Select Committee on International Development Twelfth Report


The AIDS epidemic continues to have a devastating impact in the developing world. 33 million people currently live with AIDS; every day nearly 6,000 people die and nearly 7,000 become infected. 12 million children are estimated to have lost one or both parents to the disease in sub-Saharan Africa.

Against the background of an ongoing global search for solutions to this epidemic, the Department for International Development (DFID) launched its new HIV/AIDS Strategy Achieving Universal Access: the UK's strategy for halting and reversing the spread of HIV in the developing world in June 2008.

DFID is widely acknowledged as a global leader in tackling HIV/AIDS, particularly amongst vulnerable and marginalised groups, including women and children. Its Strategy provides an excellent analysis of the challenges faced in tackling HIV/AIDS effectively. It makes substantial financial commitments, most notably £6 billion over seven years to strengthen health systems in partner countries. We wholeheartedly support this level of funding for health systems: HIV/AIDS will never be halted without well-resourced and capable health services in developing countries.

DFID has also allocated £1 billion over the same period for the Global Fund to Fight AIDS, Tuberculosis and Malaria. We agree that direct and specific HIV/AIDS funding of this kind continues to be necessary to fill the gaps in prevention and treatment services in high-prevalence countries. However, it is crucial that DFID ensures that the two funding streams are fully integrated to avoid some of the negative impacts which have occurred in the past.

Despite these significant funding commitments, we find the Strategy to be strong on rhetoric but weak in communicating how DFID will implement it. There are few measurable targets or indicators of how the Strategy's effectiveness will be assessed. DFID fails to explain how the high-level funding commitments will be broken down by country or sector, making it difficult to understand how implementation will occur on the ground.

No monitoring and evaluation framework has yet been provided for the new Strategy although DFID is expected to publish this very shortly. It is essential that this sets out specific targets and corresponding indicators so that it is possible to identify whether the programmes which DFID supports are achieving their aims.

We have concerns that social protection programmes, which are now DFID's main instrument for assisting children orphaned and made vulnerable by HIV/AIDS, will not be specifically targeted at this vulnerable group and may not reach children who live outside traditional households.

Women are more likely than men to be affected by HIV/AIDS. Gender inequalities and lack of financial empowerment mean that they are more vulnerable to infection and have less capacity to access prevention and treatment services. Gender-based violence is a frequent contributory factor in transmission of HIV infection. DFID fully acknowledges these problems but fails to set out in any detail how it plans to address them.

DFID has a strong record of assistance to people living with HIV who belong to so-called marginalised groups: intravenous drug users, sex workers, prisoners and men who have sex with men. However, the Strategy does not make clear what specific practical steps DFID will take to assist these vulnerable people in the future. The Strategy also fails to explain how DFID will engage with civil society to implement its pledges. Civil society organisations fulfil a crucial role in providing advocacy and services for people who suffer stigma and discrimination and are therefore much less likely than the general population to use state-provided health and social services.

The Strategy is best seen as laying the foundations for a new UK approach to tackling HIV/AIDS in developing countries. The challenge remains for DFID to build on this and to make clear to all stakeholders, and particularly partner countries, how these plans will be taken forward. This needs to be done soon. The overall aim of the Strategy is universal access to HIV prevention, treatment and care, but the target date for achieving this is only two years away in 2010.

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Prepared 30 November 2008