You are here: Parliament home page > Parliamentary business > Publications and Records > Committee Publications > All Select Committee Publications > Commons Select Committees > International Development > International Development

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.

 

5. Recommendation: 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 per cent 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.

 

9. Recommendation: 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.

 

13. Recommendation: 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.[1]

 

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.[2]

 

15. Recommendation: 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.[3] [4]

 

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.

 

19. Recommendations: 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


[1] OHCHR and UNAIDS (2006) International Guidelines on HIV/AIDS and Human Rights, www.ohchr.org/Documents/Publications/HIVAIDSGuidelinesen.pdf.

[2] 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.

[3] 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.

[4] Joint House Committee on Human Rights (2007) The Treatment of Asylum Seekers, www.publications.parliament.uk/pa/jt200607/jtselect/jtrights/81/81i.pdf.