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Memorandum submitted by Professor A 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.[1] 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 harmonize 'the current disparate response to HIV and AIDS'. It 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 free at the point of delivery. 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 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. Yours truly, Alan Whiteside [1] Commission for Africa, Our Common Interest: Report of the Commission for Africa, March 2005. Available from the website: www.commissionforafrica.org. |