Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 40 - 59)



  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 present?
  (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.

Mr Robathan

  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.

Ann Clwyd

  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.

Mr Khabra

  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.[3]


  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.

Mr Khabra

  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.

Ms King

  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 agenda?
  (Dr Lob-Levyt) I am not sure what you mean by permanent condom.

  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.

Mr Robathan

  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.

Ann Clwyd

  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.

Mr Khabra

  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 suggestion.

Ann Clwyd

  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.[4]

  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 in.

3   See Evidence pp. 69-71. Back

4   See Evidence pp. 71-72. Back

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