1 Introduction
1. Millennium Development Goal 6 is to combat HIV/AIDS,
malaria and other diseases by 2015. In 2005, under the UK presidency
of the G8 and the European Union, the international community
made a further commitment: to ensure universal access to comprehensive
HIV prevention, treatment, care and support by 2010.[1]
2. It has been our practice during this Parliament
to conduct an annual inquiry to assess the extent to which the
Department for International Development (DFID) is fulfilling
its pledges on HIV/AIDS. In 2005, we looked at provision of anti-retroviral
treatment; in 2006 we focussed on marginalised groups; and in
2007 we integrated our work on HIV/AIDS into our inquiry into
Maternal Health.[2] DFID's
role as a global leader on HIV/AIDS is widely recognised. The
launch in June 2008 of the Department's updated HIV/AIDS Strategy,
Achieving Universal Access:
the UK's strategy for halting and reversing the spread of HIV
in the developing world, therefore provided
an obvious focus for our inquiry this year.
3. The main elements of DFID's 2008 strategy are:
- £6 billion over seven
years targeted at health system strengthening;
- £1 billion for the Global Fund to Fight
AIDS, Tuberculosis and Malaria to 2015;
- A pledge to work with others to increase to 80%
the percentage of HIV-infected women who receive anti-retroviral
treatment by 2010 to reduce the risk of mother to child transmission;
- An undertaking to work with international partners
to provide at least 2.3 health professionals per 1,000 population;
- A commitment to work with others to halve the
unmet demand for family planning by 2010 and to achieve universal
access by 2015;
- £200 million to support social protection
programmes over the next three years to assist children orphaned
and made vulnerable by HIV/AIDS;
- A 50% increase in funding for research and development
of AIDS vaccines and microbicides;
- £90 million channelled through UNITAID to
increase access to paediatric care.[3]
The scale of the challenge
4. Since DFID's 2004 Strategy Taking Action[4]
was launched, some progress has been made in tackling the HIV/AIDS
epidemic. The percentage of the world's adult population living
with HIV has levelled off although the absolute number is still
rising; the number of people with access to anti-retroviral treatment
reached three million in 2007, reducing the number of HIV related
deaths; and the cost of front line drugs has dropped below $100
per unit for the first time.[5]
5. However the AIDS epidemic continues to pose a
huge challenge in the developing world. More than 33 million people
are living with HIV and nearly 7,000 more become infected every
day. Prevention services are still not reaching a large proportion
of marginalised groups which include sex workers, intravenous
drug users, men who have sex with men and prisoners.[6]
As well as the human costs of the AIDS epidemic, it poses a severe
threat to economic development, security, and public services
in many countries. Tackling the disease therefore remains central
to effective development assistance.
Structure of our Report
6. DFID's new Strategy (and its accompanying evidence
volume[7]) provides an
excellent analysis of the challenges the world faces in tackling
HIV/AIDS and offers significant high-level funding commitments
to take forward DFID's work in this area, which have been welcomed
by our witnesses and which we fully support. But as the Minister
himself admitted in oral evidence:
Nobody has questioned DFID's mission or its strategy
but there are some serious questions to be asked about delivery
and also about our interaction with donors, with NGOs and with
governments in terms of achieving what we say we want to achieve.[8]
We share the concern that many questions remain to
be answered about delivery of the Strategy. Our Report therefore
seeks to highlight the areas where we believe DFID needs to provide
more detail and explanation than is given in the Strategy document.
In particular we will examine:
- how the funding will be allocated
and spent and the steps which will be taken to ensure that it
specifically benefits people living with HIV and AIDS (Chapter
2);
- the action DFID will take to tackle the interaction
between HIV/AIDS and other diseases, particularly tuberculosis
(Chapter 3);
- how the disproportionate impact of HIV/AIDS on
women, children and other vulnerable and marginalised groups can
be mitigated (Chapters 4 to 6);
- how DFID intends to involve civil society in
delivering the Strategy (Chapter 7); and
- how DFID plans to monitor and evaluate the Strategy
(Chapter 8).
We hope that some of these issues will be clarified
when DFID publishes its Monitoring and Evaluation Framework for
the Strategy, which was not available to us in preparing this
Report but which the Minister told us would be available on World
AIDS Day on 1 December 2008.[9]
7. In the course of this inquiry, we received written
submission from 16 organisations and individuals. We held two
oral evidence sessions: the first was with non-governmental organisations
(NGOs), activists and academics, including by videolink with Lucy
Chesire, an HIV/TB advocate based in Kenya. The second session
was with Ivan Lewis MP, Parliamentary Under-Secretary of State
for International Development and DFID officials. We would like
to thank all those who contributed to our inquiry.
1 DFID, Achieving Universal Access: the UK's strategy
for halting and reversing the spread of HIV in the developing
world, June 2008, Foreword Back
2
International Development Committee: First Report of Session 2005-06,
Delivering the Goods: HIV/AIDS and the provision of anti-retrovirals,
HC 708-I; Second Report of Session 2006-07, HIV/AIDS: Marginalised
groups and emerging epidemics, HC 46-I; Fifth Report of Session
2007-08, Maternal Health, HC 66-I Back
3
Achieving Universal Access, pp 4-5; Ev 34 Back
4
DFID, Taking Action: Summary of the UK's strategy for tackling
HIV and AIDS in the developing world, 2004 Back
5
Achieving Universal Access, pp 1 and 8 Back
6
Achieving Universal Access, p 8 Back
7
DFID, Achieving Universal Access - Evidence for Action Back
8
Q 106 Back
9
Q 72 Back
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