from experts
in country—be they NGO or National AIDS Commission experts,
to do that.
Q43 Tony Baldry: Certainly in Africa
many of those looking after orphans, whether they be AIDS orphans
or orphans whose parents have died from other causes, are faith
groups, but the reality is that whereas through primary education
and basic health care one can help deliver that through budgetary
support, we are still going to need, are we not, to work through
recognised NGOs, like Christian Aid and others, who have the capacity
to give the support to faith-based groups in countries where there
is a high instance of HIV/AIDS, because very often they do not
receive that sort of support from their own governments.
Gareth Thomas: I think for the
short term and indeed the medium term there is certainly a lot
of truth in that. The priority for DFID and for the international
community is to scale up the government's response in country
so that we do not have to rely on NGOs, so those governments can
learn from how NGOs in country are providing the service where
they are providing a particularly innovative service, but ultimately
it must be for the country governments to be providing services
that are needed to meet the needs of their citizens, and they
may want to use faith-based organisations or other community based
organisations, but that essentially is an issue that they have
to get to grips with themselves, but I accept in the short term
we will need to be doing that. One example of where progress has
been made in terms of response of governments is South Africa,
where the government is seeking to provide funding in terms of
grants direct to children and pension contributions to over 65s
which clearly will help grandmothers, etc, caring for Orphans
and Vulnerable Children. Each country government has to make a
decision whether or not it can do that and clearly that is beyond
at the moment a range of country governments, hence another reason
for the need to continue to use the NGOs who are working in country
at the moment.
Q44 Mr Colman: Bishop Paul Verryn who
leads the Methodist Church in South Africa is very keen that this
should go forward but at the moment your picture is incomplete
in that the South African government have not yet agreed that
faith-based organisations are going to be part of the support
for antiretrovirals, and we await the outcome of these discussions.
My question is really around HIV/AIDS treatment and prevention.
What is to be done for the parents and carers, secondly, for the
HIV/AIDS positive children and, thirdly, the HIV/AIDS negative
children. Starting with the parents and the carers, to what extent
is DFID in its work with countries working to ensure that there
is prolongation of the lives of parents and carers to ensure that,
if you like, the parents and carers get first stab at the antiretrovirals
and stay alive?
Gareth Thomas: That leads to an
issue raised Mr Bayley earlier as to whether DFID should be stipulating
who gets access to antiretrovirals and who does not. As I indicated
in my answer to him, I do not think that is an issue for DFID
to make; that is a judgment for country governments to decide.
Of course mothers and young children, as he suggested, we would
clearly want to see treated, if at all possible. I think the issue
for DFID is to concentrate on supporting the roll-out of antiretrovirals
more generally so many more people can have access to those drugs.
Meeting the challenge of 3 million on treatment by the end of
2005 is a very challenging target.
Q45 Mr Colman: But surely if you have
an Orphans and Vulnerable Children strategy within the HIV/AIDS
strategy, you would be encouraging countries to ensure that the
parents or the carers of those children should take priority in
having antiretrovirals to ensure they were alive to care for those,
so it would be something you would wish to see in the Orphans
and Vulnerable Children section of an HIV/AIDS strategy?
Gareth Thomas: In terms of access
to antiretrovirals, one of the issues that is covered in an Orphans
and Vulnerable Children strategy, it needs to be, absolutely.
The issue at the moment is that so few countries have Orphans
and Vulnerable Children strategies in place, and therefore one
of the key issues for DFID and the international community more
generally is to try to accelerate with country governments the
production of those strategies.
Q46 Mr Colman: I would agree but I note
perhaps your hesitation to wish that the priority should be given
to parents or carers as something which should be left to national
governments to decide. Going on to HIV/AIDS treatment for HIV/AIDS
positive children and orphans, are you encouraging pharmaceutical
manufacturers particularly to look at this and go forward in this
area? WorldVision in their evidence particularly suggested that
there needs to be further work done on ARV syrups that can be
more easily consumed by children which could be part of a strategy
to ensure that children with HIV/AIDS can receive their retrovirals
in a rather more acceptable way?
Gareth Thomas: Let me deal with
the preface to this substantive question and just say that I was
not disagreeing with you, Mr Colman: I just do not think it is
my place to be dictating to country governments who they should
give access to treatment to. In terms of ARV syrups, etc, there
are real issues, as you indicated, in helping people to stay the
course in terms of antiretroviral treatments, and we need to look
at a range of ways to achieve that and to come up with a more
effective way for people to benefit from drugs, and ARV syrups
may well be something that the pharmaceutical companies can help
with, and it may well be something that the public sector needs
to look at in the United Kingdom. Again, these are the sorts of
questions we would be happy to welcome responses and suggestions
on for our revised HIV/AIDS strategy.
Q47 Mr Colman: So you will be looking
for comments from the pharmaceutical companies?
Gareth Thomas: Yes, sure. We are
hoping they will respond to the consultation document, just as
much as we are hoping that NGOs and members of the Select Committee
will respond.
Q48 Mr Colman: What about the third area,
which is children who are HIV negative, who have been born without
it although their parents have it, who have the possibility of
going forward without HIV/AIDS? To what extent is DFID looking
at the issues around breast milk versus formula milk powder bearing
in mind that the child could be reinfected again through the breast
milk of the parent? Is this move towards breast not being necessarily
best one that DFID is exploring to see whether it should go forward
with its advice by country's officers to ensure that formula milk
is provided as a choice for parents who are to deal with concerns?
Gareth Thomas: I am going to bring
Ms Gorna in to answer that specific point but adding to the point
about syrups and treatment for children more generally, we are
in discussions with both the WHO and the Medical Research Council
on the research programme in those areas.
Ms Gorna: In terms of the response
to breast milk and bottle feeding, we follow WHO guidance on that
and have given guidance to country officers on the prevention
of mother to child transmission. We do keenly follow the debate
with WHO and it is our understanding that exclusive breast feeding
does offer some benefits but obviously formula feeding should
be provided in some situations and circumstances, so we work for
national governments to develop the most appropriate standards
in line with WHO guidance.
Q49 Mr Colman: I understand new evidence
has come out in the 12,000 family survey in Thailand. We were
told in earlier evidence that it has come out in the last few
days. The other area which I raised back in Westminster Hall was
to do with the transmission of HIV/AIDS via immunisation programmes
in many developing countries and, again, we asked this of the
NGOs earlier on and they seem to accept the 5% level of UNICEF
but reject the higher levels proposed in terms of 30-35% of children
being infected with HIV/AIDS after they were born through immunisation.
To what extent is DFID working with UNICEF and national governments
on ensuring there are single use objectives for immunisation,
so that no child contracts HIV/AIDS through the immunisation programme
anywhere in the world?
Ms Gorna: Again we would follow
the WHO and UNAIDS guidance on this. There has been a lot of debate
about the rates of infection to do with non sterile equipment,
and so once again we follow the UN's best advice on this and encourage
national governments to follow it.
Q50 Mr Colman: Perhaps the Minister might
want to respond more fully to this having thought about it in
terms of this being something which is quite an explosive issue,
if you like. Clearly there are a lot of people within WHO who
are very concerned that this has come out into the open because
they are concerned this could lead to low take-up of immunisation
campaigns, and it is a very difficult balance if you are infecting
a child with HIV for the rest of their life because they are going
through immunisation.
Gareth Thomas: Madam Chairman,
we will reflect a little further on the answers we have given
and if there is anything else I think we need to add to the responses
we have given then I will write to you.
Q51 Chairman: Minister, we are all very
aware of the proud record that DFID has, and there is no question
that DFID is much admired throughout both countries that receive
aid and countries that are our fellow donors. Can I ask you what
influence DFID has with other donors, and I am thinking here particularly
of the United States, and is DFID able to encourage other donor
countries to target for AIDS? Can you encourage other donor countries
to support UNICEF's strategy?
Gareth Thomas: We have a range
of discussions with all sorts of other countries through fora
such as UN General Assembly, and Special Sessions and through,
for example, the Commonwealth Heads of Government Meeting back
in December, and as I say we are prioritising the issue for the
G8 and EU Presidencies which will give further impetus in terms
of the encouragement to other donors to offer more resources.
The issue of trying to harmonise and co-ordinate our responses
with other donors is something that we are actively working on,
and that is why we are supporting so hard the UNAIDS Three Ones
initiative, and that is one of the reasons too why we have increased
for this financial year the amount of money we are giving to UNAIDS
to support the Three Ones initiative.
Q52 Chairman: Are there steps that DFID
can take to ensure that orphaned and other vulnerable children
do not continue to be marginalised? There are plenty of international
initiatives, and I am thinking perhaps of the Global Fund in particular,
but is there anything DFID can do to make sure that orphaned and
vulnerable children are not cut out from these kinds of things?
Gareth Thomas: I think the Global
Fund have set themselves a target of making sure they treat 1
million children as part of the first three funding rounds, so
I think that is some evidence that they understand the need to
prioritise the needs of Orphans and Vulnerable Children. More
generally, I think our work with country governments to encourage
them to develop strategies for dealing with Orphans and Vulnerable
Children with HIV/AIDS is probably the most effective way of addressing
this issue, because that is designed to make sure there is a cross-government
response, be it from education departments or via trade ministries,
etc, that addresses all sorts of issues that are caught up in
terms of the needs of Orphans and Vulnerable Children.
Q53 Chairman: Lastly, how does DFID link
its policies on HIV/AIDS to its other policies, and I am thinking
particularly of those on agriculture and economic development.
Gareth Thomas: I gave the example
of working with ministries of education, but equally we are working
with ministries of agriculture in a range of countries to make
sure they address the needs of Orphans and Vulnerable Children
or those with HIV/AIDS generally are absolutely the type of cross-multisectoral
response we think is ideal in terms of the response to HIV/AIDS.
Q54 Mr Colman: Lastly, and you might
want to pass this to the Permanent Secretary who is giving evidence
to us in four weeks' time, will DFID specifically include Orphans
and Vulnerable Children support as an indicator against which
DFID is required to report in its annual report, and will you
be appointing a full time Orphans and Vulnerable Children adviser
to ensure that your policy commitments are fulfilled in this?
Will we be seeing an indicator on this, and are you going to have
a full time adviser on it?
Gareth Thomas: I do not think
we will be seeing an indicator specifically on how many Orphans
and Vulnerable Children we are supporting, which is certainly
the approach that the Americans have taken, for example, and the
reason is that we think it is for country governments to devise
their own responses and targets and for us to come in behind those.
But I will take Mr Colman's two questions as contributions to
our consultation exercise, if you like on the HIV/AIDS strategy,
and I am sure the Secretary of State will read the transcript
of this hearing and be aware of it.
Chairman: Thank you very much, Minister,
for sparing us your very valuable time, and your two very senior
advisers. Thank you.
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