Examination of Witnesses (Questions 40
THURSDAY 8 JUNE 2000
40. What does not work is the opposite of what
works, is it?
(Dr Lob-Levyt) I could go into a lot of detail if
you would like me to.
41. We have some of the detail. It is political
commitment and religious commitment, sensitive approach and wholehearted
backing. We have seen that happen in Uganda and that has produced
a result. Where else in sub-Saharan Africa are those conditions
(Dr Lob-Levyt) What we are seeing and that has happened
over the last year or so, is that we are seeing that higher level
of political commitment from African leaders and that is very
exciting and very important.
(Ms Graham) A specific recent example in Botswana.
The national AIDS committee is actually headed by the President
himself and the committee plan to meet about two or three times
a year and that date is fixed in everybody's diary and everybody
will turn up. The lead coming from the President himself; you
cannot really hope for much more than that. The sad thing is that
it is coming at such a late stage in the epidemic. In Botswana
it is very far advanced, it is about 25 per cent amongst adults
at the moment. It is that kind of lead which needs to be replicated
across sub-Saharan Africa. We do not see it in every country and
that is unfortunate. Quite often the national AIDS committee will
be housed in the Department of Health, which obviously does not
give it the political weight it needs to drive programmes forward
across all sectors.
42. What would you think of the political lead
given in South Africa? Is it clear?
(Ms Graham) I am perhaps not qualified to talk about
this, not knowing the situation in South Africa so well. Obviously
they are working through a very complex range of issues. President
Mbeki is actually very well informed himself and has perhaps gone
further than many other leaders in trying to work out the issues
for himself and he is to be commended for that. If nothing else,
it is promoting a huge national debate on the issue and raising
awareness in that respect.
Mr Robathan: On the question of President
Mbeki, I understood that President Mbeki may have informed himself
very well but he seems to have come to one or two slightly strange
conclusions. Is that not the case? Is it not the case that he
has actually said that he does not think, perhaps someone can
help me ...
Ms King: He has said that he does not
think HIV leads to AIDS.
43. Which is an interesting medical comment.
(Dr Lob-Levyt) He has also said the opposite in fact.
The message we would take at the moment is that there is a certain
amount of confusion coming out in what is being said. I would
reinforce what Ms Graham is saying, that the fact it is provoking
an intense debate in South Africa is positive, because it is down
on the agenda of many people. We should like to support that dialogue
and get the facts clearer and straighter and I am confident that
the facts will come out clearly in time in South Africa and that
as a result we shall be able to have a much more intensive programme
of support to South Africa.
44. We have some evidence from the all-party
group on AIDS and they suggest that the solution offered by western
governments is actually irritating African leaders and that that
may have been one of the reasons for President Mbeki's alternative
views, particularly when western leaders and governments are offering
solutions which include the use of expensive pharmaceuticals produced
in western countries. Would you agree?
(Dr Lob-Levyt) I should agree that what we need is
the African leadership to take the agenda forward and we are beginning
to see that and the kind of recipes drawn up in the West and presented
in a rather top down approach are not necessarily helpful at all.
Certainly from DFID's point of view, we are very keen to work
in a genuine and meaningful partnership with African governments
who wish to take the leadership on that and that is the way to
do it and it must be African solutions to the problems, informed
by best international practice. We should respect that and be
responsive to that.
45. At the international conference on AIDS
in Africa last year there was not one representative of a state.
How can you claim that leaders are taking a more active role when
obviously no leader bothered to go to that conference and that
was only last year?
(Dr Lob-Levyt) Yes, you are absolutely right, at that
time there was quite large concern that there did not appear to
be that political commitment. I think we would say that now we
are seeing a greater political commitment from a number of individual
states. It is not only confined to Botswana, it is a number of
states including Zimbabwe, Zambia, Mozambique to name but a few
and more recently Tanzania, where since that conference government
leaders and presidents have taken very strong action and made
very strong statements in a way they were not at that time. You
are right, that sent a very negative message.
46. You mentioned the use of condoms as a preventive
measure. Are condoms now readily accessible and affordable to
sexually active persons in the developing world? Given the reluctance
by some men to use a condom, what is being done to market and
distribute female condoms as an alternative?
(Mr Grose) There is no single simple answer. It is
a very patchy picture. Many, many more condoms are now available
to very many more people and we could come back to you with some
specific figures from specific countries if you would like that.
47. Yes, I think we would.
(Mr Grose) To talk about DFID's specific experience,
we are for example, and have been for some years now, financing
the supply of condoms which are socially marketed in countries
like Nigeria, Kenya, Zambia, South Africa and in Asian countries
too. We first began socially marketing condoms for family planning
purposes and that has transformed in part to socially marketing
specifically for control of HIV and sexually transmitted diseases.
Other finances are also supporting social marketing and the supply
of condoms through non-private sector sources, for example through
clinics and so on as well. The general picture is that access
to affordable condoms has improved hugely over the last eight
years or so but there is still a long way to go. In some countries
there is a lot further to go than in other countries. May I just
add one specific example from a case we know quite well in Botswana
where the local affiliate of the international organisation Population
Services International has been working for some years supported
and financed by the government, which is a very good indication
of government commitment. They have had quite a useful impact
on getting more condoms out but have not focused on the main transport
route across Botswana, which is where the highest HIV prevalence
levels are. It is another example of how there is progress on
the one hand, but not enough progress on the other hand.
48. How safe are these condoms? How do you check
the quality of these?
(Dr Lob-Levyt) Good quality condoms are very safe
of course and where DFID supply condoms or with organisations
we ask to procure condoms on our behalf for governments and for
programmes we place very great emphasis on quality control to
ensure that there is good quality.
49. What about the female condom which we have
not dealt with? Is it a satisfactory alternative?
(Dr Lob-Levyt) The female condom has its niche in
the market; it will probably never be as important as the male
condom for a number of reasons, partly price, sometimes preference.
What we are seeing in a number of countries where DFID has been
one of the lead donors in supporting this particular condom is
an increasing usage amongst women. We have also been supporting
research on how female condoms can be used by commercial sex workers,
whether they can be re-used or not. It will have its niche and
be an important one.
50. We have been told at a conference we were
attending at the South African High Commission that the colour
of condoms was important. Is that something you have experienced,
that they should be black rather than white for a black population?
(Dr Lob-Levyt) I honestly cannot give you the answer
to that. I know that in most of our programmes where they are
socially marketed we do an awful lot of consumer research on preferences,
size, shape, colour.
51. I know a lot of research is going into a
vaccine. It seems to me, as a woman, if there were research which
went into a permanent female condom, you would at a stroke wipe
out much of the infection. There is none of that, is there, as
far as I am aware? Is that the case that this is not even on the
(Dr Lob-Levyt) I am not sure what you mean by permanent
52. In the same way that you can get a coil
which you do not have to take out, you do not have to negotiate
with the man. That is the main problem women have, is it not?
All that would be gone but is anyone even considering this might
be something to investigate?
(Dr Lob-Levit) A lot of the work on the female condom
is about how long it can be used for, whether it can be washed
and re-used. You cannot leave them in permanently because there
are risks of associated infections and all sorts of problems.
There is a lot of research into that and the durability issue.
53. I have to say I am not an expert on this
but is not the problem with the female condom, especially with
prostitutes, that they will use them to protect themselves, very
wisely, but as I understand the HIV infection it is very long
lasting and even if they washed them, the risk of infection from
one client to the next would remain very high. This is something
which was mentioned to us in South Africa by a prostitute.
(Dr Lob-Levyt) I understand that research into that
has demonstrated in fact HIV need not be transmitted if they are
cleaned properly. The other area which is important is microbicides.
We are investing a lot of money into microbicides.
54. Could you define a microbicide?
(Dr Lob-Levyt) A microbicide is where a woman inserts
a pessary or tablet into her vagina which is actually an agent
which will kill the HIV virus itself. We are putting a lot of
money into that and that is entirely under a woman's control,
it is one which is likely, if we can get over a number of technical
issues, to offer a lot of promise in the future.
55. Some years ago I went to Thailand with a
population and development group and I can remember how irritated
the government officials in Thailand got when we attempted to
discuss this subject. One of the things they asked us was why
we did not control our sex tourists, what we were doing to give
them some sense of responsibility if they came to that country
for this purpose. It is not only Thailand of course where sex
tourists go, it is many other countries as well. Are we doing
anything through tourist agencies which might be promoting holidays
of this kind? Is that something you see as one of your responsibilities?
(Dr Lob-Levyt) You are absolutely right, though I
do not know of any specific examples where we are doing that and
it is an important issue. The international sex tourist industry
is one we need to look at and see what the British Government
can do in that area. We have to be a little cautious when we hear
government people saying that. Of course it is important, but
if you look in Cambodia or Thailand the main clients of the commercial
sex workers are their own people by far. We have to be careful
that it is not used as an excuse for governments themselves not
to take their responsibilities. I do not think the Thais do that.
56. Why can you not put out a general caution
for people travelling to those countries through the tourist office?
(Dr Lob-Levyt) Yes, a very practical and sensible
57. This is an important point. If we are saying
to other countries that this is what you should be doing, this
is the advice we in the West are giving you, then they can rightly
turn round and ask what we in the West are doing as far as our
own responsibility for our own population is concerned when they
go off on holidays of this kind, which seem to be on the increase
despite the dangers rather than on the decrease.
(Dr Lob-Levyt) I take your point completely and I
think we should be paying more attention to that.
58. Is it something you could perhaps come back
to us on with possible proposals?
(Dr Lob-Levyt) Yes.
59. The other thing I wanted to ask as far as
prevention and possibly treatment is concerned is improving access
to drugs. In a document given us by the all-party parliamentary
group on AIDS they call for a look at the relationship between
multinational pharmaceuticals and governments which lack the health
care infrastructure and funding to purchase drugs at western prices.
What work is DFID doing in that area?
(Dr Lob-Levyt) This is also set in the context of
the recent announcement by the drug industry to reduce prices
dramatically, which offers hope and possibilities but the costs
of $1,000 per head per year, which is what it might come to, is
beyond the reach of many countries and not sustainable when they
can only spend perhaps as little as $2 to $3 per head per year
on all their health care. That is the context we are operating
3 See Evidence pp. 69-71. Back
See Evidence pp. 71-72. Back