| Summary
Progress has been made on providing HIV/AIDS treatment in developing countries but the 2010 target of universal access to treatment will not be met. The disease remains a significant development and public health challenge in many developing countries.
The absence of a monitoring and evaluation framework for DFID's new HIV/AIDS Strategy when it was published in June 2008 meant that there were few measurable targets or indicators of how its effectiveness would be assessed. The subsequent publication of the Framework and the accompanying Baseline document are positive developments. The next step will be the publication of the first biennial progress report in December 2010.
Capable and well-resourced health services are an integral part of an effective HIV/AIDS strategy and DFID's substantial funding for health system strengthening is welcome. However, DFID still has no mechanisms in place to track the impact which its £6 billion funding for health systems will have specifically on HIV/AIDS care, despite this being one of the key elements of its Strategy.
Some of the essential components of universal access, particularly prevention and long-term care in the community, may not benefit from health systems funding. DFID needs to set out how it will ensure that its HIV/AIDS Strategy promotes an holistic approach which includes prevention, treatment, care and support for all people living with HIV/AIDS, including those vulnerable to discrimination and stigmatisation. It must recognise that prevention and care services are often provided outside the public health sector by family members and community groups, and that targeted prevention programmes aimed at marginalised groups are often one of the most effective HIV interventions.
Social protection is another key element in DFID's AIDS Strategy. However, only £80 million of the £200 million pledged to social protection programmes is new money, additional to existing commitments. This funding is part of DFID's broader support for vulnerable households rather than being specifically aimed at those affected by HIV/AIDS.
Moreover, cash transfers, while very effective in some situations, are not a sufficient mechanism for reaching those most in need and many of the most vulnerable people affected by HIV/AIDS, particularly children, may be excluded from social protection programmes. Marginalised people, particularly those engaged in activities deemed to be illegal, such as sex workers and drug users, are often unwilling or unable to access services and their children may therefore fail to be reached by generalised provision of this kind. DFID needs to have mechanisms in place to track its funding for social protection to ensure that it is reaching children and other vulnerable people affected by HIV/AIDS.
The global economic downturn has contributed to the failure of many donors to honour pledges made on HIV/AIDS funding. The UK's adherence to its commitments is welcome but it must do more to put pressure on donor partners to meet their pledges, including to the Global Fund to fight AIDS, TB and malaria, which has suffered a US$3 billion deficit in funding this year. It is very disappointing that the 2010 target for universal access will be missed by a wide margin. This must not be compounded by failure to maintain the levels of support for HIV/AIDS programmes agreed by the international community.
Treatment for women and children, and particularly prevention of mother to child transmission services, must be prioritised. DFID should continue to work to develop mechanisms which help to increase availability and lower the cost of anti-retroviral treatment in developing countries, including patent pools.
DFID's focus is now shifting to fragile states. Lead responsibility for HIV/AIDS programmes in middle-income countries, where DFID no longer has a presence, but where prevalence rates are often high, will be taken by the Foreign and Commonwealth Office. It is not clear that the FCO has the necessary resources or expertise to undertake this task, particularly in relation to marginalised and vulnerable people, or that mechanisms are in place for DFID to provide the necessary advice and assistance.
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