Memorandum submitted by the National Aids
Trust
EXECUTIVE SUMMARY
OF RECOMMENDATIONS
NAT (National AIDS Trust) welcomes the opportunity
to provide evidence to the International Development Committee
on the Department for International Development's (DFID) new global
HIV strategy Achieving Universal Access. NAT congratulates
DFID on this new strategy and particularly welcomes its unprecedented
commitment to spend £6 billion between 2008 and 2015 to support
health systems, including HIV activities, in developing countries.
In summary:
1. NAT is concerned about how the significant
amount of DFID funding to be funnelled through international agencies
like the World Bank will be monitored. Reassurance from DFID that
these funding flows will be transparent would be welcomed. NAT
recommends that DFID include in its monitoring and evaluation
framework indicators around tracking and regularly reporting on
the support it provides through international agencies including
the World Bank.
2. NAT recommends Government funding should support
social and behavioural research around HIV vaccines and microbicides.
This will ensure that these prevention products, when developed,
will be acceptable to and used by those who need them most.
3. NAT believes that it is increasingly and urgently
important that the UK Government has a consistent and "joined-up"
approach to the HIV pandemic. The FCO, Home Office, Department
of Health and other Government departments must ensure their policy
positions, particularly around human rights, support DFID to take
forward the commitments in the strategy. International standards
on HIV and AIDS and human rights should be used as a basis to
support and guide this work.
4. For example NAT recommends that DFID and the
FCO proactively engage with UNAIDS, other international agencies
and their in-country representatives to influence Governments
to not enact legislation which stigmatises people living with
HIV.
5. NAT recommends that the cross-departmental
Whitehall committee on HIV should:
— hold meetings on a regular basis;
— include departments with relevant
domestic responsibilities; and
— look at both national and international
responses.
For example domestic policy in the Home Office
and Department of Health on HIV and migrant populations has to
be integrated according to principles of human rights and public
health with our international efforts. As such, NAT also recommends
that HIV treatment be provided to all in the UK free of charge
irrespective of residency status.
1. NAT (National AIDS Trust) is the UK's
leading charity dedicated to transforming society's response to
HIV. We provide fresh thinking, expert advice and practical resources.
We campaign for change.
2. NAT welcomes the opportunity to provide
input into the International Development Committee's inquiry on
the Department for International Development's (DFID) new global
HIV strategy Achieving Universal Access. This inquiry provides
an important opportunity to increase effectiveness of the UK Government's
HIV programmes and policies for the benefit of both the UK and
developing world.
3. NAT commends DFID for its longstanding
commitment to tackling HIV and AIDS in the developing world. The
UK has shown great leadership on HIV and in championing the rights
of women, young people and other vulnerable groups. The Government
has also taken a central role in the international community,
particularly the Group of Eight (G8) and United Nations, to help
secure international commitments for achieving universal access
to comprehensive prevention programmes, treatment, care and support.
Under the new strategy, DFID will continue to be a strong leader
and support further resources for tackling HIV.
4. NAT welcomes DFID's unprecedented commitment
to spend £6 billion between 2008 and 2015 to support health
systems, including HIV activities, in developing countries. About
half of this support will reach countries through international
agencies like the World Bank.
RECOMMENDATION
5. NAT is concerned about how the significant
amount of DFID funding to be funnelled through international agencies
like the World Bank will be monitored. Reassurance from DFID that
these funding flows will be transparent would be welcomed. NAT
recommends that DFID include in its monitoring and evaluation
framework indicators around tracking and regularly reporting on
the support it provides through international agencies including
the World Bank.
6. NAT particularly welcomes the commitment
by DFID to increase by 50% funding available for the research
and development (R&D) of HIV vaccines and microbicides. Vaccines
and microbicides form an important part of a combination approach
to HIV prevention. Just as no single drug or medical approach
is effective in treating a person living with HIV, a combination
approach and an enabling environment are needed to help people
prevent HIV transmission. Strategies must offer people, including
those living with HIV, real choices which meet their different
and changing needs and that address the contexts in which decisions
are made.
7. Investment in R&D for new prevention
tools such as HIV vaccines and microbicides today will pay significant
future dividends. In the best case, widespread availability of
new prevention methods will dramatically increase the impact of
HIV prevention efforts and open the possibility of bringing the
HIV and AIDS pandemic to an end. Policy and advocacy relating
to the support and development of NPTs forms an important element
of the work plan of NAT.
8. However, there is a clear need for social
research into NPTs to complement scientific R&D and to ensure
the products will be acceptable to and used by those who need
them most. Social research will enable an effective assessment
of likely uptake and of the fit with existing prevention technologies
such as condoms.
RECOMMENDATION
9. NAT recommends Government funding
should support social and behavioural research around HIV vaccines
and microbicides. This will ensure that these prevention products,
when developed, will be acceptable to and used by those who need
them most.
10. Achieving Universal Access is
a Government-wide strategy, which includes actions for not only
DFID but for other Government departments. With globalisation,
public health issues in both domestic and international agendas
are inextricably linked and NAT believes there is a vital need
for clear and explicit coordination between Government departments
as well as domestic and international strategies.
11. In particular, the new strategy states
that the Foreign and Commonwealth Office (FCO), Department of
Health and Home Office will work with DFID to ensure broad and
effective UK support to international and national HIV responses.
12. For example the FCO is responsible for
working with DFID to ensure broad and effective UK support to
international and national HIV responses that promote and protect
human rights. The FCO is primarily responsible for this in all
middle-income countries. These countries include those in central
and eastern Europe where concentrated HIV epidemics are growing
among injecting drug users and other vulnerable communities, as
well as some sub-Saharan African countries with generalised epidemics
such as South Africa.
RECOMMENDATION
13. NAT believes that it is increasingly
and urgently important that the UK Government has a consistent
and "joined-up" approach to responding to the HIV pandemic.
The FCO, Home Office, Department of Health and other Government
departments must ensure their policy positions, particularly around
human rights, support DFID to take forward the commitments in
the strategy. International standards on HIV and AIDS and human
rights should be used as a basis to support and guide this work.[33]
14. Particularly worrying is a trend in
some highly-affected countries to pass legislation which claims
to act to end discrimination against people living with HIV, but
which in fact stigmatises them. For example recent legislation
in some countries has required people with HIV to disclose their
status in a wide range of contexts or has placed inappropriate
limitations on their sex lives. Mozambique is the latest in a
line of countries that have enacted, or may well enact this "model"
HIV legislation.[34]
RECOMMENDATION
15. NAT recommends that DFID and the
FCO proactively engage with UNAIDS, other international agencies
and their in-country representatives to influence Governments
to not enact legislation which stigmatises people living with
HIV.
16. In addition, whilst the Government's
G8 commitments are to be commended, antiretroviral (ARV) access
policy in England does not appear to be based on public health
considerations or to be consistent with G8 commitments. Nowhere
is this more clear than immigration policy. For example undocumented
migrants who are then diagnosed with HIV are denied access to
free HIV treatment. NAT believes that migrants to the UK, who
are often traumatised, extremely vulnerable and destitute, should
whilst resident in the UK have their human rights protected and
upheld. If ARV provision is to be truly universal by 2010, what
will DFID have to say when anyone can access ARVs in Lusaka but
people are effectively being denied them in Lewisham?
17. The UK Government should implement domestically
the same policies on access to HIV treatment that it wants high-prevalence
developing countries to adopt. To restrict access to treatment
in high-prevalence developing countries only to those with the
right papers would fatally undermine the global response to the
pandemic. This is a particularly blatant example of inconsistent
Government policy, which both the House of Commons Health Committee
and Parliament's Joint Committee on Human Rights have recommended
should be changed to provide free HIV treatment in the UK to all
who need it.[35],
[36]
18. It is particularly important that migrants
with no further right to remain in the UK should be maintained
appropriately, consistently and without interruption on antiretroviral
therapy so they can benefit from whatever first-line therapy is
available in the country to which they are deported or removed.
RECOMMENDATIONS
19. NAT recommends that the cross-departmental
Whitehall committee on HIV should:
— hold meetings on a regular basis;
— include departments with relevant
domestic responsibilities; and
— look at both national and international
responses.
For example domestic policy in the Home Office
and Department of Health on HIV and migrant populations has to
be integrated according to principles of human rights and public
health with our international efforts. As such, NAT also recommends
that HIV treatment be provided to all in the UK free of charge
irrespective of residency status.
NAT
October 2008
33 OHCHR and UNAIDS (2006) International Guidelines
on HIV/AIDS and Human Rights, www.ohchr.org/Documents/Publications/HIVAIDSGuidelinesen.pdf. Back
34
For further information about these "model" laws see
the Canadian HIV Legal Network at www.aidslaw.ca and the discussions
on this issue held at the 2008 International AIDS Conference at
www.aids2008.org/Pag/PSession.aspx?s=554. Back
35
House of Commons Health Committee (2005) New Developments in
Sexual Health and HIV/AIDS Policy, www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/252/252.pdf. Back
36
Joint House Committee on Human Rights (2007) The Treatment
of Asylum Seekers, www.publications.parliament.uk/pa/jt200607/jtselect/jtrights/81/81i.pdf. Back
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