DFID's role in achieving the international
targets on HIV/AIDS
2. The international community has found significant
financial resources to begin to meet the commitments it has made
on HIV and AIDS. The US$8.3 billion dedicated to responding to
the pandemic in low- and middle-income countries in 2005 is within
the target range of US$7-10 billion set out at the UN Special
Session in 2001.[9] While
we welcome this funding commitment and the consequent scaling
up of programmes, we are concerned that evidence from UNAIDS suggested
that a funding gap remains.[10]
More worrying still is the fact that, despite progress towards
global funding targets, universal access to anti-retroviral therapy
(ARVs) and the prospect of halting and reversing the spread of
HIV, what might be called 'outcome targets' rather than 'funding
targets', appear some way off. [11]
Adequate funding is a means not an end. Outcomes such as fewer
infections and more people on appropriate treatment are the underlying
aims of action on HIV/AIDS. If these programmes are not delivering
the necessary outcomes fundamental questions arise about the focus
of the programmes into which international funding is being channelled.
The UNAIDS 2006 Report found that:
"While funding for HIV programmes has increased
in recent years, many countries fail to direct financial resources
towards activities that address the prevention needs of the populations
at highest risk, opting instead to prioritise more general prevention
efforts that are less cost-effective and less likely to have an
impact on the epidemic."[12]
3. 2007 will be the mid-point between the Millennium
Summit and the 2015 deadlines for many of the MDGs, and there
remain just three years before other deadlines fall, such as the
Gleneagles G8 commitment on universal access to ARVs.[13]
As the time for setting targets recedes and deadlines for achieving
those targets draw nearer, a key period of delivery is approaching
for donors and the developing world alike. Leadership by respected
development agencies such as DFID will be critical. In our 2005
Report, we commended DFID for the "important role which it
played in securing the G8 commitment to universal anti-retroviral
treatment provision by 2010".[14]
In evidence to the Committee, Plan UK argues that DFID should
continue "to provide political leadership to ensure that
the world comes as close as possible to the goal of universal
access".[15] DFID
believes that it is doing just that:
"The UK is the second largest bilateral donor
to AIDS, committing £1.5 billion to AIDS work over the period
2005-2008… [and] The UK has helped influence international
discussion on the importance of comprehensive prevention strategies"[16]
4. DFID's Parliamentary Under-Secretary of State,
Mr Gareth Thomas, explained how DFID's strategy relies heavily
on effective national HIV/AIDS plans:
"I think the targets for the response to AIDS
must be country-owned and they must be put in place by the country.
Ideally they should be targets which the whole of the donor community
in a particular country endorse … I think we can show how
our programmes have made a difference … but our approach
is not to have separate targets ourselves but to come in behind
the targets that countries themselves set."[17]
We understand that DFID is in the process of making
an interim evaluation of Taking Action, the UK strategy
on HIV/AIDS in the developing world.[18]
We fully support efforts to measure progress in the implementation
of such strategies and look forward to the results of the evaluation.
We accept that DFID's strategy of support for effective national
HIV/AIDS plans is vital if developing countries are going to meet
the targets they set themselves. We do not, however, accept that
DFID support for national HIV/AIDS plans and transparent benchmarks
for DFID's contribution to the achievement of international 'outcome
targets' are mutually exclusive. We
are concerned that DFID's indicators of success are linked primarily
to funding targets rather than to outcomes.
We recommend
that in the interim and final evaluations of Taking Action,
success is measured against transparent 'outcome indicators' as
well as 'funding indicators'. Outcome indicators should set out
DFID's contribution to achieving the international targets on
HIV/AIDS treatment, prevention and care.
Whitehall policy coherence on
HIV/AIDS in the developing world
5. In our 2005 Report, we looked principally at DFID,
the lead Government Department on HIV/AIDS in the developing world.
We also looked at other Departments which have responsibilities
in this area and at the relationship between Departments.[19]
In Taking Action, DFID undertook to "Improve coherence
across UK policy-making on AIDS by establishing an informal cross-Whitehall
working group on AIDS".[20]
6. Despite efforts at improved Whitehall coherence,
evidence from the International HIV/AIDS Alliance (IHAA) noted
the need for closer cooperation on the Government's international
action on HIV/AIDS and in particular between DFID and the Foreign
and Commonwealth Office (FCO):
"Significant gains in HIV prevention and impact
mitigation could be made through UK efforts outside the remit
of the Department for International Development. The Foreign Office's
efforts aimed at promoting good governance, respect for human
rights, democratic principles and sound management of natural
resources… do not currently adequately consider opportunities
to advance the UK's commitment to universal access to HIV treatment,
prevention and care." [21]
At present, the FCO does not have a specific desk
or unit to deal solely with HIV/AIDS issues.
7. In our 2005 inquiry, we were informed about a
lack of coordination and consultation between the Home Office,
FCO and DFID concerning access to ARV treatment for people living
with HIV who have failed in their application for asylum and deportation
of some people living with HIV.[22]
Evidence received from African HIV Policy Network and Naz
Project London suggests that the situation remains substantially
the same in 2006: people living with HIV in the UK without documentation
who have been refused asylum or leave to remain must routinely
pay for HIV/AIDS treatment while in the UK and may be returned
to countries where ARVs are "not practically available".[23]
The Parliamentary Under-Secretary of State said that payment was
an issue if asylum seekers wanted to start a course of treatment
after their application had been rejected.[24]
He viewed these issues as a question of balance "between
the needs of an individual who is HIV positive and the overall
need to ensure that we have a strong immigration system".[25]
We see
a clear contradiction between a policy of routinely charging those
failed asylum seekers who want to start a course of treatment
after their application has been rejected and Government advocacy
of the universal access goal. We believe that undermining the
needs of minority groups in this way is a denial of their human
rights and weakens DFID's international leadership on this issue.
We believe that DFID should play a role in ensuring that asylum
seekers living with HIV are not returned to countries where access
to ARVs is not practical. We regret that more progress has not
been made on these matters since our last report.
8. We are concerned
that Taking Action, although billed as the UK
strategy on HIV/AIDS in the developing world, is in reality only
the strategy of DFID. We recommend that DFID work closely with
other Departments, particularly the FCO and the Home Office, to
develop a truly integrated strategy for the UK's action on HIV/AIDS
internationally. This should draw the FCO fully into the governance
and human rights aspects of HIV/AIDS and the Home Office into
broader UK advocacy of the international goals on HIV/AIDS, such
as universal access to treatment.
4 International Development Committee, First Report,
Session 2005-06, Delivering the goods: HIV/AIDS and the provision
of anti-retrovirals, HC 708 Back
5
UNAIDS, Report on the global AIDS epidemic, May 2006, and
UNAIDS/WHO, AIDS Epidemic Update, December 2006 Back
6
Target 7 in Millennium Development Goal 6; the WHO '3 by 5' initiative
aimed to have 3m people in low- and middle-income countries on
anti-retroviral therapy by the end of 2005 (50% coverage). Back
7
http://www.fco.gov.uk/Files/kfile/PostG8_Gleneagles_Communique,0.pdf Back
8
International Development Committee, Delivering the goods:
HIV/AIDS and the provision of anti-retrovirals, HC 708, para
1 Back
9
UN, Declaration of Commitment on HIV/AIDS, June 2001 [A/Res/S-26/2] Back
10
Qq 3 and 4 [Dr Anindya Chatterjee] Back
11
http://www.fco.gov.uk/Files/kfile/PostG8_Gleneagles_Communique,0.pdf;
and Target 7 in Millennium Development Goal 6 Back
12
UNAIDS, 2006 Report, pp 14-15 Back
13
Another goal linked to 2010 is to have 80% of pregnant HIV-infected
women on ARVs which is in the 2001 UN Declaration on HIV/AIDS. Back
14
International Development Committee, Delivering the goods:
HIV/AIDS and the provision of anti-retrovirals, HC 708, para
2 Back
15
Memorandum submitted by Plan UK, para 34 Back
16
Memorandum submitted by DFID, para 3 Back
17
Q18 Back
18
DFID, Taking Action: The UK's strategy for tackling
HIV and AIDS in the developing world, July 2004 Back
19
International Development Committee, Delivering the goods:
HIV/AIDS and the provision of anti-retrovirals, HC 708, paras
9 and 10 Back
20
DFID, Taking Action, p 3 Back
21
Memorandum submitted by the International HIV/AIDS Alliance, para
11 Back
22
International Development Committee, Delivering the goods:
HIV/AIDS and the provision of anti-retrovirals, HC 708, para
10 Back
23
Memorandum submitted by Naz Project London, para 6 Back
24
Q 42 Back
25
Q 43 Back
