Written evidence submitted by NAT (the
National AIDS Trust)
INTRODUCTION
1. NAT (the National AIDS Trust) welcomes
the opportunity to present a short submission to the International
Development Committee for its inquiry into "HIV/AIDS: Progress
on Implementation of DFID's HIV/AIDS Strategy".
2. NAT 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.
3. We work primarily on HIV policy issues
in the UK, but we also advocate for donor support for research
and development of new prevention technologies, such as vaccines
and microbicides, and we are engaged in HIV policy at the European
level, being represented on the Steering Committee of AIDS Action
Europe and on the EU's HIV/AIDS Civil Society Forum (which our
Director of Policy also co-chairs).
UNIVERSAL ACCESS
AND THE
NEEDS OF
MSM IN DEVELOPING
COUNTRIES
4. An issue increasingly recognised as important
to the global response to HIV is addressing effectively the HIV
epidemic amongst men who have sex with men in developing countries.
For too long there was neglect of the rights and HIV-related needs
of MSM in many developing countries, and in particular sub-Saharan
Africa. Research is increasingly demonstrating how essential it
is to address this aspect of the HIV epidemic in all countries,
including those with an as yet poor record on MSM rights (see
for example The Lancet 1 August 2009 Vol 374 "Men
who have sex with men and HIV/AIDS in sub-Saharan Africa").
5. In the last five years a global movement,
supported by pre-meetings at the last two International AIDS Conferences
in Toronto and Mexico City, has focussed international and donor
attention on this issue. The Global Forum on MSM and HIV (MSMGF)[32]
has also been established to campaign and work to ensure increased
investment in HIV services for MSM worldwide. Currently it is
estimated that only 2% of global funding for HIV-related programming
is directed at MSM. Only one in 20 MSM worldwide are estimated
to receive HIV-related services. Surveillance, research and reporting
on the MSM epidemic remain very weak in most countries.
6. DFID announced in August this year a
three-year grant of US$1.2 million to the Global Forum on MSM
and HIV. It is the first government agency to support the MSMGF
substantially and directly. NAT considers this to be an effective
way of contributing to the universal access commitment and also
ensuring appropriate services for one of the key marginalised
groups affected by HIV. NAT commends DFID for its vision in supporting
this important rights-based work and trusts this will be sustained.
PREVENTION
7. 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 vulnerable groups. The Government has also taken a central
role in the international community, particularly through 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,
Achieving Universal Access, DFID will continue to be a strong
global leader and support further resources for tackling HIV.
8. NAT welcomed DFID's unprecedented commitment
to spend £6 billion between 2008 and 2015 to support health
systems, including HIV activities, in developing countries. NAT
particularly welcomed 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 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.
9. Investment in R&D for new HIV prevention
tools (NPTs) such as 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. The recent announcement of
an encouraging vaccine trial in Thailand—the first to demonstrate
efficacy in humans—makes the case for DFID's commitment
to new prevention technologies.
10. Policy and advocacy relating to the
support and development of NPTs forms an important element of
the work plan of NAT. However, there is also 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 of these new products, when available, and of
their fit with existing prevention technologies such as condoms
(this will be especially important in relation to partially effective
new prevention technologies). We trust that DFID will not only
continue to support long-term and predictable funding streams
for NPT R&D but also fund the social research necessary to
ensure appropriate uptake for vaccines or microbicides once they
are developed.
CONCLUSION
11. NAT commends DFID's HIV strategy for
continuing investment in vaccine and microbicide development,
and for its engagement and investment in addressing the HIV-related
needs of men who have sex with men across the world. Both have
been far-sighted and bold initiatives, which have led the way
for other donors. We hope the International Development Committee
in its report might:
— congratulate DFID on its work on the
HIV-related rights and needs of men who have sex with men around
the world;
— congratulate DFID on its ongoing support
for new prevention technologies;
— encourage DFID to continue to support
these important strands of work; and
— encourage DFID also to advocate for such
work and support in relevant international forums, including to
the European Union, which remains a significant provider of development
assistance.
September 2009
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