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The UN Report on HIV/AIDS in 2006 shows that Africa remains the region hardest-hit by the HIV/AIDS pandemic. It also highlighted emerging epidemics in Eastern Europe and Asia. These new epidemics are often being 'driven' by groups that are marginalised in these societies, including commercial sex workers, intravenous drug users, men who have sex with men, and prisoners. The existence of these groups is often denied or the illegal nature of their activity means that governments fail to take action appropriate to their needs.
Questions of morality are not the issue: what is important is finding the most effective way to halt the spread of HIV/AIDS. Emerging epidemics generally start with concentrated epidemics among marginalised groups and can then spread to the wider population. Countries may then face a hyper-epidemic where HIV can spread exponentially — as can be seen in many southern African countries. To combat epidemics effectively, the rights and needs of those most at risk must be as central to strategies as are treatment and prevention.
It is right that DFID and the international community are channelling money to countries' national AIDS programmes. DFID must work with governments to ensure that these programmes are properly focused and that the rights and needs of marginalised groups are not overlooked. Marginalised groups are in fact key to an effective response to the epidemic. Therefore, AIDS prevention programmes which target the general population should not be getting the lion's share of the resources made available by the international community.
There is no one-size-fits-all response to HIV/AIDS epidemics. National programmes should be based on careful assessments of local need. Africa has carried the heaviest regional HIV/AIDS burden for decades and has seen a wide range of responses employed. As a key development partner in Africa, DFID has a valuable perspective on these responses and on best practice that most national governments facing new epidemics will not have. DFID must ensure best practice in Africa is shared with governments elsewhere, especially in Asia and Eastern Europe.
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