House of Commons - Public Accounts

Select Committee on Public Accounts Fourteenth Report

1 The scale of response to the epidemic

1. The scale of the epidemic is illustrated in Figures 1 and 2. At least 65 million people have been infected with HIV over the last two decades and about 20 million people have died of AIDS, nearly three million in 2003 alone.[1] In 2003, nearly 5 million people were newly infected with HIV.[2] By 2010, an estimated 25 million children worldwide will have lost at least one parent to the epidemic.[3] The epidemic deprives developing countries of their most productive people, erodes the capacity of governments to provide essential services and stops or reduces economic growth.[4] Figure 1: The global distribution of adults and children living with HIV/AIDS at the end of 2003

Region	Adults and children living with HIV/AIDS (million)²	Adult¹ prevalence %²
Sub-Saharan Africa	23.1-27.9	6.9-8.3
East Asia	0.45-1.5	0.1-0.2
Oceania	0.021-0.046	0.1-0.3
South & South East Asia	4.1-9.6	0.4-0.9
Eastern Europe & Central Asia	0.86-1.9	0.4-0.9
Western Europe	0.46-0.73	0.2-0.4
North Africa & Middle East	0.2-1.4	0.1-0.6
North America	0.52-1.6	0.3-1.0
Caribbean	0.27-0.76	1.4-4.1
Latin America	1.2-2.1	0.5-0.8
Global Central Estimate	37.8	1.1
Global Range	34.6-42.3	1.0-1.2

Notes:
1. Adults are defined as individuals aged between 15-49 years

2. The ranges represent the low and high estimates

Source: 2004 Report on the global AIDS epidemic, UNAIDS 4^th Global Report, June 2004Figure 2: Deaths due to HIV/AIDS

Region	Adult and child deaths due to AIDS during 2003 (000)¹
Sub-Saharan Africa	2,000-2,500
East Asia	22-75
Oceania	‹1.3
South & South East Asia	290-700
Eastern Europe & Central Asia	32-71
Western Europe	‹8
North Africa & Middle East	9.9-62
North America	8.3-25
Caribbean	23-59
Latin America	65-110
Global Central Estimate	2,900
Global Range	2,600-3,300

Note:

1. The ranges represent the low and high estimates

Source: 2004 Report on the global AIDS epidemic, UNAIDS 4^th Global Report, June 2004

2. The Department is committed to tackling the epidemic and has been involved in HIV/AIDS programmes since 1987.[5] But its overall response has been slow, as has that of the international community as a whole. The Department issued its first formal strategy on HIV/AIDS only in 2001[6] and currently spends 5% of its budget on HIV/AIDS,[7] some £270 million in 2002-03. This makes the Department the second biggest donor on HIV/AIDS after the United States,[8] but it must be set against a current estimate by the Joint United Nations Programme on HIV/AIDS (UNAIDS) of some £4 billion needed to tackle the epidemic.[9] In the 2004 Spending Review, the Government announced that the United Kingdom will spend at least £1.5 billion between 2005-06 and 2007-08 on bilateral and international efforts to combat HIV/AIDS.[10]

3. The shortfall in international funding threatens the success of global initiatives such as the '3 by 5' programme run by the World Health Organisation and UNAIDS to provide treatment to three million people by 2005.[11] The Department published in July 2004 a new strategy to raise the profile of HIV/AIDS within the international community.[12] The strategy describes how the Department aims to address, along with the international community, the need to close the funding gap; strengthen political leadership; improve donor co-ordination; and support more effective HIV/AIDS programmes.

4. The Department sees HIV/AIDS as a development and a humanitarian issue, in line with current international thinking. However, its strategy is not clear on the balance between these two perspectives, between bilateral and multilateral programmes, or between the risk of future spread of the epidemic and dealing with current crises. The Department saw that the scale of the epidemic and the speed with which it was taking hold in many countries required an emergency response to meet immediate needs.[13] And in some countries, such as Zimbabwe, the lack of government co-operation leads the Department to restrict its efforts to humanitarian support.[14]

5. The balance between humanitarian and developmental perspectives has important consequences. For example, some poor countries with the highest HIV prevalence rates in the world are not in the 20 countries in which the Department currently focuses its HIV/AIDS support.[15] The Department told us that it gave priority to the poorest countries that were least able to raise resources themselves. Other countries with large-scale epidemics had resources which they could re-allocate to tackle HIV/AIDS but had decided not to give it priority.[16] The Department saw its approach as reflecting its policy of focusing aid on those most in need. At the same time, four Asian countries, including India and China, feature in the current Public Service Agreement target for HIV/AIDS even though they are among the less deprived "low income" nations and currently have low rates of HIV/AIDS prevalence. From 2005-06, when the extra funding will become available, a further five Asian countries will be added to the target.[17]

1 C&AG's Report, Department for International Development: responding to HIV / AIDS (HC 664, Session 2003-04) , para 1.4 Back

2 2004 Report on the global AIDS epidemic, UNAIDS 4^th Global Report, June 2004, p10 Back

3 Taking Action: The UK's strategy for tackling HIV and AIDS in the developing world, DFID, July 2004, foreword; Ev 15 Back

4 Q 9 Back

5 Q 3 Back

6 ibid Back

7 Q 7 Back

8 Q 27 Back

9 Taking Action: The UK's strategy for tackling HIV and AIDS in the developing world, DFID, July 2004, p17 Back

10 2004 Spending Review: New Public Spending Plans 2005-2008, HM Treasury, July 2004 (Cm 6237) Back

11 Q 28 Back

12 Taking Action: The UK's strategy for tackling HIV and AIDS in the developing world, DFID, July 2004 Back