Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)



Mr Rowe

  20. One of the controversies about HIV/AIDS at the moment is mother/child transmission. What effect is that having on DFID's health policies in other ways? They have been madly sponsoring breast feeding and so on and now they have this slight horror facing them. I just wondered what effect this was having as part of the communicable disease burden.
  (Dr Lob-Levyt) On that particular issue we are working closely with UNAIDS and UNICEF for example on developing the appropriate strategies for dealing with mother/child transmission. Part of those strategies is making anti-retroviral therapy available to women and then counselling women if they turn out to be HIV positive as a first step as to what their options might be on a country by country basis, whether it should be breast feeding or not breast feeding. It is a difficult issue because it is very complicated both to administer the treatment and to follow women and counsel them and provide alternatives to breast feeding. It is affecting our policy and it varies from country to country and the capacity of systems to deliver the appropriate responses. Overall breast feeding remains very much a priority for us and it is saving many children's lives.


  21. It is said that in Uganda, Senegal and Thailand, the spread of HIV/AIDS has plateaued or been controlled. Do you agree with that?
  (Dr Lob-Levyt) Yes, I think so and they offer clear messages of hope and a very positive message that with the political commitment and the ability to mobilise resources, but more importantly open and free discussion on the issues, led from the highest level but coming down through society, you can make an impact. That is the message for governments and for donors, that we can do something. It is the open discussions in Uganda which have enabled people to access technologies to protect themselves and to change behaviours and that clearly has made a difference. In Thailand it has again been government commitment and substantial resources focused on particular at-risk groups that has made the difference. There is recent data coming out of Thailand suggesting that though they have had this enormous fantastic success, in younger age groups we are beginning to see slightly higher transmission rates and they are beginning to increase and the Thai Government is beginning to respond to that. They had perhaps taken their eye off the ball with that younger at risk group. My message again is that you cannot be complacent about HIV.

  22. To what extent should the international response to HIV be part of an integrated approach to poverty and communicable disease? To what extent does it demand a distinct and different approach?
  (Dr Lob-Levyt) It has to be part of the poverty and development agenda. What is qualitatively different is the size of the problem which requires that we have a particular attention and focus to it within that context and that it does actually need substantial resources to make a difference. We are going to be looking for more resources and greater political commitment within that poverty and development agenda to address the HIV needs.

  23. Is it not distinctive in that in order to combat it, you have actually to change human sexual behaviour, whereas with other communicable diseases you do not have to do that?
  (Dr Lob-Levyt) Broadly I would completely agree. In the absence of a vaccine, in the absence of affordable and effective drugs, it is about social change which is going to enable people to protect themselves better.
  (Mr Ackroyd) One distinctive factor is the one you are alluding to here, that it does raise very sensitive and social issues which make it very much more difficult to talk about than it is to talk about malaria or TB or these diseases which do not have that emphasis. This whole issue of how you raise the awareness in culturally sensitive subjects like this is a very key part of this whole attempt to deal with the epidemic.

Ms King

  24. DFID has committed itself to the eradication of poverty and to the international development targets as a measure of success in poverty eradication. Could we look for a second at the impact of HIV/AIDS on these targets? Several members of the Committee heard the Secretary of State the day before yesterday saying how HIV/AIDS was having a detrimental impact on that and she quoted Zimbabwe as having lost 22 years of life expectancy as a result. Does that mean some of the targets have now become unachievable due to HIV/AIDS?
  (Dr Lob-Levyt) Yes, you are absolutely right. In some parts of sub-Saharan Africa those targets which were a challenge already are very unlikely to be attained, particularly those for child mortality. There we are seeing increasing child mortality, we are seeing reductions in life expectancy and in sub-Saharan Africa that is going to make a difference to the overall development goal of reducing by half those living in poverty. Yes, we would agree with that.

  25. Would it make a difference in the sub-continent, in India for example?
  (Mr Ackroyd) My judgement would be, if you are talking about the overall target of reducing poverty, that the overall picture in East Asia is that we shall almost certainly achieve the target; there is very little doubt about that on present trends. In South Asia it is going to be pretty close as to whether we halve poverty by 2015 but there is a reasonable prospect. My judgement would be that on the rate of HIV infection at present it will probably not make a significant difference. That is not to say that if the epidemic starts to spread significantly out of the high risk groups which have been discussed into the mainstream population it will start to have an impact although we are talking about a gestation period which may actually hit after 2015 in fact. My view in Asia would be that probably HIV at present will not make a tremendous difference to the achievement of the overall poverty target. It may have more impact on some of the individual targets, particularly the maternal mortality and the child mortality targets.

  26. Are there not lots of other targets like this? I know some of my colleagues are going to be asking you later about universal primary education for example, but I recently returned from Zambia and more teachers died last year of AIDS than completed the teaching course. I do not see how it is not going to have an absolutely devastating impact.
  (Dr Lob-Levyt) In Africa you are absolutely right; it is going to have a devastating impact on teachers and other groups as well, which is going to impact on other targets.

  27. Looking at the most recent international development target which was adopted in 1999, which was about the aim of a 25 per cent reduction in HIV infection amongst 15 to 24-year-olds in the worst affected countries by 2005 and globally by 2010, could you tell me whether a strategy was adopted to go with this aim?
  (Mr Grose) May I first comment on the target itself? We think it is an extremely good thing that there is a target. We think its applicability varies from country to country depending on the nature of the epidemic and that it is going to be much more achievable in some countries than in others. Whether or not there was a strategy, UNAIDS is now leading a process to try to formalise a new global AIDS strategic framework which will be a relatively short, limited framework really showing the most important things that all the different players can do from whichever government or organisation they come. That will build on what is known already about what is likely to have most impact on prevalence levels, which will be working in as targeted a way as possible on people who are taking the most sexual risks. In some places that will be the kinds of groups we have talked about, in other places it will be the general population and everywhere will focus on young people.

  28. I know this was a very recent target obviously, but how has it affected DFID's policies?
  (Dr Lob-Levyt) I would say that by having this international target, DFID has become even more focused on the importance of HIV and we really are driving to mainstream HIV into all our development efforts. We really are taking an intersectoral multidisciplinary approach to this and it is really out of the health box, which I am absolutely delighted about because I think that is the way forward.

Mr Colman

  29. Taking HIV/AIDS out of the health box, the Committee is looking at the impact of HIV/AIDS on developing countries' social and economic development. The five-year follow up to Copenhagen is taking place at the end of this month. Could I ask whether DFID—and I am assuming that the Secretary of State will in fact be representing us at Geneva at the five-year followup—will be submitting any proposals to amend the 100-point plan which came out of Copenhagen to take account of what has happened in the intervening five years and particularly the impact of HIV/AIDS on social and economic development?
  (Dr Lob-Levyt) I do know that DFID is addressing HIV and other issues as part of the Copenhagen meeting and we are ensuring that it has been adequately addressed and has reflected changes since the last meeting.

  30. Would you be able to go into any details of what you will be proposing in terms of any amendments of those goals? I am assuming this has already gone through the prep con for Geneva.
  (Dr Lob-Levyt) I cannot actually give you that detailed information. It is being led from a different part of our department. I can certainly provide the Committee with that information.[2]


  31. Could you ask that department to send to us what they have done in preparation for Copenhagen? I should be very grateful.
  (Dr Lob-Levyt) Yes.

Mr Khabra

  32. Most DFID HIV-related projects have been in prevention. What preventive strategies have been proven to work? What evaluations has DFID undertaken of its own preventive programmes? What strategies appear not only to disseminate information but also affect behavioural change?
  (Dr Lob-Levyt) On the prevention side, yes DFID has put a lot of effort into the prevention side. We are increasingly moving towards care and support and impact mitigation. Specifically on the prevention side, we have focused on intervention and have contributed to research to determine whether these interventions are effective, such as the treatment of sexually transmitted disease, the use of male and female condoms, as important technical ways of prevention and a substantial input in all our HIV programmes into working with communities to ensure that they are well informed and knowledgeable about the issues and the broader social prevention strategies rather than the technological side of it. On the evaluation side, there has been good research work evaluating the impact of different kinds of interventions, in particular treatment of sexually transmitted diseases and measuring the impact of that. We have funded work jointly with other donors with UK institutions which have done trials and studies in Africa and in Asia. Of our own programmes and evaluating the impact of our own programmes, this is a highly complex area with many multiple interventions and it is still fairly early days to determine whether the specific interventions that DFID have made have made a difference. We can point to countries like Uganda where there have been comprehensive interventions in many different dimensions which have contributed to a reduction of the epidemic. We played our full part in doing that. On the question on dissemination, is that dissemination within the country or internationally?

  33. Within the country.
  (Dr Lob-Levyt) Yes, we work in all the programmes that we support very closely with governments and with members of civil society and the lessons which are drawn from the programmes which we support in partnership with these organisations are widely disseminated within countries. Increasingly we are trying to work at a much higher sectoral level rather than individual project so these are national programmes, national interventions drawing on best practice and best lessons.


  34. Has that information changed behaviour?
  (Dr Lob-Levyt) At the individual level?

  35. Yes.
  (Dr Lob-Levyt) I think we would say that in countries like Uganda there is evidence that there is behaviour change and in other countries like Thailand. It is a complex area and an area where more attention is needed to evaluate the impact.
  (Mr Ackroyd) Dr Lob-Levyt is right that generally speaking it is rather early but there is one project in Bangladesh which we have been supporting for five years which may indeed be the one the Chairman alluded to earlier, where we have done an evaluation of the first phase experience and come up with some very positive indications that we have had an impact on behaviour and on rates of transmission in that area.

  36. The evidence we got in the brothel in Bangladesh was that the sex workers had increased the use of condoms for example from close to zero to 50 per cent of their interactions. Fifty per cent is not enough but I suppose you would say that is evidence that you have changed behaviour at least to 50 per cent.
  (Mr Ackroyd) Indeed; that is right.

Mr Khabra

  37. What sort of consideration did the department give to the traditional sensitivities of a particular community?
  (Dr Lob-Levyt) That is absolutely important and all interventions we support are carefully tailored to meet the particular cultural issues and sensitivities of where they work or they would not work. We spend a lot of time listening to people consulting with stakeholders and helping others to do that to make our interventions as effective as possible. Clearly that is an important issue.

Mr Rowe

  38. At long last it seems to me that a lot of the international organisations and organisations like your own are taking the influence of the faith communities in the different countries seriously. In many countries they are merely, sadly, used to reinforce the worst possible practices but clearly on a matter of this kind where, for example, chastity is by far the best defence, presumably a dialogue, first of all to get the faith communities to admit that bad habits exist and then to use their influence to improve them, is important. I just wondered whether you would like to say something about that.
  (Dr Lob-Levyt) That is absolutely right and we have learned that from before HIV in reproductive and family planning programmes. Bangladesh would be a good example. Intensive work with mullahs at the village level enables us to bring them on board into important programmes and they became strong champions. It is exactly the same cultural approach which is needed in these very delicate issues. Clearly these are important stakeholders and important agents for change.


  39. Are you in a position to say therefore what really works and what really does not work?
  (Dr Lob-Levyt) Yes, we can say with quite strong confidence that political commitment is the most important thing and that is what is required to make the difference and that has to be translated into societies' open and free dialogue of the issues and the very sensitive issues around HIV and that is the prerequisite for making a difference. Then it is the behaviour change which follows from that which enables women in particular to negotiate the sexual contacts and to access the technologies to protect themselves. That makes a huge difference. The second thing which makes a huge difference is that people living with AIDS can be supported to have much better quality of life in a number of different ways, both with medical treatment of opportunistic infection and with the support of communities and the support of individuals not to fall into poverty because of HIV. We can make a massive difference. We must be selling a very positive message. It is not doom and gloom, it is a desperate epidemic but with that kind of commitment we can make a big difference and that is the important message which DFID is sharing with others.

2   See Evidence p. 71. Back

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