Memorandum submitted by the Department
for International Development
SUMMARY
The global response to AIDS—and the UK's
role in supporting this—has developed rapidly over the last
five years moving from global advocacy to building strong political
commitment and securing substantial financing, including new instruments
like GFATM (the Global Fund to fight AIDS, TB and Malaria). In
the past two years, energy has turned to addressing the impact
of these enhanced efforts, agreeing the "Three Ones"
principles to enhance greater donor harmonisation and alignment
with country priorities to make the money work more effectively.
The UK has made AIDS a centrepiece of the 2005 G8 and EU Presidencies,
emphasising the importance of securing "more aid and better
aid" for AIDS, combined with strong policies on scaling up
towards universal access to AIDS treatment, and maintaining momentum
on HIV prevention. As we move into 2006, there is a clear global
priority to move from commitment, targets and money to a strong
emphasis on delivering better AIDS services to poor people. Accountability
for action will be highlighted in June 2006 when the High Level
UNGASS meeting reviews achievements against the targets set in
the 2001 Declaration of Commitment on AIDS, and the new goals
set at this year's G8 summit in Gleneagles and the subsequent
Millennium Review Summit.
Until recently ARV provision for poor people was
seen as largely unworkable. Prohibitively expensive medicines,
weak health services, and limited resources and attention for
AIDS meant that the 2001 UNGASS Declaration of Commitment on HIV/AIDS
gave a very basic indication of intent, " . . . in an urgent
manner make every effort to provide progressively and in a sustainable
manner, the highest attainable standard of treatment for HIV/AIDS
. . . ". Less than five years on, global commitments have
shifted dramatically. Following substantial reductions in the
cost of ARVs, significantly increased financing, evidence on the
effectiveness of treatment for poor people, and the role of treatment
in supporting prevention, UNAIDS and WHO launched the "3
by 5" initiative in September 2003. The then Minister of
State for International Development, immediately pledged the UK's
support to meet this goal. Building on this commitment, in 2005
the UK government mobilised international attention and secured
global agreement (through the G8 summit at Gleneagles and the
UN Millennium Review Summit) to work towards as close as possible
to universal access to treatment by 2010. The UK has accepted
UNAIDS' invitation to co-chair the Global Steering Committee on
Scaling Up Towards Universal Access, and will use this opportunity
to ensure that real action follows this ambitious agreement.
The UK now plays a substantial role in global
efforts to tackle AIDS. As the second largest bilateral donor
on AIDS (and providing one of the highest proportions of GNI to
AIDS) the UK is committed both to securing greater financing for
AIDS, and to ensuring that the money is used efficiently to secure
high quality AIDS programmes benefiting as many poor people as
possible. The UK's approach to AIDS in general—and ARV provision
in particular—has a number of strands. The UK engages in
policy dialogue at global and country levels to promote effective
action. UK finances are directed both through multilateral channels
(GFATM, World Bank, the UN family) and through direct bilateral
assistance. Much of the UK's bilateral assistance—especially
in Africa—is provided through Poverty Reduction Budget Support
(PRBS) and Sector Wide Approaches (SWAps). Some AIDS-specific
programming is also supported, and the UK is making some strategic
long-term investments (eg in research and development). This means
that in terms of ARV provision, the UK's action cannot be wholly
disaggregated from broader global efforts which the UK supports
and influences. By placing AIDS at the centre of the 2005 G8 and
EU Presidencies, the UK has helped achieve new international commitments,
focused on AIDS treatment (G8/MRS Commitments), and improved the
broader environment within which AIDS services are provided (the
GTT, the wider commitments to increase aid flows to Africa). Balancing
action on specific AIDS issues with action to tackle poverty is
fundamental to the UK's approach.
ADDRESSING THE
HIV/AIDS PANDEMIC: WHAT
ARE THE
PRIORITIES IN
2006?
1. The global response to AIDS—and the
UK's role in supporting this—has developed rapidly over
the last five years moving from global advocacy to building strong
political commitment and securing substantial financing, including
new instruments like GFATM (the Global Fund to fight AIDS, TB
and Malaria). In the past two years, energy has turned to addressing
the impact of these enhanced efforts, agreeing the "Three
Ones" principles to enhance greater donor harmonisation and
alignment with country priorities to make the money work more
effectively. The UK has made AIDS a centrepiece of the 2005 G8
and EU Presidencies, emphasising the importance of securing "more
aid and better aid" for AIDS, combined with strong policies
on scaling up towards universal access to AIDS treatment, and
maintaining HIV prevention momentum. As we move into 2006, there
is a clear global priority to move from commitment, targets and
money to a strong emphasis on delivering AIDS effective services
to poor people. Accountability for action will be highlighted
in June 2006 when the High Level UNGASS meeting reviews achievements
against the targets set in the 2001 Declaration of Commitment
on AIDS, and the new goals set at this year's G8 summit in Gleneagles
and the subsequent Millennium Review Summit.
Progress on Achieving Target 7 within the Sixth
MDG
2. Assessing progress on the Sixth MDG on AIDS
is hampered by the fact that the MDG target to halt and reverse
the spread of HIV and AIDS is rather broad, and there is insufficient
data. In line with the commitments in Taking Action, to play an
active role in the monitoring and evaluation activities of the
international community to measure the impact of our combined
response to AIDS, the UK is participating in the UNAIDS-convened
"Monitoring and Evaluation Reference Group" (MERG) which
seeks to develop multilateral solutions to address problems related
to inadequate data.
3. The steps needed to reach this MDG are elucidated
in the UNGASS (UN General Assembly Special Session) Declaration
of Commitment on AIDS, agreed in 2001. Achievements against this
road map will be reviewed at the High Level meeting in June 2006.
An interim review was held in 2003, and at this time the UN Secretary
General noted that the world appears to be off-track.
4. According to UNAIDS, every day an estimated
14,000 people are newly infected with HIV. The total number of
people living with HIV is estimated at 39.4 million, with an estimated
4.9 million people newly infected with HIV in 2004. The total
number of AIDS deaths in 2004 was an estimated 3.1 million. Women
and young people are disproportionately affected—76% of
young people with HIV are female.
5. In sub-Saharan Africa women and girls make
up 60% of all people infected. And in 2004, there were 3.1 million
new infections across sub Saharan Africa with 2.3 million deaths.
Yet while the picture across Africa is sobering, there are pockets
of hope. In some parts of East Africa there are suggestions of
modest declines in prevalence among pregnant women in urban areas.
In West and Central Africa there is little evidence of changes
in prevalence levels, which have stayed steady at 5% or lower.
National prevalence statistics, though, can hide much higher levels
of infection in particular provinces, states or districts. While
HIV prevalence measured at antenatal clinics has edged lower in
parts of some countries and in specific age groups, there is no
sign yet of an overall, national decline in Southern Africa. In
South Africa, HIV prevalence rates continue to rise.
6. DFID has identified 16 countries in Africa
within its Public Service Agreement (PSA). All have generalised
epidemics—ie HIV prevalence greater than 1%—ranging
from 2.1% in Sudan through to 21.5% in South Africa and 28% in
Lesotho. In Mozambique, current projections indicate that by 2010
almost one fifth of adults will be infected with HIV, and if current
trends continue, AIDS will cause a drop in life expectancy to
36.5 years by 2010 (from a previously anticipated "high"
of 50.3 years).
7. In Asia the only PSA country with falling
rates of both new infections and overall numbers of people infected
with HIV is Cambodia. Prevalence rates confirm a generalised epidemic.
Six states in India have official prevalence rates over 1%, and
the number of high prevalence districts within states doubled
between 2003 and 2004. The overall prevalence rate in India is
0.9%. Elsewhere in Asia national HIV prevalence rates remain below
1%, but there are increasing rates of infection in vulnerable
groups and/or geographic spread of HIV in Pakistan, Nepal, Bangladesh
and Indonesia and Vietnam. New data from China will be available
in December 2005.
8. After Africa, the Caribbean is the most affected
region, where five countries have national HIV prevalence rates
exceeding 2%. In many places the epidemic is concentrated among
sex workers. Yet there is also an increasing impact on the general
population, especially in Haiti, where prevalence is around 5.6%.
Cuba has been an exception in this region, with very low HIV prevalence.
Universal free access to AIDS treatment has kept the number of
cases and deaths very low.
9. In Latin America Brazil accounts for more
than one third of people with HIV. HIV in Argentina remains concentrated
largely in urban areas. 65% of HIV infections are estimated to
occur in Buenos Aires and its surrounding areas. In the Andean
region HIV has been concentrated among sex workers, their clients
and men who have sex with men. In Central America among those
with HIV men outnumber women by roughly 3:1 in most countries.
Mexico's prevalence in the adult population has remained under
1%, but overall heterosexual transmission of HIV has increased
in recent years.
10. In Eastern Europe and Central Asia the Russian
Federation is home to the largest epidemic, and the Ukraine is
experiencing a surge of reported infections. Several Central Asian
and Caucasian republics have entered the early stages of the epidemic.
In most of the countries HIV is spreading rapidly among injecting
drug users.
The Delivery of ARVs in Resource Poor Settings
11. With the current global push to secure as
close as possible to universal access to AIDS treatment in poor
countries, it is easy to lose sight of the fact that it is just
two years since the ambitious "3 by 5" target—to
get 50% of poor people on treatment—was proposed by WHO
and UNAIDS. Prior to that, the very real challenges and costs
of delivering Antiretrovirals (ARVs) to people in resource poor
settings were seen as substantially outweighing the arguments,
from a human rights perspective, of scaling up access to treatment.
12. Provision of ARVs is highly complex in resource
poor settings. Without broader attention to the wider context,
including strengthening weak health care systems, ARV provision
is not feasible. There are very real fears that ARV programmes
will not be sustainable (yet sustainability is essential if people
are to benefit from life-long treatment for a chronic condition)
and parallel concerns that a firm emphasis on AIDS treatments
could detract from other essential services (eg maternal health).
13. DFID published its Treatment and Care Policy
in 2004 (at the time of "Taking Action", the UK Government
Strategy on tackling HIV and AIDS in Developing Countries). The
Policy identifies a broad range of interventions required to provide
AIDS treatment and care services, including education and awareness
campaigns; community mobilisation and treatment literacy; greater
access to testing services, in particular voluntary counselling
and testing (VCT); support for people with HIV; campaigns to tackle
stigma and discrimination; prevention and treatment of opportunistic
and sexually transmitted infections; strengthening human resources
and wider systems issues; securing high quality, affordable ARVs,
and essential laboratory and clinical backup; systems of drug
management and procurement; palliative and home-based care.
14. The UK approach recognises that treatment
and care services cannot be divorced from comprehensive multi-sectoral
AIDS programmes, embedded in poverty-reduction strategies and
wider development processes. Harmonisation among donors, and efforts
to ensure that programmes are fully aligned with country ownership
and priorities (in line with the Three Ones principles)[1]
are essential. Once implemented, the recommendations of the Global
Task Team on Improving AIDS Coordination Among Multilateral Institutions
and International Donors should secure long-term sustainable country-led
programmes, properly supported by the international system. These
concerns are reflected in the G8 and MRS statements which recognise
that efforts to get as close as possible to universal access to
AIDS treatment will only be feasible if embedded in the Three
Ones principles, and if countries develop and implement a comprehensive
package of care, treatment and prevention initiatives. Delivering
all of this in resource poor settings is extremely difficult.
Gaps in Treatment: Children and Other Vulnerable
Groups
15. The UK's approach to AIDS is founded in DFID's
overarching commitment to poverty eradication—an ambition
which the AIDS pandemic endangers. In this context the UK has
consistently pushed to ensure that the needs of the poor, vulnerable
groups, women and children are prioritised in respect of service
provision. Yet there is very limited data on equity in ARV provision
and few countries have disaggregated systems for tracking ARV
provision in rural settings, among sub-populations, women, children
etc.
16. Ensuring ARV provision for the most vulnerable
is a substantial challenge. AIDS treatment scale up has been slowest
in countries where there is major conflict or political instability,
and where HIV is concentrated among injecting drug users and sex
workers. There are substantial problems with securing continuity
of treatment for prisoners, refugees and internally displaced
people.
17. There has been widespread concern that women
will not have equitable access to treatment due to cultural attitudes
giving men priority over women despite the greater impact of HIV
on women. Of the limited disaggregated data available, evidence
suggests that there are not wide disparities. In sub-Saharan Africa,
almost 60% of adults on treatment are women, reflecting an equitable
distribution in line with known epidemiology. It is thought that
women may in fact be over-represented as maternal health clinics
may be a convenient venue for ARV provision. However, there are
concerns about the ability to stay on treatment—and therefore
to realise the consequent real benefit—as compared to enrolment
(eg women and girls may enrol on treatment during pregnancy, but
ongoing adherence rates, eg post-partum, are rarely monitored).
18. Globally, access to treatment for children
is low, despite the fact that—in the absence of treatment—50%
of children with HIV will die before their second birthday. In
Mozambique and Malawi, for example, 5% and 7% of those on treatment
are children, whereas equitable access would require coverage
of approximately 13%. Effective AIDS treatment is more than just
ARVs. A DFID-supported trial in Zambia found that providing the
cheap antibiotic cotrimoxazole to children with HIV reduced mortality
by as much as 43%. Yet there is no adequate data on current provision,
and certainly no evidence to suggest that the four million children
currently in need of cotrimoxazole prophylaxis, and the 660,000
in need of ARVs have access.
Prevention and Treatment: Achieving a Balance
19. Globally, less than one person in five has
access to basic HIV prevention services. This "prevention
gap" is fuelling the spread of HIV. Access to evidence based,
effective HIV prevention information services and supplies has
never been more important. This is why one of the key themes DFID
has adopted for 2005 is "Maintaining HIV Prevention Momentum".
This approach reflects the fact that as global attention shines
a spotlight on efforts to increase ARV provision, it is vital
to support countries in maintaining properly balanced, comprehensive
AIDS programming, not distorted by false dichotomies, or simplistic
cost-benefit analyses between "treatment" and "prevention".
Countries, communities and individuals demand a more nuanced approach
which recognises the inter-connectedness of services.
20. "Taking Action" emphasises the
need for comprehensive evidence based prevention strategies, embedded
in broader social, education and health systems, integrated with
sexual and reproductive health services and grounded in rights-based
approaches which confront gender inequality, stigma and discrimination.
Effective HIV prevention cannot be reduced to simple public health
interventions. Rather it must take account of economic and socially
entrenched gender and other inequalities that shape people's behaviours
and limit their choices. It is vital that those who are most vulnerable,
and often marginalised, including sex workers, men who have sex
with men, drug users, prisoners, migrants have access to prevention
services.
21. Virtually every region, including sub-Saharan
Africa, has several countries where the epidemic is still at a
low level or at an early enough stage to be held in check by effective
action. Studies suggest that AIDS treatment can support HIV prevention
and that HIV prevention is essential to make AIDS treatment affordable.
It is estimated that a comprehensive HIV prevention package could
avert 29 million (63%) of the 45 million new infections expected
to occur by 2010. The cost of these prevention measures is estimated
at US $4.2 billion annually by 2007.
22. Significant challenges remain to providing
comprehensive and evidence based HIV prevention. Governments are
often reluctant to tackle taboo subjects such as sex, sexuality
and drug use. Yet tackling stigma and discrimination—and
the underlying structures and societal attitudes which fuel them—is
fundamental to effective responses. Evidence based HIV prevention
requires steps to confront ideological approaches and gender power
dynamics that may not recognise women and girls' vulnerability
to abuse and violence, or simple lack of social and economic power
to abstain from sex or control mutual fidelity. In addition, services
need to be aligned with need. Improving health systems performance
is also key, including in terms of addressing the lack of access
to vital supplies such as condoms and kits for the diagnosis and
treatment of sexually transmitted diseases—improved systems
that assure sustained commodity security are also critical.
23. The UK played an important role in supporting
UNAIDS finalise a new comprehensive prevention policy "Intensifying
HIV Prevention", and continues to play a key role in increasing
political support for attention to sexual and reproductive health
and rights, and for support to evidence based HIV prevention efforts.
We helped to ensure greater attention to reproductive health in
the Millennium Summit Outcome and are now working to ensure that
this is translated into the revised Millennium Development Goals
(MDG) monitoring framework. Under the EU Presidency DFID is working
with the EC and EU Member States to prepare a European Statement
of support for comprehensive and evidence based HIV prevention.
A UK policy position on Harm Reduction for Injecting Drug Users
will be published later this year.
INTERNATIONAL TARGETS
FOR ARV PROVISION
24. Until recently ARV provision in resource
poor settings was seen as largely unworkable. Prohibitively expensive
medicines, weak health services, and limited resources and attention
for AIDS meant that the 2001 UNGASS Declaration of Commitment
on HIV/AIDS gave a very basic indication of intent, " . .
. in an urgent manner make every effort to provide progressively
and in a sustainable manner, the highest attainable standard of
treatment for HIV/AIDS . . . ". Less than five years on,
global commitments have shifted dramatically. Following substantial
reductions in the cost of ARVs, significantly increased financing,
evidence on the effectiveness of treatment in resource poor settings,
and the role of treatment in supporting prevention, UNAIDS and
WHO launched the "3 by 5" initiative in September 2003.
The Right Hon Hilary Benn MP, the Minister of State for International
Development immediately pledged the UK's support to meet this
goal. Building on this commitment, in 2005 the UK government mobilised
international attention and secured global agreement (through
the G8 summit at Gleneagles and the UN Millennium Review Summit)
to work towards as close as possible to universal access to treatment
by 2010. The UK has accepted UNAIDS' invitation to co-chair the
Global Steering Committee on Scaling Up Towards Universal Access,
and will use this opportunity to ensure that real action follows
this ambitious agreement.
Lessons Learnt from the WHO 3 by 5 Initiative
25. 3 by 5 was launched in September 2003 with
the aim of getting three million people—50% of those in
poor countries in need of treatment—on antiretroviral therapy
(ART) by the end of 2005. In addition to the substantial contributions
the UK makes to WHO's core budget, the UK was the first government
to provide a specific contribution to 3 by 5—earmarking
an extra £3 million contribution to 3 by 5 for 2004-05. DFID
also placed a leading technical expert in WHO Geneva to drive
forward efforts in the 3 by 5 initiative.
26. In June 2005 WHO estimated that whilst the
target of three million was not going to be met, one million people
were now on treatment in low and middle income countries, a substantial
increase from 400,000 people when the initiative was launched.
Of 49 "focus countries", 40 had declared national treatment
targets and 34 had completed, or were developing, national treatment
scale up plans. Funding for ART has risen sharply during this
time from international and domestic sources.
27. It is clear that substantial challenges remain
for countries to expand access to treatment, including in terms
of ensuring continued equitable access as treatment widens and
promoting the integration of prevention and treatment programmes.
Expanded treatment relies on broader health systems, yet these
are often weakened by critical problems with human resources,
procurement and supply management systems and appropriate, accessible
health care infrastructure. These challenges are often exacerbated
by AIDS—death and disease may deplete health cadres further.
28. During 2005, the Global Task Team on Improving
AIDS Coordination among Multilateral Institutions and International
Donors (the GTT) identified further challenges to improving
the performance of the multilateral system on AIDS, of which the
3 by 5 initiative is an important element. These include challenges
to:
— secure inclusive national leadership
and ownership;
— harmonisation and alignment of multilateral
institutions and international partners;
— the effectiveness of the multilateral
response; and
— accountability and oversight.
29. There have been criticisms of the 3 by 5
initiative that it has been highly "vertical"—imposing
new targets on countries that may not accord with existing planning
processes. Certainly there have been tensions between the 3 by
5 advocacy role, and the complexities of implementation. The target
has served as an effective advocacy tool for increased political
commitment to treatment, and mobilising countries and communities
to respond. Yet some have made vocal accusations of heavy-handedness
and top-down approaches, believing that the approach is distorting
country-driven priorities. An evaluation of 3 by 5 is underway,
and DFID sits on the Steering Committee. The purpose of the evaluation
is to review the accomplishments and lessons learnt by WHO during
the implementation of 3 by 5. It will examine WHO activities at
global and national levels and will report in March 2006.
The G8 Commitment to Universal ARV Provision by
2010
30. The G8, at the Gleneagles Summit in July
2005, made a commitment to "working with WHO, UNAIDS and
other international bodies to develop and implement a package
of HIV prevention, treatment and care, with the aim of as close
to possible to universal access to treatment for those who need
it, by 2010". The UN Millennium Review Summit in September
reaffirmed this commitment, and as such there is a clear global
agreement to pursue this goal.
UNAIDS strategy to achieve the 2010 goal, including
DFID's role
31. UNAIDS—the secretariat and its ten
co-sponsors—has been coordinating efforts on how to take
the 2010 target forward. It is generally agreed that the target
can only be achieved if it is country-owned and based in specific
country approaches, integrated with broader development processes.
The Global Task Team's recommendations have created the groundwork
for increased action by countries to scale up comprehensive responses,
with the support of the international community, and to use donor
and domestic resource flows to maximum effect. Efforts to expand
services and aim for as close as possible to universal access
to treatment by 2010 will rely on these agreements and the Three
Ones principles. Significantly the G8/Millennium Review Summit
texts emphasise that this goal depends upon developing and implementing
a comprehensive response—prevention, treatment and care—not
simply the provision of ARVs. As a co-sponsor of UNAIDS, WHO are
playing a key role in developing the health systems components
of the essential package of prevention, treatment, care and support.
32. UNAIDS is in the process of establishing
a Global Steering Committee, which the UK will co-chair. It will
be based on the principle of country ownership—recognising
the need to work through existing national structures and processes—and
focus on mobilising countries to scale up ambitious national action
plans in line with the 2010 target. In addition the Global Steering
Committee will encourage countries to identify key obstacles—and
develop solutions—to scaling up towards universal access.
UNAIDS will provide a small secretariat for the Global Steering
Committee, and assist at the regional and country level through
existing Regional Support Teams, UN Theme Groups on AIDS and UNAIDS
Country Coordinators.
33. Efforts to scale up towards universal access
will build on existing processes, including the implementation
of GTT recommendations, planned Regional meetings and consultations
to secure country ownership, and provide regional peer review
of proposals. In early 2006, it is expected that there will be
a meeting to review progress, and in particular to consider how
to align donor commitments behind local plans. A likely blockage
to progress will be a lack of predictable and sustainable financing
to give countries confidence in committing to long-term plans,
including for life-long treatment. A Roadmap or Global Action
Plan, which will include steps to be taken to find solutions to
common obstacles (eg procurement), will be tabled at the UN Heads
of State conference in June 2006 to review progress on the UNGASS
Declaration of Commitment on AIDS.
34. DFID has accepted UNAIDS invitation to co-chair
this process. In this role DFID will continue to work closely
with the broad range of stakeholders, including bilateral donors
(including G8), UNAIDS, WHO, World Bank and other members of the
international community. DFID's country offices will be encouraged
to work with national authorities, through existing country dialogue.
DFID will continue to support multilaterals to engage in this
process in line with GTT recommendations, and programme assistance
that is consistent with the GTT and Universal Access goals.
THE UK CONTRIBUTION
35. The UK now plays a substantial role in global
efforts to tackle AIDS. As the second largest bilateral donor
on AIDS (and providing one of the highest proportions of GNI to
AIDS) the UK is committed both to securing greater financing for
AIDS, and to ensuring that the money is used efficiently to secure
high quality AIDS programmes benefiting as many poor people as
possible. The UK's approach to AIDS in general—and ARV provision
in particular—is multi-faceted. The UK engages in policy
dialogue at global and country levels to increase the political
space for effective action. UK finances are directed both through
multilateral channels (GFATM, World Bank, the UN family) and through
direct bilateral assistance. Much of the UK's bilateral assistance—especially
in strong policy environments in Africa—is provided through
Poverty Related Budget Support (PRBS) and Sector Wide Approaches
(SWAps). Some AIDS-specific programming is also supported, and
the UK is making some strategic long-term investments (eg in research
and development). This means that in terms of ARV provision, the
UK's action cannot be wholly disaggregated from broader global
efforts which the UK supports and influences. By placing AIDS
at the centre of the 2005 G8 and EU Presidencies, the UK has advanced
new international commitments, focused on AIDS treatment (G8/Millennium
Review Summit Commitments), but also to improve the broader environment
within which AIDS services are provided (the GTT, the wider commitments
to increase aid flows to Africa). Balancing action on specific
AIDS issues with action to enhance the broader environment, within
a clear poverty focus, is fundamental to the UK's approach.
DFID policy and practice on HIV/AIDS: the implementation
of Taking Action
36. In 2004 the UK published "Taking
Action, the UK's strategy for tackling HIV and AIDS in the developing
world", alongside new DFID policies on Treatment and
Care and Sexual and Reproductive Health, and UK government policy
and plans on increasing access to medicines in developing countries.
At this time the UK pledged to spend at least £1.5 billion
on AIDS-related activities over the three year period 2005-06—2007-08.
37. The UK's strategy outlines action to:
— close the funding gap;
— strengthen political leadership,
internationally and nationally;
— improve the international response,
including in terms of greater harmonisation between international
initiatives and multilateral organisations, and ensuring a better
fit between these responses and national approaches in developing
countries;
— support better national programmes,
including through our bilateral assistance to country responses;
and
— our work to improve the long term
response, including through support for research into new medicines,
preventative technologies and AIDS programmes.
Taking action to close the funding gap
38. A revised estimate of the resource needs
for an expanded response to AIDS in low and middle-income countries,
was prepared by UNAIDS in response to calls from the Making the
Money Work meeting. It showed that there were annual needs of
US$15 billion in 2006, US$18 billion in 2007 and US$22 billion
in 2008 (with at least an additional $18 billion required over
the next three years) to achieve universal AIDS programmes including
steps towards universal access to treatment by 2010, comprehensive
HIV prevention services, and to deliver care for 12 million orphans
and vulnerable children in Africa by giving them better access
to education, health care, home support and cash transfers. The
UK has taken active steps not just to increase its own contributions
to AIDS, but also to encourage a broad range of other donors—and
countries themselves—to increase resources for AIDS.
39. The Global Fund to fight AIDS TB and Malaria
(GFATM) is one of the most important multilateral instruments
to support a scaled up AIDS response. The UK hosted the GFATM
Replenishment Conference in London (5-6 September). This was largely
successful with donors pledging a total of US$ 3.7 billion, just
over half the US$ 7.0 billion required for 2006 and 2007. Progress
was also made on embedding the GFATM within the wider architecture
for AIDS financing, supporting GFATM to be even more effective,
especially harmonising and aligning to strengthen engagement at
the country level. The UK has pledged £359 million (US$ 640
million) to the GFATM over seven years (2002-2008), which includes
£100 million for 2006 and £100 million for 2007. Over
half of this can be attributed to AIDS. The UK is now the fourth
largest donor for the period 2006-07 and the second largest in
the EU. The EU provides over 50% of the Fund's finance. Through
GFATM, the UK contributes to substantial scale up of ARV provision—with
GFATM's latest update showing 200,000 people on ARVs through their
finance.
40. The World Bank is an important source of
financing for AIDS, with financing dramatically increasing over
the last four years to $250-300 million annually in Sub Saharan
Africa, and having provided some $2.5 billion cumulative global
lending to date. The UK's IDA 14 contribution is £1.43 billion,
making us the second largest donor. The UK as such plays an important
role in directly scaling up ARV provision, as well as building
the broader environment.
Taking action to strengthen political leadership
41. Taking Action committed the UK to make AIDS
a centrepiece of our Presidencies of the G8 and EU. This has clearly
been achieved. HIV and AIDS has had a high profile throughout
both Presidencies, and in terms of the G8, this led directly to
an international commitment to universal access to treatment.
42. The UK played an active role at the UN Millennium
Review Summit in September to ensure AIDS and sexual and reproductive
health had a high profile, working with other UN members to secure
the international mandate for Universal Access in the Millennium
Review Summit outcome document, which reflects the G8 language.
43. The Commission for Africa (CfA) achieved
much in challenging the international community on those factors
affecting Africa's development, including AIDS. The CfA recommendations
in this area were widely welcomed and provided a foundation for
the subsequent G8 and UN Millennium Review Summit commitments.
The CfA also provided an additional way in which the UK Government
worked closed with the Africa Union and NEPAD to encourage scaled
up responses to AIDS.
44. The "Three Ones in Action: Making the
Money Work" meeting in London in March was the beginning
of a process both to deliver more aid and better aid to tackle
HIV and AIDS. The meeting identified four key problems:
(a) AIDS money is spread unevenly including high
prevalence countries lacking support;
(b) The huge administrative burden placed on
governments by AIDS donors
(c) Overlap among international AIDS agencies
(d) More investments needed in people and systems
to deliver prevention, care and treatment.
The meeting also set up the Global Task Team on Improving
AIDS Coordination Among Multilateral Institutions and International
Donors (GTT) to develop solutions to these problems. Progress
has been substantial and has been achieved through a constructive
and inclusive process that was very outcome orientated.
Taking action to improve the international response
45. In 2003-04, the UK worked closely with UNAIDS
and the US to secure global agreement to progress the set of principles
known as the "Three Ones": one HIV and AIDS strategy;
one national AIDS coordination authority; and one monitoring and
evaluation system. The Three Ones translates broader agreements
made on harmonisation and alignment, (particularly OECD/DAC on
aid effectiveness) into the AIDS context. However, change is slow,
and whilst many countries established coordinating bodies and
strategies, many are still struggling to use the increasing levels
of financing available effectively. Also, donors remain insufficiently
harmonised.
46. On 9 March 2005 the UK hosted a meeting of
leaders from donor and developing country governments, civil society,
UN and other multi-national agencies to review the global response
to AIDS with the theme: "Making the Money Work". Participants
called for urgent measures to improve the impact of global AIDS
action and to make the system more coherent. The GTT was established
at the meeting to make specific time bound recommendations to
improve coordination and enhance the quality of national responses.
47. GTT recommendations were released in June
and build strongly on the commitment made by the UN and others
to the Three Ones and the Paris DAC Aid Effectiveness agenda,
including measures to: improve the effectiveness of national responses,
drawing on country leadership; reduce unnecessary management and
technical burden on governments and to reduce competition and
duplication in the provision of technical support; and, streamline
and improve accountability in the UN and the GFATM. UNAIDS has
developed and costed a Consolidated UN Technical Support Plan,
for 47 high priority countries to ensure the GTT recommendations
are implemented within timeframes provided.
48. The UK government has also worked to improve
the international response in terms of its impact on poor people's
access to medicines, including for HIV and AIDS.
49. The UK has worked with EU partners to shape
a new EU Programme for Action on HIV/AIDS, TB and Malaria, with
proposals to support improved access to preventive and therapeutic
treatment and increased R&D for new medicines, diagnostics
and vaccines.
50. The UK has continued to take a lead role
in efforts to secure agreement on an EU Regulation on the Trade
Related aspects of Intellectual Property rights (TRIPS) agreement
and Public Health, to implement in EU domestic legislation the
TRIPS waiver agreed on 30 August 2003. This allows countries with
no domestic pharmaceutical capacity to import copies of patents
from third party countries, in accordance with the provisions
of the decision. Under the EU Presidency the UK has also continued
efforts to secure international agreement on the amendment of
the TRIPS agreement at the WTO to incorporate the 30 August Decision.
51. In March 2005 DFID with the Department of
Health and the Department of Trade and Industry launched Increasing
People's Access to Medicines in Developing Countries: A Framework
for Good Practice in the Pharmaceutical Industry, which was
developed in consultation with the pharmaceutical industry and
its stakeholders and which brings together good practice in the
industry to encourage pharmaceutical companies to go further in
making their medicines available in developing countries and in
undertaking increased R&D for diseases disproportionately
affecting developing countries.
Taking action to support better national programmes
52. The following are short summaries of how
Taking Action is being implemented by DFID country programmes
in Africa, Asia, Europe, Middle East and the Americas. However,
DFID's geographical reach is far greater than its 40 country programmes.
Working through the multilateral system, the UK reaches a far
broader range of countries.
Africa
53. Within the framework of Taking Action DFID
has used a mix of aid instruments including general budget support
(eg Ethiopia), sector budget support (eg Malawi and Uganda), and
specific bilateral HIV and AIDS programmes to strengthen national
government, civil society and private sector responses to country
AIDS epidemics. Focus has been on developing political leadership,
national planning and priority setting along with better coordination
amongst government, civil society, private sector and international
agencies to provide comprehensive prevention, treatment (including
ART) and care services.
54. In many African countries there is significant
existing financial support available for AIDS treatment via the
GFATM and the US President's Emergency Plan for AIDS Relief (PEPFAR).
DFID has focused on supporting better coordination and harmonisation
of efforts based on the "Three Ones" principles.
55. Support is being provided to strengthen comprehensive
and integrated national programmes to prevent, treat, care and
mitigate AIDS. Some examples include:
— In Ethiopia, DFID provides direct
budget support to the government for the implementation of the
new strategic plan for 2004-08. In January 2005 the government
launched a programme to provide ART free of charge with a target
of 140,000 patients served by more than 300 health care facilities
by the end of 2006.
— DFID Malawi is providing £4.5
million direct support to the National AIDS Commission as part
of pooled funding to support the implementation of the National
Action Framework (2005-2009). This supports comprehensive, integrated
programmes, filling gaps that are un-funded by other financing.
The groups covered by the interventions include women, the young,
the affected, the most at risk and OVCs. DFID Malawi is also providing
support for comprehensive reproductive health care, essential
drugs and critical human resources in the health sector. Pooled
funding covers a number of sectors including ministries of health,
education and security.
— DFID Ghana supports a wide array
of programmes including ART, condom procurement and distribution,
VCT and prevention of mother to child transmission. This includes
support across sectors including education, health and social
protection.
Asia
56. The governments of China and India have both
increased their policy and financial commitments to address HIV
and AIDS during the past year. The Indian government has committed
to provide free ARV treatment in the six high prevalence states
plus Delhi. In China, the challenge is to translate policy commitments
into action at provincial and county level, and scale up implementation
to a level that will have an impact on the spread of infection.
Increasing commitment at national level in Indonesia and a doubling
of the AIDS budget between 2003 and 2006 are encouraging. There
has been an increase in the government of Vietnam's efforts to
secure multi-sectoral action in prevention and control, and to
scaling up treatment provision. Rising HIV rates in vulnerable
groups in Pakistan have contributed to increased political commitment.
Political leadership is lacking in Bangladesh and the response
relies largely on NGO implementation. Afghanistan has a fledgling
national AIDS control strategy and programme, including plans
for safe blood transfusion, but very little specific action. The
government response in Burma is limited and the space for political
advocacy appears to be shrinking, but UN and NGO engagement remains
firm.
57. Some examples of DFID support include:
— DFID has made a commitment to fund
HIV and AIDS activities in Indonesia for the first time (£25
million to the Indonesia Partnership Fund for 2005-08).
— In China, design of the new £30
million programme with the government, UN and Global Fund is underway,
and implementation will start in 2006.
— In Burma, DFID is closely engaged
with the UN in efforts to ensure continuity of implementation
in the wake of the GFATM's cancellation of its grant.
— In India, DFID's £123 million
support over seven years to March 2007 to the National AIDS Control
Programme (NACO) has been reviewed. It supports targeted interventions
with vulnerable groups, education initiatives and care in eight
key States. It also funds technical cooperation, and a challenge
fund to address key groups such as children affected by AIDS,
young people, men who have sex with men, and advocacy to address
stigma and discrimination.
— In Bangladesh support to the NGO-led
response continues while HIV and AIDS components are agreed and
implemented within the multi-donor supported health sector and
urban health programmes.
Europe and Central Asia
58. Universal access is commonly applied in Eastern
European countries and Central Asia, but informal fees for health
services and drugs limit access to the poor and vulnerable. There
remains significant unmet need for ARVs in Russia. WHO estimates
that only 1,000 out of an estimated 50,000 in need of treatment
are currently receiving ARVs. Clear gaps in treatment include
the need to look at TB/HIV co-infection and multi drug resistant
TB (MDR-TB)
59. All DFID-supported AIDS interventions in
the region are fully consistent with Taking Action and are in
line with the Three Ones principles. Some specific examples of
DFID support include:
— DFID is providing £6.4 million
over four years to the Central Asia Regional HIV Programme, which
focuses on scaling-up harm reduction strategies with government
and NGO partners. Support is also provided to the regional UNAIDS
office (2-years £500k).
— £0.6 million over two years
is provided to the Russia UNAIDS 3-Ones Facility project.
— £0.5 million over two years
is provided to the Ukraine UNAIDS 3-Ones Facility project to support
flexible technical assistance delivered through UNAIDS cosponsors
to support the government's response to HIV and AIDS.
— DFID provides £1.5 million
over 3 years to Serbia and Montenegro's Regional HIV project.
Overseas Territories
60. Most Overseas Territories (OTs) (Montserrat,
Anguilla, Pitcairn, St Helena, and Turks and Caicos Islands) have
national AIDS plans. St Helena is in the process, with help from
DFID, of developing one. The plans are based on an expanded response
and include prevention and treatment. The priority in the OTs
is still prevention, as many have low prevalence. All OTs, where
there are HIV cases, have ART available.
61. Priorities for 2006 include: improve expanded
response through a new DFID-supported regional programme; improve
involvement of Caribbean OTs in regional programmes through EU
funding; ensure St Helena remains HIV free.
Caribbean
62. Small island states should work more collaboratively
to procure lower cost ARVs. The Pan-Caribbean Partnership Against
HIV and AIDS (PANCAP) has developed a collaborative agreement
with support from DFID with Brazil for south-south technical cooperation
and provision of free first line ARVs for countries in the Organisation
of Eastern Caribbean States (OECS). DFID funding for the Clinton
Foundation in close cooperation with the regional Pharmaceutical
Procurement Service (PPS) has slashed procurement costs from $1,200
at the start of the programme to $275 per patient per year (for
AZT 3TC and NVP). Second line treatment is now $532, down from
over US$4,000. There remains a need to maintain a balance between
effective prevention and the provision of treatment given a tendency
in Caribbean programmes to focus too heavily on provision of treatment.
63. Stigma and discrimination is a major factor
in the spread of HIV in the region, causing people to not present
for care and treatment. DFID is working with CIDA and PANCAP on
programmes to tackle stigma and discrimination.
Latin America
64. DFID is supporting Brazil in maintaining
and expanding its leading role in the local manufacture and distribution
of generic ARV drugs, particularly first line treatments. Brazil
is playing a key role in negotiating with multi-national drug
companies to significantly reduce the costs of second line ARVs.
Brazil is also providing technical assistance and advice on local
generic manufacture to Russia, China, Thailand and India.
65. DFID is working jointly with the government
of Brazil, UNAIDS and the German Technical Cooperation Agency
(GTZ) on a new International Technical Cooperation Centre (ITCC),
the first of five centres (three others in Africa, one in SE Asia)
to develop south-south technical cooperation. DFID, with GTZ,
is also supporting south-south cooperation in Latin America, including
Brazil's support for first-line ARV treatments for 10,000 people
in Bolivia, Ecuador and Peru, which is soon to expand to cover
Honduras and Nicaragua.
66. Expertise from Brazil is also critical in
improving the technical quality of AIDS programmes in the region.
Brazil strongly believes that universal access cannot be achieved
without a strong rights-based approach. Brazil has been leading
on innovative prevention strategies, involvement of civil society,
involvement of the private sector and encouraging greater involvement
of faith-based groups. There is a need to increase the focus on
stigma and discrimination, a major factor in Central America and
the Andes, and maintain a balance between effective prevention
and the provision of treatment.
67. DFID was the earliest supporter of the south-south
model of technical cooperation, supporting Brazil and helping
them expand into other parts of Latin America. This is now expanding
into the Caribbean (PANCAP and OECS see above), Lusophone countries
in Africa, and collaborative ventures with Portugal are under
discussion. DFID inputs, through the Latin America regional programme,
have been relatively modest (£1 million) but have started
the work and encouraged the later involvement of GTZ and UNAIDS.
DFID will provide additional inputs for the development of the
ITCC and a second phase of the Latin America Regional Programme
(estimated £2 million).
Taking action in the long term
68. In Taking Action the UK committed to increase
our support for research into: microbicides; treatments and new
technologies for the poor, women and young people; and the social,
economic and cultural impact of AIDS.
69. DFID continues to support R&D for new
technologies to prevent HIV, including significant funding for
microbicide development and funding to Product Development Public
Private Partnerships (PDPs) for the development of HIV vaccines.
70. The UK was the first government to fund the
International AIDS Vaccine Initiative (IAVI), with an initial
grant of £200,000 in 1998. This was followed by a grant of
£14 million for 2000-05. An additional grant of £4 million
was made for 2005-06. Further multi-year funding is currently
under review. DFID is also supporting microbicide research, and
provided an initial grant of £16 million to the MRC for the
Microbicide Development Programme (MDP) in 2001. In 2005 an additional
£23.8 million was provided to support Phase Three clinical
trials for the leading MDP microbicide candidate, PRO 2000. A
grant of £1.2 million (£300,000 per year for four years)
was provided in 2002, to support the International Partnership
for Microbicides (IPM) work on microbicide research, policy and
advocacy. Further funding for IPM is currently under consideration.
71. In 2005 DFID's Central Research Department
launched nine Research Programme Consortia on health in developing
countries, including work on communicable diseases, sexual and
reproductive health, maternal health and HIV. DFID has also funded
research on the appropriate use of existing medicines in developing
country settings including, clinical trials demonstrating the
efficacy of cotrimoxazole prophylaxis in reducing mortality among
children living with HIV and co-funding of the DART Trials with
the MRC exploring HIV treatment modalities in resource limited
settings.
72. The UK has also been active in developing
innovative financing to encourage additional R&D investment
into treatments and vaccines for diseases disproportionately affecting
developing countries, including for HIV and AIDS. R&D tax
credits for small and medium sized companies were introduced in
2000, and for large companies in 2002. In 2003 the "Vaccine
Research Relief" was introduced for R&D investment on
HIV, TB or malaria treatments or vaccines focused on the needs
of developing countries. The UK has worked with G8 partners to
develop proposals for "Advance Market Commitments" as
a "pull incentive" for priority vaccines, such as for
HIV. Under such proposals, donors would commit in advance to guarantee
a developing country market of a certain size for a new vaccine
that meets pre-agreed criteria (eg for efficacy).
73. DFID has also provided support to the WHO
Commission on Intellectual Property, Innovation and Public Health
(CIPIH), which is exploring how investment in and access to new
public health goods that better meet preventive and therapeutic
health needs can be increased.
Accountability and monitoring
74. DFID is held accountable through internal
and external scrutiny, including through the Public Service Agreement
which sets our objectives and how we intend to achieve them, the
DFID Departmental Report which reports on progress towards the
Public Service Agreement targets, and Resource Accounts, which
are primary financial statements recording the full costs of activities,
assets and liabilities as well as providing information on how
resources have been used to meet objectives.
75. DFID, through Ministers, is held accountable
to Parliament, including through individual MPs and parliamentary
committees. In the period from November 2004 to November 2005
DFID received a total of 467 letters from MPs on HIV and AIDS.
Over the same period DFID Ministers responded to 44 Parliamentary
Questions on HIV and AIDS. DFID's work is audited by the National
Audit Office, with the last audit of work on AIDS in 2004. In
addition, DFID is subject to scrutiny from the general public,
the media, NGOs and the private sector.
76. In terms of internal monitoring of the effectiveness
of Taking Action, two independent evaluations are planned. Both
will concentrate on the work of DFID, which is the lead government
department, but will also look at some work of other government
departments. An interim evaluation will take place in 2006 and
a final evaluation in 2008-09. The objective of the interim evaluation
is to produce recommendations in four areas:
— to improve implementation and monitoring
of the current strategy
— on indicators of success to be used
in the final evaluation
— for the UK Government's next steps
on AIDS and
— lessons for other UK (especially
DFID) strategies on development issues.
77. The final evaluation will be for accountability
purposes and is expected to concentrate on assessing the overall
effectiveness and efficiency of the policy and its implementation.
Policy coherence on HIV/AIDS across Whitehall
78. The UK's work to tackle HIV and AIDS in developing
countries requires concerted and coherent work across Whitehall,
led by DFID. Key issues are noted below. Much of this work is
coordinated through two formal Cross-Whitehall Groups. The
Cross-Whitehall Coherence Group on Tackling HIV and AIDS in the
Developing World comprises representatives from No 10, HMT,
FCO, Home Office, Department of Health, DTI, MOD, NAO, HMRC, Patent
Office, Scottish Executive and Welsh and Northern Irish Assemblies.
Many of these departments are also on the Cross-Whitehall Group
on Access to Medicines, including representatives of HMT,
FCO, Home Office, Patent Office, and DTI.
79. DFID, No 10, the FCO and HMT have worked
closely and with other departments through 2005 on issues of international
development and financing (including aid and debt relief) and
specifically on G8 and EU commitments on HIV and AIDS, including
the G7 Finance Ministers and G8 Africa communiqué text
on AIDS treatment.
80. DFID has worked extensively across Whitehall
to further the UK Government's work to increase access to medicines
in developing countries, including for the treatment of HIV and
AIDS. This is an area that relates to many departments work areas.
Key issues include: trade policy, and specifically the Trade Related
Aspects of Intellectual Property (TRIPS) agreement; R&D incentives
for diseases affecting developing countries; engagement with the
pharmaceutical industry.
81. The 2001 Doha Declaration on TRIPS and Public
Health and the 30 August 2003 Decision on compulsory licensing
for export have provided a balanced framework that respects the
importance of intellectual property rights and the need for countries
to have the flexibility to important generic medicines where needed.
DFID worked with Whitehall Departments, notably the Patent Office
and DTI, on the UK's position in the run up to the 30 August agreement,
and on the subsequent EU legislation implementing the 30 August
Decision, and the EU's position at the WTO for how the TRIPS agreement
needs to be amended to permanently reflect the Decision.
82. The UK has taken a lead internationally in
developing innovative incentives to promote R&D for diseases
affecting developing countries. These include the R&D tax
credits introduced in 2000 and 2002, and the Vaccines Research
Relief introduced in 2003 which specifically seeks to incentivise
the development of treatments and vaccines for HIV, malaria, and
TB. In addition, Advanced Market Commitments represent a significant
opportunity to accelerate the development of a preventative vaccine
for HIV. The development of these initiatives has involved close
collaboration across Whitehall, and particularly with HMT and
HMRC.
83. DFID has also worked closely with Whitehall
Departments, including HMT, DTI and the Department of Health as
part of the department's engagement with the pharmaceutical industry.
This engagement led to the development of Increasing poor people's
access to essential medicines in developing countries: a framework
for good practice in the pharmaceutical industry, which was
jointly published by DFID, the DTI and Department of Health in
March 2005.
84. Shortages of health workers are an obstacle
to progress in expanding access to services including the provision
of AIDS treatment in a number of countries, particularly in sub-Saharan
Africa. Three of the factors compounding health worker shortages
are:
— Chronic under-investment in health
systems and services.
— HIV and AIDS is tipping already
stressed systems in some countries into crisis.
— Movement of health workers to non-health
sector jobs, and to wealthier countries.
85. Over the last two to three years there has
been increasing global attention directed to the shortages of
health workers, particularly in sub-Saharan Africa, and increasing
national and international initiatives to find appropriate solutions.
86. DFID is supporting country-led, systemic
approaches to increase the supply of health workers. This includes
increasing training capacity, improving working conditions, pay
incentives, morale and motivation, effective and active management.
Although the primary agenda is long-term, DFID is working with
the international community to identify fast-track efforts and
to accelerate the availability of health workers where countries
are facing acute shortages. One example is DFID's support to the
government of Malawi's Emergency Human Resource Programme, which
will almost double the number of nurses and triple the number
of doctors in Malawi over the next six years.
87. In addition to the work that DFID does to
support many countries to address the "push" factors
associated with migration of health workers (low morale, poor
pay, career paths and working conditions generally, including
lack of supervision, poor housing, workloads etc), the UK also
has systematic policies that prevent the targeting of developing
countries in the international recruitment of health care professionals
including:
— Guidance and a recently revised
Code of Practice embodying ethical principles for the international
recruitment of healthcare workers.
— An agreed list of developing countries
that should not be targeted for recruitment.
— A Memorandum of Understanding has
been signed with South Africa, that will give opportunities for
exchange of knowledge and skills.
88. The UK is also putting significant investment
into the expansion of training of healthcare professionals to
meet our healthcare needs, for example, the numbers of nurses
and midwives entering training in England is currently increasing
year on year.
89. The UK has extensive and comprehensive services
available to treat and care for people with HIV and AIDS. DFID
contributes to the work of other Whitehall departments, notably
the Department of Health and Home Office, on issues related to
access to HIV services by immigrants, including in terms of charges
for overseas visitors. Under the provisions of the NHS (Charges
to Overseas Visitors) Regulations 1989, as amended, treatment
for HIV is not free if the patient is an overseas visitor liable
to pay for any hospital treatment received. The regulations also
contain a large number of exemptions from charges so that, for
example, asylum seekers and people coming here to work are eligible
for free NHS hospital treatment, including HIV treatment.
90. To mark World AIDS Day this year DFID, working
with other departments under the banner of the EU Presidency are
hosting a High Level meeting of Ministers for International Development
on 30th November, at which an EU Presidency Statement on HIV Prevention
agreed by the European Commission and all member states will be
launched.
91. A new UK government policy paper on harm
reduction relating to drugs use and HIV prevention in the developing
world will be launched for World AIDS Day. The paper builds on
cross-Whitehall consensus on harm reduction, ensuring a coordinated
and collaborative UK voice. DFID's work on harm reduction covers
needle and syringe access and disposal programmes, drug substitution
therapy and information/advice on sexual and reproductive health.
92. DFID, the FCO and the British Council developed
a joint HIV and AIDS workplace policy in 2002. This covered a
number of "good practice" management policies including
the principle of non-discrimination against HIV positive staff
and provision of voluntary counselling and testing on a confidential
basis. DFID, the FCO and the British Council amended the policy
in 2005 to extend provision of antiretroviral therapy so that
as well as employees and one partner, dependent children up to
the age of 21 would also qualify.
November 2005
1 The Three Ones Principles are one agreed AIDS Action
Framework for each country that drives alignment of all partners,
one national AIDS authority, with a broad-based multi-sectoral
mandate and one agreed country-level monitoring and evaluation
system. Back
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