6 Marginalised Groups
83. Our 2006 Report on HIV/AIDS focused on emerging
epidemics amongst what UNAIDS described as "marginalised
groups": sex workers, intravenous drug users, men who have
sex with men, and prisoners. We pointed out that, in some countries,
the existence of these groups is often denied or the illegal nature
of their activities means that governments fail to address their
needs.[159] We stressed
then that marginalised groups are central to an effective HIV/AIDS
response because they are frequently the 'drivers' of the epidemic:
infection becomes endemic within these groups and then spreads
out to the general population. We recommended that DFID ensure
that all the national programmes it supported tackled stigma and
discrimination and that social and legal barriers to prevention
and treatment were addressed. We also recommended that DFID work
with partner governments to ensure that HIV/AIDS programmes were
properly focused on marginalised groups and that their rights
and needs were not overlooked.[160]
84. In its written evidence, DFID acknowledged that
"stigma and discrimination remain major barriers to achieving
Universal Access and require urgent attention."[161]
The Strategy makes clear that DFID recognises that marginalised
groups "are most likely to be failed by existing policies,
programmes, support and services" and that "we will
collectively fail to address the epidemic if we fail to reach
these groups with appropriate services—which take into account
the realities of their lives".[162]
DFID accepts that it is often difficult to reach these groups
with effective interventions and that some national authorities
continue to deny the existence of some groups or classify their
behaviour as illegal.[163]
The International HIV/AIDS Alliance stressed that members of marginalised
and vulnerable groups "have limited trust in government"
to meet their needs and that they are often excluded from wider
political and social participation so that "general health
service development may continue to fail to meet their needs.[164]
MSF emphasised that "country plans often exclude vulnerable
groups" partly due to the "generalised, one-size-fits-all
approach which frequently neglects specific needs and gaps in
care delivery" and partly due to "stigmatisation and
the prejudice of planners".[165]
85. The Alliance acknowledged the leadership role
DFID has played in advocating for barriers to be removed which
prevent marginalised groups from accessing services and welcomed
the actions the FCO has taken to promote the rights of marginalised
groups through its policy position on lesbian, gay, bisexual and
transgender populations. But the Alliance believed that the Strategy
gave "inadequate attention to the challenges of meeting the
needs of key populations, including sex workers and MSM [men who
have sex with men]."[166]
Its Executive Director stressed in oral evidence that:
[…] containing the HIV epidemic requires stopping
the fastest growing epidemics, many of which are outside sub-Saharan
Africa, many of them are in middle income countries and many of
them are fuelled by key populations, by marginalised groups.[167]
86. We have set out earlier why we believe prevention
is vital. Effective prevention strategies which reach the 'drivers'
of the epidemic—marginalised groups—are clearly crucial
if DFID is to achieve its aim of halting and reversing the spread
of HIV. Alvaro Bermejo of the International HIV/AIDS Alliance
emphasised the need for interventions targeted on the needs of
marginalised groups. He gave the example of transgender individuals,
in India and Latin America, amongst whom HIV prevalence is around
40%, the highest sub-group prevalence in the world. He stressed
that no amount of funding channelled through health system support
would reach groups such as transgender individuals because they
are stigmatised and publicly-provided services cannot properly
cater for them. He believed that DFID's Strategy recognised this
need but did not specify how the challenge would be addressed.[168]
87. If the global
effort on HIV/AIDS is to achieve the goal of halting and reversing
the spread of the disease, it must be effective in reaching marginalised
people, including sex workers, intravenous drug users, men who
have sex with men and transgender individuals. If the epidemic
is not tackled in these groups it will continue to spread to the
general population and the number of people affected will continue
to increase. DFID's Strategy acknowledges this reality but does
not adequately explain how DFID will ensure that these marginalised
people are provided with the prevention, treatment and support
services they require. We would welcome further information on
DFID's plans in this area in response to this Report.
88. Civil society is particularly important in reaching
marginalised groups who are much less likely to use services provided
by the state. It is not clear to us from the Strategy how DFID
will support civil society organisations in this vital work. We
will explore the role of civil society in the next chapter.
159 Second Report of Session 2006-07, HIV/AIDS:
Marginalised Groups and Emerging Epidemics, HC 46-I, Summary Back
160
Second Report of Session 2006-07, paragraph 5 and Summary Back
161
Ev 42 Back
162
Achieving Universal Access, p 23 Back
163
Achieving Universal Access, p 23 Back
164
Ev 71 Back
165
Ev 80 Back
166
Ev 75 Back
167
Q 24 Back
168
Q 24 Back
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