Memorandum submitted by Professor Alan
Whiteside, University of KwaZulu-Natal, Health Economics and HIV/AIDS
Research Division (HEARD)
Thank you for giving me the opportunity to submit
written evidence to this committee.
I am the Director of the Health Economics and HIV/AIDS
Research Division. I have been working on issues around HIV/AIDS
and development for nearly 20 years now. During this time I have
been engaged with DFID and a number of British institutions including
Universities. We are getting support from DFID for some of our
programmes. When I gave evidence in 2000 on the impact of HIV/AIDS
on social and development I gave DFID a C+ on a notional report
card. Since then there has been huge progress with the 2003 "UK's
Call for Action on HIV/AIDS", and the 2004 Treatment and
Care Policy and the UK Strategy. There have also been missed opportunities
and I think particularly of the Africa Commission which reported
in early 2005 and the Gleneagles Summit, where the ink was barely
dry before some countries began back tracking on "promises".
The Africa Commission's report proposed a "coherent package"
for Africa to address inter-related problems, simply rolling out
ARVs is not a coherent package. The Commission argued challenges
could only be met through a new kind of partnership and development,
based on mutual respect and solidarity, as well as an analysis
of what works in practice. With regard to HIV/AIDS we are still
not trying to analyse what works. The Commission's report identifies
the economic impact of HIV and AIDS as one of the two key challenges
to growth.[23]
It tries to consider AIDS as a cross-cutting issue and contains
some innovative ideas but the recommendations are predictable—specifically
with regard to HIV/AIDS it says that the international community
must reach global agreement by 2005 to harmonise "the current
disparate response to HIV and AIDS". I would suggest that
this something the select committee might address.
I would like to make a number of important points.
1. Prevention must remain the priority.
I am troubled by the global emphasis on ARVs. While I believe
providing therapy is crucial it seems that the response is becoming
too simple, medical and technical as I will outline below. It
is unbelievable that we should take our eye off prevention. All
our experience with health, in the rich and poor world alike,
tells us that prevention is better than cure. We also know in
broader development that we need to look at the root of issues.
This has been done with academic rigour and detailed policy analysis
in areas such as food aid and debt relief. It baffles me that
simplistic analysis is used with regard to HIV/AIDS. Even more
concerning is the tendency to brand anyone who raises questions
with regard ARVs is branded as a Luddite or Jeremiah (or even
Eeyore in the thistle patch).
2. Provision of Anti-retroviral therapy
needs to be expanded but it must be done in a planned manner.
At the moment we are faced with an unplanned expansion of treatment
in many settings as funds flow in specifically for the treatment.
One of the results is that health services are loosing staff to
ARVs programmes or even worse to the planning of treatment and
the result is that there are even fewer people to implement the
programmes.
3. Priorities. Governments, activists and
donors need to engage in a dialogue around priorities and this
should include listening specifically to the needs of women, the
poor and the marginal.
4. Capacity. Issues of human capacity are
not being addressed properly. It needs to be understood that it
is not just a case of providing medical staff but also ancillary
staff and facilities. This includes pharmacists, clerks and planners.
5. Anti-retroviral therapy should be free
at the point of delivery—even if it means that fewer people
are treated. Attached is a description of the "Free by five"
initiative which sets out why therapy must be free at the point
of delivery.[24]
6. The political leadership in the UK would
do well to listen to those who are trying to ensure a continuum
of development assistance. HIV is just one of the issues being
faced in the resource poor world. For example Lesotho recently
saw the loss of tens of thousands of jobs when foreign owned textile
factories closed in December 2004 and simply did not reopen in
January 2005; Swaziland faces late rains after several years of
drought. HIV is only one of the health issues—the fact that
the health sector is faced with a huge number of people seeking
care for AIDS related illness does not mean that malaria, malnutrition
or road accidents no longer place calls on the health service.
Having said that in many settings AIDS must be integrated into
development programmes—the catch phrases are mainstreaming
or cross cutting.
7. There are no easy answers. The idea that
throwing money, human resources and drugs at the HIV/AIDS epidemic
will provide answers is, at best naïve, and worst damaging
because if the numbers of infections continues to rise the ARV
treatment will be unaffordable.
November 2005
23 Commission for Africa, Our Common Interest: Report
of the Commission for Africa, March 2005. Available from the website:
www.commissionforafrica.org. Back
24
The "Free by 5" Campaign for Universal, Free Anti-retroviral
Therapy, Alan Whiteside and Sabrina Lee, August 2005. Copy placed
in Library. Back
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