Examination of Witnesses (Questions 20-39)
MR GARETH
THOMAS MP, MR
ANDREW ROGERSON
AND MS
ROBIN GORNA
16 NOVEMBER 2006
Q20 Chairman: In response to that,
the Committee did obviously hear about that programme when we
were in Malawi and it is very encouraging to hear that it had
that effect. Is that a net figure, in other words that 700 returned?
Are they still leaving as well or have you managed to stop that
process?
Mr Thomas: My understanding is
that the numbers leaving have dropped to a trickle. I did add
a rider, that it is a bit early to make conclusive judgments,
but certainly the initial evidence is encouraging.
Q21 Chairman: That is helpful. You
have said that you are in the process of reviewing and evaluating
where you are at. Is this likely to lead to a stated change of
response? Having done the review are you likely then to say, "We
have evaluated it and on the basis of this we are going to have
to change or reprioritise"? Is that the objective?
Mr Thomas: One thing that the
Secretary of State and I have both acknowledged previously is
that we need as a Department and as Ministers to be better at
demonstrating results about aid programmes. We are confident internally
that our aid programmes on AIDS as well as across a variety of
other spectra are making a substantial difference. I recognise
that the House has asked a number of times for us to give further
information and further clarity about the results that we are
having. I think the evaluation will help with that but the whole
point of having a review under way is so that we have a look at
the full range of the work we are doing and come to some conclusions
at the end of that review process.
Chairman: That is why I have not asked
you the question that is down here, because I thought you would
answer in that way.
Q22 James Duddridge: For the record,
I have replaced the late Jeremy Hunt and, as was described, he
has moved onto the Front Bench of the Conservative Party, which
is hopefully a fate better than death.
Mr Thomas: I would think that
is relegation or demotion.
Q23 James Duddridge: Minister, you
will find me equally passionate about AIDS, particularly in sub-Saharan
Africa where I spent much of my career before coming to the House
of Commons, but increasingly the geographic reach of AIDS is moving
away from sub-Saharan Africa. How is the Department coping with
that geographic move, particularly in relation to the epidemic
in Eastern Europe and Central Asia?
Mr Thomas: I think you are right
to highlight that whilst the numbers and proportion of the population
in Africa are particularly high in terms of AIDS, we face rising
problems in Asia, in Latin America and the Caribbean, and indeed
in Eastern Europe. My understanding is that on current trends
the numbers of people as opposed to the prevalence rates in Asia
will be higher than for Africa by 2010 if things do not change.
HIV/AIDS is an increasing part of our discussion with the various
countries that we work in, Asia, for example. If we take India
as one example, we have a £123 million programme through
to next year under way. We are working in some eight states, in
particular looking at the needs of marginalised groups in those
states, and our interventions have helped the Indian Government
to scale up their AIDS programmes to support the needs of those
marginalised groups. Given the original focus, as I understand
it, of this inquiry, I think it is particularly appropriate to
say that in Asia at the moment the epidemic is predominantly concentrated
among the groups that I have described—sex workers, men
who have sex with men, injecting drug users and prisoners, and
it is there that we need at the moment to concentrate our response,
and we are working, as I say, with a variety of governments to
do just that.
Q24 James Duddridge: It is particularly
worrying in India given that that sounds like the early stages
of the epidemic before it spreads much more widely and quickly.
More generally, how flexible is the funding and planning of DFID
to a new epidemic within a region? We have heard a lot about the
key populations and there seems to be the potential for an epidemic
to take part in a new part of the world and drive forward pretty
rapidly because of the nature or concentration of those key populations.
Mr Thomas: AIDS is an issue in
every part of the world and in the countries where we have an
established tradition of working it is part of the dialogue that
we have with countries. For example, in the Caribbean we have
an AIDS programme. In particular we are working with the private
sector in the Caribbean because of the tourist trade, for example,
and indeed to make sure that we are explaining to people what
they need to do to protect themselves from HIV infection and to
look at the contribution that business could make there in helping
to get those protection messages out. We are working in Latin
America, for example, with centres which UNAIDS have set up in
Brazil, looking to spread best practice across the region, and
our harm reduction programmes, for example, in Serbia, have been
used as a model by the government for scaling up their harm reduction
work across their country. Similarly, we have had effective work
done in Ukraine, which again has influenced the government to
take forward that work and tackle harm reduction initiatives.
Q25 Mr Davies: Mr Thomas, I gather
that the Government have set up a cross-Whitehall HIV/AIDS Cohesion
Group, I think it is called. Can you tell us how often that group
has met and when it last met?
Mr Thomas: I will bring Ms Gorna
in to tell you the specifics of when it last met, but it discusses
a whole range of issues from the extent to which AIDS is a topic
for G8 presidencies to the policy we should be asking our G8 Sherpa
to be articulating to other G8 Sherpas. We have discussed the
evaluation and process for our aid strategy at that working group.
When we develop a new policy, for example, we developed a policy
last year on harm reduction, that was discussed within that working
group. I will now bring Ms Gorna in to give you the specifics
about when the committee last met.
Ms Gorna: The cross-Whitehall
Working Group on AIDS meets three times a year, so the next meeting
will be in January. We had a meeting two months ago. It brings
together the Ministry of Defence, the Foreign and Commonwealth
Office, the Department of Health, the Home Office, the Department
of Trade and Industry, the National Audit Office, the Treasury,
Revenue and Customs, the Patent Office, the Scottish Executive,
the Welsh Assembly and the Northern Ireland Assembly, and the
Department for Culture, Media and Sport is also joining. In addition
to the areas the Minister mentioned we have also been looking
at workplace policies across Whitehall and also at the Access
to Medicines Agenda which has its own separate focus within the
group.
Q26 Mr Davies: Gosh! How many people
do you have round the table when you meet?
Ms Gorna: Quite a few. We often
have about 20 people round the table.
Q27 Mr Davies: What difference has
this group made? What has been achieved which would not in your
judgment have been achieved without it?
Mr Thomas: One of the issues,
for example, that we need by way of support is the active involvement
of all our embassies on occasion to get messages across in the
run-up to UN General Assembly special sessions on AIDS, where
there was an intense debate about the language that we needed
to include in the outcome document from that statement. That was
one of the issues that was discussed at the Whitehall meeting.
It helps to make a difference in galvanising discussion and, on
occasion, galvanising the activity of other departments when it
is appropriate in the work that we seek to do.
Q28 Mr Davies: You have not actually
answered my question. I did not ask you what sort of matters were
discussed. I asked what the group had achieved. You do not need
the presence of people from HM Revenue and Customs and from the
Patent Office in order to talk to the Foreign Office. You have
a whole range of interfaces with the Foreign Office right across
the globe. What actually has been achieved as a result of the
constitution of this group which in your judgment would not have
been achieved had that group not existed?
Ms Gorna: Perhaps the most significant
issue, which I think was mentioned in the previous evidence session,
is the harm reduction policy. That is a cross-Whitehall policy
clarifying the approach to injecting drug users and ensuring that
we have a coherent whole-of-government approach across the Department
of Health's work within the UK and our work internationally, and
that is not the case with some other governments. My understanding
is that through the efforts of the FCO and others that has also
enabled us to interface most effectively with the UN agencies
concerned with drug use and harm reduction. That was launched
on World AIDS Day last year and has been used extensively by other
governments and by the UN as well as by ourselves to drive that
forward. Secondly, in terms of our engagement on the G8 and in
the EU, we have had a common position across government that has
been achieved through that group.
Q29 Mr Davies: It is my impression,
Mr Thomas, purely a personal impression, that in those areas of
the world most affected by AIDS, in Africa and Asia particularly,
there has been a considerable failure of leadership by local politicians
in addressing the issue, a great reluctance to talk about the
issue, and an attempt to cover up when prominent people die of
AIDS which we would hope might have a shock effect if due publicity
was given to it. Sometimes, frankly, deplorable misguidance is
given by leaders, and I think Mr Mbeki's statement some years
ago that he thought there was no connection between HIV and AIDS
was particularly deplorable. I wonder to what extent you, the
Secretary of State or your Foreign Office colleagues, in private
conversation with politicians in those countries have been able
to persuade them to look again at the case for a rather stronger
degree of leadership being given by local politicians on this
issue.
Mr Thomas: I think to say that
there has been a failure of leadership by all politicians in the
most affected parts of the world is unfair.
Q30 Mr Davies: Please do not distort
my question by rephrasing it in an absolute way in which it was
not actually formulated.
Mr Thomas: Okay.
Q31 Mr Davies: If you would just
answer it I would be very grateful.
Mr Thomas: You referred specially
to South Africa and I will answer the question about South Africa.
I think there are examples in many parts of Africa where there
has been significant political leadership, leadership from the
very top. The President of Malawi, for example, has spoken out
on AIDS and a series of other cabinet ministers, for example,
in Malawi have spoken out.
Q32 Mr Davies: Would you agree with
my characterisation of President Mbeki's remarks on the subject?
Mr Thomas: They were comments
that I certainly did not agree with and I welcome the change of
policy that appears to be taking place in South Africa. I would
pay tribute to the work of a whole group of NGOs in South Africa
who have led the effort to try and get the policy changed.
Q33 Mr Davies: My question did not
address NGOs.
Mr Thomas: You also asked whether
we had done anything.
Q34 Mr Davies: I asked whether you
took advantage of the opportunities to have private conversations
with politicians of these countries to raise this matter—
Mr Thomas: Yes, we do.
Q35 Mr Davies: —which is probably
most effectively raised informally.
Mr Thomas: Yes, we do take the
opportunity to raise these issues both formally and informally.
Our Ambassador in South Africa made a series of representations
to President Mbeki and his government on this issue. I know the
Secretary of State has raised these issues many times formally
and informally. On occasion, when I have gone to countries in
Africa I too have raised those issues and I have certainly raised
those issues in the countries that I have been to in Asia as well.
Q36 James Duddridge: Earlier we discussed
Uganda and the increase in AIDS after quite a successful ABC regime
and then the move towards just abstinence. Is the increase in
AIDS resulting from a reduction in the promotion of condoms in
Uganda something the British Government has been able to raise
with Museveni?
Mr Thomas: I need to check on
the specifics about the conversations that we have had with President
Museveni but we have certainly made clear that we want to see
a continuing increase in the availability of access to condoms.
I think we have made clear many times that whilst there is a role
for encouraging and supporting messages to particularly children
and young girls, supporting them to be able to resist starting
sexual activity at an early age, bluntly abstinence as a policy
in our view does not work, you do have to recognise the reality
of today and what some people might want to see as the practice
in particular countries we need to recognise is not the reality
and we need to put in place the policies to deal with that reality,
which is why trying to increase access to condoms is very important.
Frankly, the figures for access to condoms in Africa are deeply
concerning. At the moment there is an average of just eight condoms
available per adult man in Africa which is a ridiculously small
number. We do need to do more to increase the availability of
condoms and that is something we are working on with UNFPA[5]
and other bodies.
Q37 James Duddridge: Will you be able
to write to the Committee specifically relating to the issue of
to what extent these representations are helpful? President Museveni
and his family are particularly influential in this issue and
it would interest me to learn what representations you have been
able to make on behalf of the British Government.
Mr Thomas: I will be happy to
provide the Committee with exactly that answer[6].
Q38 Mr Davies: If I may say so, Mr Thomas,
my own impression is that the main problem in Africa is not so
much access to condoms, although that may be a problem in some
cases and certainly one that we should address, it is inclination
to use condoms, it is motivation to use condoms. I think that
is the biggest problem of all. I wonder whether there is any way
in which you think that issue can be addressed. Obviously it can
be addressed only by education, by PR of various kinds, and the
main role must be played local governments, it is not something
which can be imposed from outside, the message cannot be effectively
delivered from London or Geneva or New York. Are there any comments
you would like to make on that?
Mr Thomas: I agree with you that
education is as important as availability and local governments
have got to take the lead. There are things as donors that you
can do. We do support, particularly in South Africa and it is
now being rolled out across southern Africa as well, what is called
an "edutainment" programme, Soul City, which
seeks in a very populist way to get across messages about AIDS
and how to prevent yourself being infected with AIDS. Through
popular media and through funding popular media we can get prevention
messages across. You are right, the leadership has got to come
from local governments—donors can only support local governments—if
we are really going to make a difference on AIDS. Perhaps the
one caveat is the issue of Zimbabwe where there is not good political
leadership, as you, Mr Davies, and the Committee will know, and
where there is nevertheless a responsibility on the international
community to do as much as we can to get both prevention messages
across and improve availability of services. The Secretary of
State recently approved further funding to Zimbabwe to try to
continue to make a difference in that country. We have seen a
reduction in increasing prevalence in Zimbabwe and that certainly
is not down to the leadership of the government at a local level,
it is a result of the international community working together
with a series of quite brave NGOs and people committed to this
agenda in Zimbabwe.
Q39 Mr Davies: Yes. I spent a very
disturbing afternoon a couple of years ago with about 40 or 50
prostitutes in Nairobi, all of whom were HIV positive, none of
whom were receiving anti-retrovirals or had any prospect of receiving
them, all of whom were therefore dying and knew it. I had quite
a frank discussion and asked them why they had not used condoms
and universally they said, "Our customers won't accept it"
or "I needed to feed my family and I was only going to be
paid a reasonable amount of money if I did not use one".
They all knew perfectly well why they had ended up with HIV and
the problem was the one that I have just stated. It has occurred
to me for a long time that there is probably as much promiscuity
or commercial sex in any part of the globe as there is in Africa,
the difference is not the level of sexual activity, it is the
use or non-use of condoms. I think the Government is right to
put great emphasis on that. If I may say so, trying to encourage
people to use them is probably even more key to solving the problem
than making the things physically available.
Mr Thomas: While I agree with
you that education is absolutely fundamental I think your example
of the conversation that you had in Nairobi raises another issue
where we are working, and in a sense that is supporting groups
such as sex workers to come together to understand, first of all,
the issues you have just described and, secondly, to work together
on encouraging the clients who come into the areas that they are
living and working to use condoms. You might initially think that
is too difficult but we have funded for some time a clinic in
the Sonagachi area of Calcutta, which is a very similar area to
the area that you describe in Nairobi, and as a result of the
peer education work that that clinic has inspired the level of
infection among the sex workers in Calcutta is dramatically lower
than in other cities in India where that work is not as advanced
as it is in Calcutta. There are reasons for optimism. There are
programmes that do work around the world, but I accept your point
absolutely that education is key to making progress on it. What
I do not think we can say, and I accept you are not saying it,
is that we can relax on the issue of availability.
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