Select Committee on International Development Third Report



1. In 1999, 2.7 million people worldwide died with AIDS. More than three times the combined deaths from war, murder and violence. The catastrophe of HIV/AIDS must be the priority for action by the international community (paragraph 1).

HIV/AIDS — a medical account

2. We must state unequivocally at the outset of this Report that AIDS is caused by HIV infection (paragraph 6).

3. HIV/AIDS is currently the greatest humanitarian crisis facing our planet. That is why we need to act. Added to that, in a world ever more interdependent, the implications of the pandemic and its appalling statistics in the South for the health, economies and security of the North are most serious (paragraph 7).

HIV/AIDS — a disease of poverty

4. HIV/AIDS is not just about health. It is also about wealth (paragraph 12).

HIV/AIDS is exacerbated by poor health systems

5. Recent work by the European Commission and the G7 have linked HIV/AIDS with TB and Malaria in a single communicable disease strategy. This is commendable and necessary. All these diseases are diseases of poverty. The relief of poverty and the provision of health care for the poor will have a fundamental impact on all three diseases (paragraph 20).

HIV/AIDS is exacerbated by the denial of human rights

6. We are convinced that an essential part of any effort to tackle HIV/AIDS must be the ending of gender-based discrimination and violence, the promotion of women's rights and development, and the protection of the rights of widows and of children, girls in particular (paragraph 26).

To fight HIV/AIDS it is essential to fight poverty and promote human rights

7. The fight against HIV/AIDS can only be won through progress in the elimination of poverty. It is poverty which spreads HIV, with all its terrible consequences, and it is only the reduction of poverty which constitutes a sustainable basis for the control of the disease (paragraph 28).

8. We consider the declining amounts given in official development assistance to be a worrying indication of a failure of will by the international community to eliminate poverty. This decline must be reversed immediately ... Increasing amounts spent on HIV/AIDS will be limited in their effect if poverty itself is allowed to continue and deepen (paragraph 29).

Why consider HIV/AIDS separately?

9. We consider that a distinct HIV/AIDS strategy is essential for all donors of official development assistance and for all countries affected by the epidemic (paragraph 37).

Two crises, not one

10. The levels of HIV infection are so high in many sub-Saharan African countries that there is a real danger of the collapse of systems and infrastructures, the erosion of the state, and the reversal of all recent gains made in development. Such deterioration would make effective action against the epidemic almost impossible. We do not believe that the international community has as yet fully grasped the scale and seriousness of this African HIV/AIDS crisis, nor that they are agreed on how to address it (paragraph 38).

The Impact of HIV/AIDS on the International Development Targets

11. The region most severely affected by HIV/AIDS, sub-Saharan Africa, is both the poorest (in terms of the proportion of those living in poverty) and also the region making least developmental progress (paragraph 43).

12. The infant mortality target is particularly affected by HIV/AIDS. By 2005-2010 infant mortality in South Africa will be 60 per cent higher than it would have been without HIV/AIDS. In Zambia and Zimbabwe 25 per cent more infants are already dying than would be the case without HIV/AIDS. By 2010 infant and child mortality rates in these two countries will have doubled (paragraph 44).

13. It is important to bear in mind that a large proportion of the world's poor live in two countries, India and China. Neither is as yet as severely affected by the HIV/AIDS epidemic as sub-Saharan Africa. Thus there is greater room for progress against the IDTs. If these two countries succeed in making significant inroads into poverty the global figures for the IDTs will look healthy, obscuring the fact that at a regional and country level the epidemic is condemning a continent to remain in extreme poverty, if not decline even further (paragraph 46).

14. It is clear that the HIV/AIDS epidemic has made the international development targets impossible to achieve in those countries where it has taken hold, and that past developmental achievements have been reversed. Any responsible development policy must take account of HIV/AIDS in every aspect of its approach (paragraph 48).

15. HIV/AIDS has made many of the international development targets irrelevant to sub-Saharan Africa. The targets were agreed before the full extent of the epidemic was known. This fact needs to be acknowledged by the international community and seriously addressed. We recommend that the Special Session of the UN General Assembly on HIV/AIDS, to take place in June this year, consider how to reinvigorate efforts in sub-Saharan Africa to meet the international development targets, assessing current prospects in the region and what progress can be made, perhaps setting additional regional targets (paragraph 50).

HIV/AIDS, the economy and the private sector

16. We are sure that many large, multinational companies have yet to assess the likely impact of HIV/AIDS on their activities, are missing vital opportunities to reduce HIV/AIDS incidence, and are thus going to see their productivity and profitability seriously impaired (paragraph 58).

Business and the private sector

17. The impact of HIV/AIDS on small and medium-sized enterprises, particularly in sub-Saharan Africa, must be addressed as a priority. We expect development programmes to be reconsidering such issues as the provision of credit and management of debt, linkages with larger businesses, employment and training practices in the light of the illness and absences which HIV/AIDS produces at work (paragraph 59).

18. We consider that multinational companies have an obligation to assist, both directly and through Business Councils, small and medium-sized enterprises in countries affected by HIV/AIDS. This should include the sharing of best practice and perhaps of certain courses and facilities. It is also necessary for national governments and donors to have a strategy as to how to support the informal sector and SMEs through the HIV/AIDS epidemic (paragraph 60).

19. We believe that serious international consideration must be given as to how to respond to the growing skills shortage in countries with high HIV/AIDS prevalence. We believe systems need to be put in place both to ensure that such skills can be brought in readily but also that such interventions are considered temporary and accompanied by greater investment in the education and training of local people (paragraph 3).

20. We do not as yet see much evidence of a diversion or reduction of investment flows as a result of HIV/AIDS. We fear, however, this is not a product of reflection by the financial and business community, but rather a failure to reflect. Impacts will of course vary according to the nature of the industry. Those highly dependent on local raw materials will no doubt continue where they are and cope in other ways. The concern is over the impact of a shortage of skilled labour on any attempt by countries in sub-Saharan Africa to enhance their productive capacity and develop their industrial base (paragraph 4).

21. More investment in sub-Saharan Africa is desperately needed. We must emphasise that such investment can take place successfully and profitably, even with an HIV/AIDS epidemic. What is needed is an intelligent assessment by business of the environment and investment to be accompanied by effective prevention and care programmes in the workplace (paragraph 5).

Macroeconomic impact

22. We recommend that the World Bank, the IMF and other donors commission further research into the macroeconomic impact of HIV/AIDS so as to establish a consensus as to impact which can then be applied to particular countries (paragraph 1).

23. Structural adjustment policies, and in particular the World Bank and the IMF requirements for public sector and macroeconomic reforms, cannot continue unaffected by the impact of HIV/AIDS. We recommend that the Government request the World Bank and IMF to provide information on how they are changing their approach to civil service reform and macreconomic policy in response to HIV/AIDS (paragraph 73).

24. We recommend that in new and revised country strategy papers DFID include comment on how HIV/AIDS is expected to affect future economic performance, explaining how both the country's economic strategy and DFID's approach are taking such economic impacts into account (paragraph 4).

HIV/AIDS and Agriculture

25. We recommend that UNAIDS coordinate surveys of HIV incidence and prevalence in rural areas to improve understanding of the rural aspects of the epidemic (paragraph 82).

26. We recommend that DFID comment on the claim that HIV/AIDS interventions have been too urban-based to date and give details of those rural and agricultural projects currently supported by DFID which have the tackling of HIV/AIDS as a primary component (paragraph 83).

27. We recommend that MAFF advocate a clear mandate for the FAO in combatting HIV/AIDS and assist the FAO in consideration of how best to support Ministries of Agriculture faced with high HIV/AIDS prevalence (paragraph 85).

28. We would also bring a number of other matters to the attention of DFID, recommending their inclusion in DFID's HIV/AIDS strategy and their promotion in dealings with other donors and national governments:

  • education policies should be reviewed to provide rural children at a younger age with marketable skills, agricultural knowledge, survival and income-generating skills for city life
  • human resources in Ministries of Agriculture should be reviewed urgently to minimise the impact of the loss of skilled workers to HIV/AIDS. Adaptable civil service systems will be necessary to adapt and shorten chains of command and technical assistance may well be needed
  • rural credit should be developed to prevent destitution and there should be consideration of land tenure systems
  • the legal and human rights of women, children and the HIV-positive require attention and protection in rural communities (paragraph 85).

HIV/AIDS and the elderly

29. As in many other policy areas, the needs of the elderly with regard to HIV/AIDS have been ignored for far too long. We recommend:

  • that more research be conducted into the incidence of HIV/AIDS amongst the over 50s
  • that there be greater provision of HIV/AIDS information and education for older people
  • that there be greater provision of counselling both for older people who are HIV-positive and for those caring for the ill or those bereaved
  • that income-generation opportunities and other forms of economic and social support be provided for older people affected by HIV/AIDS and those elderly involved in caring for dependents
  • that all HIV/AIDS strategies include explicit policies and action plans to meet the needs of the elderly (paragraph 86).

30. We recommend that DFID promote such an approach in its own HIV/AIDS strategy and internationally (paragraph 90).

HIV/AIDS, children, education and household survival

31. The strategy paper 'The challenge of universal primary education' is an encouraging example of how DFID can design its development approach to take account of the impact of HIV/AIDS. Even within the last few months, there has clearly been progress and further thought in the Department on this issue (paragraph 98).

32. We consider that all donors must agree on an education strategy which both aims to achieve the international development target of universal primary education by 2015 and which also takes account of the new realities caused by HIV/AIDS. Priorities in such a strategy must include:

  • the provision of education for those unable to attend formal schooling, in particular for those having to work to provide for households;
  • the protection of children stigmatised by association with HIV/AIDS; and
  • measures to maintain the supply of teachers, perhaps involving the community, volunteers and the private sector, as well as those formally trained and employed (paragraph 99).

33. Support to households caring for vulnerable children needs to be extended and replicated on a national scale in high-prevalence countries. This is a significant challenge, particularly for public sectors already weakened by poverty. It requires determined coordination amongst national governments, donors and civil society. Consideration should be given as to whether cash payments or other forms of support are most appropriate. We recommend DFID in its response to this Report provide further details of how it plans to support the identification and care of vulnerable children in the community (paragraph 110).

HIV/AIDS and the health sector

34. We would welcome information from DFID on how best to remedy the staffing crisis in certain developing country health sectors. In general, we consider that 'Better Health for Poor People' could usefully have spelled out in more detail how health sector reform and development can be pursued in the context of high HIV/AIDS prevalence (paragraph 114).

35. A decline in the efficiency of government departments in countries severely affected by HIV/AIDS will have a whole host of implications for development. Putting aside the examples given already from agriculture, education and health, one can think of the difficulties that might be experienced in, say, revenue collection, the management of the country's debt, the efficient regulation of industry, the preparation of necessary legislation. We have noted that DFID is involved in an inter-agency group on education matters, looking amongst other things at human resource issues in education. Such consideration needs to be extended so as to encompass human resource issues across the public service (paragraph 117).

HIV/AIDS, conflict and security

36. There will be greater social insecurity and possibly conflict as a result of the HIV/AIDS epidemic (paragraph 121).

37. We request information from DFID and UNAIDS as to what representations have been made to all governments involved in the DRC conflict on the spread of HIV/AIDS amongst soldiers, refugees and civilian populations. We also wish to know what surveys of HIV/AIDS incidence have taken place in the region affected by the conflict. The area is obviously vast, difficult and extremely dangerous. But thought must be given, even in such circumstances, as to how the donors and NGOs can intervene and assist to limit the spread of HIV/AIDS (paragraph 122).

38. We recommend that DFID, the FCO and MoD discuss the implications of HIV/AIDS for their security sector reform activity. We would expect any such discussion to include consideration of how to establish good morale in forces with high HIV/AIDS prevalence; the need for training in the rights and proper treatment of civilians, and of women in particular; HIV/AIDS prevention in the armed and security services, both in terms of sexual behaviour and also other risky contacts such as open wounds; the training and 'skilling' of personnel given the likelihood of high mortality and morbidity rates (paragraph 123).

The Impact of HIV/AIDS — Some Conclusions

39. HIV/AIDS will further and profoundly impoverish those who are already poor. In those countries, particularly in sub-Saharan Africa, with high prevalence rates, its effect could well be to reverse past development gains and destroy state, social and household systems which have previously been extremely resilient to shocks. This means that development may well have to be done in a different way. Donors are now generally aware that HIV/AIDS is not merely a medical problem but a developmental one — and by this they mean it is having a pervasive and destructive effect on the poor, thus making its prevention one of the main developmental challenges. What is still lacking amongst donors is a real and determined attempt to examine how HIV/AIDS affects all aspects of development activity. Support for education, the private sector, agriculture extension and rural livelihoods, developing country government departments, to give just a few examples, must not only be increased but, more importantly, redesigned. We have on a number of occasions in this Report commented on DFID publications which ignore the impact of HIV/AIDS and how the epidemic should change the way development is done. We single out DFID because it is the donor we have a responsibility to scrutinise. But this failure is a general one, and certainly not confined to DFID (paragraph 124).

40. We do believe that one aspect of an effective HIV/AIDS strategy for DFID must be an identification of its 'added value' on the international stage. We have no doubt that one great asset of DFID is its intellectual capital and expertise. It is in our view particularly well placed to do the sort of rethinking and redesign necessary to ensure development programmes regain their relevance and effectiveness in countries with severe HIV/AIDS epidemics (paragraph 126).

41. We recommend that DFID conduct an audit of all aspects of its development programmes, particularly as they are applied in sub-Saharan Africa, to ascertain the extent to which they are prepared to withstand current and likely future impacts of HIV/AIDS. We also recommend that where they are found wanting, DFID should research how best to redesign programmes, sharing conclusions with other donors and developing country representatives (paragraph 127).

42. Reducing the impact of HIV/AIDS through appropriate development is, we must remember, itself a preventive measure of fundamental importance. In the successful reduction of poverty we target that environment in which HIV/AIDS thrives and devastates. Conversely, if we do not act to reduce the impact of HIV/AIDS we entrench further that poverty which fosters the epidemic and we allow a vicious circle of poverty and infection to develop (paragraph 128).


43. We must emphasise that the fight against HIV/AIDS is not a hopeless one. Even in the absence of a vaccine, and with limited resources, successful prevention is possible (paragraph 135).

44. Evidence raised a number of aspects of prevention which required support and further work. One important area is work amongst young people both within the school curriculum and through peer education. Many witnesses stressed the need to establish effective primary health care, sexually transmitted disease services and testing and counselling facilities. It is also vital at early stages of an epidemic to take prompt action amongst high-risk groups. We do not intend to expand on these points in this Report. We stress that this is not because they are unimportant — on the contrary they form the bedrock of any effective and meaningful prevention. As such, there is already a significant amount of literature and experience on which donors can draw. We certainly expect DFID to be advocating and supporting such interventions as a central part of its HIV/AIDS strategy and welcome the prevention work DFID has engaged in to date (paragraph 136).

45. Were the sub-Saharan Africa prevalence rate to be replicated in Asia, there would be a further 285 million HIV-positive people in the world. The consequences for the global economy and security, as well as the scale of the resulting humanitarian disaster, are unimaginable. The prevention of a high-prevalence HIV/AIDS epidemic in Asia must be a priority for the international community (paragraph 137).

Material interventions

Male Condoms

46. We are appalled that at such late and grave stage of the epidemic there remain condom shortages in sub-Saharan Africa. One aspect of this shortage could well be cost. There is also, however, a question of effective logistical planning by government health departments. DFID has recently given £25 million to UNFPA for the purchase of condoms for developing countries. We welcome this intervention and believe bilateral and multilateral donors have a vital role in this area. We would also encourage the provision of technical assistance to developing countries in the purchase both of condoms and of drugs and other medical supplies to ensure consistent and sustainable supply over time (paragraph 141).

47. We recommend that DFID take colour into account when considering the provision of condoms to the developing world and that market testing should identify whether colour could make any difference to the acceptability and use of condoms (paragraph 142).

Female-controlled protection

48. Alongside moves to develop other female-controlled prevention tools such as microbicides, the female condom clearly has an important role to play and DFID is to be congratulated for its early support. The female condom is not invisible or inconspicuous; women who currently find it impossible to get a male partner to wear a condom will not be spared the need to negotiate. However, there are situations where it will have an advantage, especially for sex workers. We recommend that DFID continue to support the promotion of the female condom (paragraph 147).


49. The Department of International Development has previously directed some funds to research into microbicide development. As the area has been relatively neglected internationally, there is clearly potential for greater investment. Investment by the UK Government would could play an important part in developing a product with the potential to reduce dramatically incidence of HIV infection. In its HIV/AIDS strategy, the Department for International Development should prioritise microbicide research alongside research for a vaccine and act as an advocate internationally to encourage other donors to give microbicides a higher priority (paragraph 150).

Vaccines against HIV

50. We believe that vaccine development partnerships and investors should take steps to ensure that research prioritises sub-types of the HIV virus found in developing and worst-affected countries as least as highly as those more commonly found in the developed world (paragraph 151).

51. We believe that the Department for International Development should continue to support the search for a vaccine. We believe that all spending on HIV prevention should be carefully monitored to ensure that there is a balance between searching for prevention technologies such as vaccines and microbicides and work aiming to achieve behavioural and social change and to promote the use of condoms. The latter will clearly remain the only proven effective means of prevention for the foreseeable future and therefore a careful balance of priorities needs to be maintained so that this work does not get neglected (paragraph 153).

52. We hope that the EUROVAC programme, and other similar initiatives, will take steps to ensure that public money is only used to fund the development of products which will be affordable in developing countries (paragraph 154).

53. We welcome the initiatives of the United Kingdom Government in attempting to secure better availability of drugs to prevent and treat HIV/AIDS, malaria and TB in the developing world (paragraph 155).

Injecting drug use

54. We look forward to DFID making clear how it is promoting harm reduction strategies amongst injecting drug users. This is a sensitive area where stigma and legal sanctions have meant it has been difficult to see progress in areas such as safe needle exchange. Nevertheless, injecting drug use is in a number of regions the main mode of transmission of HIV/AIDS and an internationally agreed approach is urgently needed (paragraph 165).

Behavioural interventions

Prevention and human rights

55. To change behaviour, people need to have a stake in their own futures. Such an outlook is difficult for the abjectly poor. The human rights to health, to education, to food and water are crucial to any change in behaviour to prevent HIV/AIDS. DFID's poverty-focussed approach, which is explicitly rights-based, is thus a vital foundation for all HIV/AIDS work (paragraph 167).

56. We would encourage DFID to include explicitly gender rights in its HIV/AIDS programmes. Such an approach must include the education of men in less exploitative models of masculinity, the rights of women and children. Programmes need to educate young women and girls in how to negotiate sexual relations and how to be able to refuse sex with those older or more powerful than themselves. A properly designed HIV/AIDS strategy will also prioritise the protection of women from domestic violence and rape through community pressure, effective policing and a gender-sensitive courts and legal system ... We request information from DFID on how many programmes it is funding which are explicitly designed to tackle HIV/AIDS and which also include such 'women's rights' components (paragraph 168).

57. A responsible HIV/AIDS strategy must counteract stigma, acknowledge the human rights of such stigmatised groups, provide information and access to prevention and treatment, survey prevalence amongst such groups and adopt strategies to reduce their vulnerability to infection (paragraph 169).

58. Those living with HIV/AIDS must enjoy the full protection of the law, access to employment, education and appropriate care. It is a duty of donors to advocate the rights of those living with HIV/AIDS, monitor and support those rights, and argue against their abuse (paragraph 170).

59. We welcome the work done by the FCO to promote human rights in the context of HIV/AIDS and its inclusion in the Annual Human Rights Report ... If DFID is no longer to have an involvement in the Annual Human Rights Report we think it is still necessary for it to report to Parliament on what it is doing to promote human rights within its work on HIV/AIDS and we recommend that there be a section to that effect in future Departmental Annual Reports (paragraph 171).

Prevention and the media

60. We welcome the work done by DFID and the BBC World Service (and the BBC World Service Trust in particular) in promoting HIV/AIDS awareness through the media ... We believe that the media should not simply disseminate factual information on HIV/AIDS but also encourage community debate and engagement. In other words, any HIV/AIDS media strategy must have a clear human rights dimension. One component should be the encouragement by DFID and the FCO of a plural, independent and healthy media in developing countries. Another must be the use of the media to generate grassroots involvement and activity in the fight against the disease (paragraph 174).

Prevention and the workplace

61. We are convinced that the opportunities of the workplace provide some of the most important means of prevention, and indeed care, in the developing world (paragraph 175).

62. We wish to stress the important role that DFID and other donors can play as catalysts to such workplace prevention and care. This can involve initial funding of programmes (though companies should take over beyond the experimental stage) and the provision of technical assistance (paragraph 177).

63. DFID should also be involved in advocacy of workplace interventions ... We recommend that DFID engage in discussions with British industry, in particular such bodies as Chambers of Commerce and the Confederation of British Industry, to promote the importance of HIV/AIDS prevention and care when operating in developing countries with high HIV/AIDS prevalence (paragraph 178).

64. We recommend that ECGD only support projects where consideration has been given to the vulnerability of the workforce to HIV/AIDS and what can be done to prevent infection ... Ethical Trading Initiative members should take HIV/AIDS into account when vetting overseas suppliers ... We also recommend that DTI in promoting investment and trading opportunities overseas discuss HIV/AIDS, making clear that it does not preclude profitability but that it is vital to take the epidemic into account in workplace policies, including prevention, care and employment rights (paragraph 179).

Priorities for treatment and care

65. All HIV/AIDS strategies must include an emphasis on the care of HIV-infected persons. This is not only a humanitarian imperative but also an indispensable component in any effective reduction in infection rates. We welcome the recent acceptance by DFID of the need to put more resources into care (paragraph 181).

66. The Committee agrees that basic healthcare is a necessary pre-requisite for the medical care and treatment of people with HIV. DFID's identification of this as a priority is clearly appropriate. Primary healthcare for all would immediately markedly and improve the health of people living with HIV through access to basic palliative and other essential medicines, effective treatment of tuberculosis and STDs, and would offer the potential for expanding access to drugs to treat common opportunistic infections (paragraph 185).

67. We strongly endorse the approach of UNAIDS in producing a clear set of priorities to inform multilateral agencies, bilateral donors and governments of developing countries. We believe that this model should determine the priorities of DFID and other agencies and that action should concentrate first on provision of essential care interventions before consideration of access to anti-retroviral drugs (paragraph 186).

Community involvement

68. It is hoped that DFID considers the way in which people living with HIV have been involved in the planning and consultation of programmes, and the ways in which they will be involved in overseeing the delivery and monitoring of all programmes it is funding. This principle needs to be constantly re-affirmed and would go a long way to change the invisibility of people with HIV in developing countries, to challenge the silence and stigma attached to HIV infection and to affirm a rights-based approach that does not simply consider people with HIV to be passive recipients of care (paragraph 188).

Access to anti-retroviral drugs

69. The provision of anti-retroviral treatments to people with HIV in the poorest developing world is clearly not a practical or sustainable development intervention. Donor funds and activities should concentrate on prevention of further infections, development of basic healthcare systems, provision of palliative drugs and basic treatments of opportunistic infections (paragraph 192).

70. In its Globalisation White Paper, DFID announced that it will set up a Commission on Intellectual Property Rights to look at how rules can be designed to benefit developing countries and in particular access to generic resources. We welcome this important step in the consideration of how both to ensure appropriate respect for patents and the encouragement of further research and development, whilst also aiming to maximise the access of the developing world to affordable drugs. It has been striking how the pharmaceutical companies, faced with mounting discontent at their pricing policies in poorer countries, have begun at last to offer significantly discounted prices for their products. Preferential pricing agreements, particularly for drugs to treat opportunistic infections, need to be agreed and implemented without delay. We criticise the slow progress being made under the Accelerated Access Initiative (paragraph 197).

71. The provisions of TRIPs under which a country can use parallel importing or compulsory licensing in a national emergency were put in for a purpose. Progress in agreeing concessional prices with the pharmaceutical companies is to be encouraged. This should not be at the expense of developing countries also pursuing alternative solutions permissible under WTO rules. We do not believe the United Kingdom Government, the European Union or any other developed country should put pressure on developing countries not to make use of available TRIPs provisions. Technical assistance should rather be given both to identify what can be done within the WTO agreement, how affordable any cheaper drugs are to the health department budget, and whether they will genuinely reach the poor, rather than an elite (paragraph 198).


Some thoughts on funding

72. We request assurance from DFID that sexual and reproductive health expenditure is only accounted for as an aspect of HIV/AIDS spending when HIV/AIDS is explicitly and specifically addressed in the programme design (paragraph 204).

73. We recommend that UNAIDS and donors reach agreement as soon as possible on how to calculate levels of expenditure on HIV/AIDS. We would expect such an agreed basis for calculation to specify, on the basis of research, the conditions necessary for mainstreamed interventions to have a real impact on HIV/AIDS (paragraph 210).

74. The figures both on the decline in ODA overall to sub-Saharan Africa and of spending per HIV-positive person make appalling reading. We seem as far away as ever from the UN target of 0.7 per cent of donor countries' GNP being spent on development assistance. And we must add that the 0.7 per cent target was agreed to in an AIDS-free world. We share the Secretary of State's cynicism over headline-grabbing announcements of cash. But this fact at least is clear — not enough money is actually being spent in the response to HIV/AIDS. It is often difficult to spend wisely and effectively, that is true. Donors must as a matter of urgency devise ways of spending significant sums in less than perfect environments, at the same time strengthening national governments' policy frameworks. We believe this should be a priority for the International Partnership Against AIDS in Africa (paragraph 214).

75. We welcome the introduction of Poverty Reduction Strategy Papers and in particular the insistence that HIV/AIDS is included in the strategies of all countries affected by the epidemic. The PRSP process requires adequate consultation with civil society...Every PRSP should have been preceded by consultations with community groups and NGOs working on HIV/AIDS, and, most importantly, with people living with the disease. Any strategy, to be acceptable, must take account of their views and include community participation (paragraph 217).

76. We recommend that UNAIDS monitor the extent to which debt relief results in the mobilization of resources by national government for HIV/AIDS and reports back to the international community (paragraph 218).

77. We would encourage the World Bank and donors to ensure that as much as possible of the US$500 million committed by the World Bank to HIV/AIDS in sub-Saharan Africa is in grant rather than loan form (paragraph 223).

78. We are concerned that funding of HIV/AIDS is done responsibly and recommend that UNAIDS be closely involved in the provision of technical advice to the World Bank in its funding decisions (paragraph 224).

79. We are concerned that certain countries are not as yet spending enough of their own resources in the fight against HIV/AIDS. Dependence solely on donors not only limits the resources available but also demonstrates the lack of real national commitment to halting the epidemic (paragraph 227).

80. We recommend that DFID inform us of how they plan to encourage community involvement in the prevention of HIV/AIDS and in the care of those who are HIV-positive. We are particularly interested in how much DFID expenditure is directed at such community activity, how long-term and sustained such expenditure is, and what technical assistance is given to national governments in the funding of a community response and its replication nationwide (paragraph 228).

National Political Leadership

81. Whatever the policies on HIV/AIDS, their effectiveness relies on the public believing and acting on safe sex messages. Even without the sort of doubts expressed by President Mbeki, it is difficult enough to change people's sexual behaviour. To encourage doubts as to whether the HIV virus causes AIDS is grievously irresponsible and can only undermine whatever good work is being done elsewhere on HIV/AIDS (paragraph 233).

82. We would encourage the setting up of parliamentary AIDS groups in all countries significantly affected by the epidemic and suggest that UNAIDS and the InterParliamentary Union act together to promote such groups. An IPU Committee on HIV/AIDS might be usefully set up to promote the establishment of such groups as well as support Members of Parliament who declare publicly their HIV-positive status (paragraph 238).

83. The response to the HIV/AIDS epidemic, particularly in sub-Saharan Africa, has been a culpable and serious failure in political leadership and governance. At relatively low cost there are certain basic interventions which all governments must introduce — a sustained, comprehensive and effective information campaign on HIV/AIDS; ensuring the widespread availability of condoms; National AIDS Commissions located in the office of the head of state with independent budgets and real authority in their relations with government departments; the reorientation of the current health budget to take account of the epidemic. But they have all too rarely occurred. Donors should consider carefully, and target effectively, before providing funds to any government which has not attempted these basic interventions (paragraph 239).

The European Community

84. We recommend that the EC consider increasing the number of HIV/AIDS experts in Brussels, and in particular that certain officials be charged with examining the HIV/AIDS sensitivity of all EC policies relating to the developing world. There must also, on the lines recommended earlier in this Report, be an audit of how development planning and implementation in-country is taking account of the new realities arising from the HIV/AIDS epidemic (we were disappointed to hear of neglect of the toolkit devised by Professor Alan Whiteside). We also request information from DFID on how the EC is coordinating its HIV/AIDS strategy and activities with those of member states, and other multilateral donors (paragraph 245).

The United Nations

85. We welcome the work of UNAIDS and consider it to be making an impressive contribution to the fight against HIV/AIDS. We trust that its work will at no point be constrained by under-resourcing. We remain concerned that there is still some way to go in coordination amongst UN bodies on HIV/AIDS and believe UNAIDS should be prepared to be publicly forthright on problems and failures, if necessary shaming organisations into improvement (paragraph 248).

86. We recommend that the forthcoming Special Session of the UN General Assembly specify the action necessary to meet the HIV/AIDS international development target. We were pleased to learn that UNAIDS is preparing a Global Strategy for the fight against HIV/AIDS. We look forward to its publication and hope it will address the main conclusions and recommendations of this Report (paragraph 249).

Regional and Multilateral Organisations

87. We look forward to an analysis of HIV/AIDS coordination to date, and recommendations for the future, to be included in the forthcoming UNAIDS Global Strategy (paragraph 251).

88. We are pleased to see the CHOGM declaration of 1999 where the heads of government committed themselves personally to lead the national commitment against HIV/AIDS in their countries. The Commonwealth Medical Association are also active in this area. We believe the Commonwealth Parliamentary Association is also well-placed to educate and mobilise Members of Parliament in the support and advocacy of effective HIV/AIDS strategies and we look forward to greater involvement by the CPA in HIV/AIDS work (paragraph 252).

The Department for International Development

89. The lack of an explicit HIV/AIDS strategy in DFID must be remedied as soon as possible. 'Better Health for Poor People' is not adequate on its own as a framework for DFID's HIV/AIDS activities. We know that a strategy has been in preparation within DFID for considerable time and we understand its agreement is now imminent. We look forward to the publication of DFID's HIV/AIDS strategy — it is long overdue (paragraph 254).

90. We trust that in the final stages of preparing their HIV/AIDS strategy DFID take full account of the recommendations and conclusions contained in this Report. We also believe that the strategy should be 'owned' by all United Kingdom government departments. To the extent that the activities of a department of state have an impact on the developing world that department should take account of how such activities impinge on the epidemic (paragraph 255).

91. We welcome the prevention work being supported by DFID in Asia (paragraph 260).

92. For DFID expenditure on HIV/AIDS to decline to sub-Saharan Africa is unacceptable (paragraph 261).

93. We recommend that DFID reverse the recent decline in its HIV/AIDS expenditure to sub-Saharan Africa and include in its HIV/AIDS strategy an account of how it plans to confront the epidemic in the region (paragraph 262).

94. We have already made detailed recommendations to DFID in this Report. We have, for example, recommended that DFID continue to increase its expenditure on HIV/AIDS. We have recommended that DFID review how HIV/AIDS is affecting all its development activity, particularly in sub-Saharan Africa, and consider how development work might need to be redesigned to meet the new realities created by the epidemic. In this section we would redirect DFID's attention to sub-Saharan Africa, encouraging its new interest in the care of those living with HIV. We are pleased to note the growing seriousness with which DFID claims to be taking the HIV/AIDS epidemic. The Department should not, of course, overestimate what it can do — as Clare Short said, they are only one player in the international community. On the other hand, nor should they underestimate the impact they can have once they apply the same intellectual rigour and energy to HIV/AIDS that they have to other development issues (paragraph 264).


95. We are concerned that the current and legitimate debate over drug pricing might distract from consideration of the real crisis — the crisis of poverty. It is the denial of resources, services and rights which has done so much to exacerbate the spread of HIV/AIDS and control of the epidemic will only be secured when such poverty issues are addressed. With inroads into poverty we would expect to see progress in the reduction of infection rates and standards of care (paragraph 265).

96. HIV/AIDS is not only a result of poverty — it also entrenches poverty still further. We have concluded that development programmes, including those of DFID, have much work to do in assessing the impact of HIV/AIDS on the whole spectrum of development activity. There is an urgent need to redesign development programmes, policies and approaches, particularly in sub-Saharan Africa, to take account of the new realities caused by HIV/AIDS (paragraph 266).

97. Are we doing enough? The answer is clearly not. More resources are in our view necessary, especially for sub-Saharan Africa. It is not, however, only a question of resources but of political determination, solidarity, and effective organisation of a response. DFID has done much good but also has the potential to do much more. We look forward to the forthcoming DFID strategy paper on HIV/AIDS refocusing the efforts of the United Kingdom Government on a successful response to the epidemic (paragraph 267).

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