The significance of prevention
15. We hope that the G8 commitment to universal ARV
provision by 2010 will add valuable impetus to the case for rolling
out ARV treatment in the global South. But the relatively new
focus on treatment should not be allowed to displace the important
work which has been done on HIV prevention. We were surprised
to hear, for example, that only 20% of the US$15 billion committed
by President Bush for the President's Emergency Plan for AIDS
Relief (PEPFAR) will be spent on HIV prevention, while a total
of 70% will be spent on HIV treatment and palliative care.
Many of the witnesses who gave oral evidence to the Committee
stressed that HIV prevention and treatment are 'two sides of the
same coin', and that
in a best-case scenario, treatment, prevention and strengthening
health systems should work together in a virtuous cycle.
Expanding access to HIV treatment should not be seen as a
simple, technical fix to the pandemic. We believe that a scaling-up
of HIV prevention must form an integral part of all programmes
to expand access to treatment. We commend DFID for the important
role it played in securing international agreement on UNAIDS'
new prevention policy 'Intensifying HIV prevention',
and urge the Department to continue to balance its work on HIV
treatment with sustained attention to HIV prevention.
16. Sandra Black, Ben Plumley and Mandeep Dhaliwal
told the Committee that there is a strong body of research supporting
the 'ABC' approach to prevention.
The 'ABC' approach refers to comprehensive HIV prevention programmes
which promote Abstinence, Being faithful to one partner and using
Condoms. However, written memoranda received by the Committee
emphasised the continuing need for research into the complex range
of factors which affect HIV transmission and determine the efficacy
of HIV prevention strategies.
The Committee is convinced that it is essential for all HIV
prevention programmes to be firmly evidence-based, and encourages
DFID consistently to analyse the HIV prevention work it undertakes,
in order to determine what works.
17. We were concerned to hear that the United States'
emphasis on abstinence within its HIV prevention work
risks undermining a comprehensive response to HIV transmission,
particularly given that the US is the largest donor on HIV/AIDS.
As Mandeep Dhaliwal told us: "An over-emphasis on one of
the letters of ABC is not evidence-based prevention".
The current US preference for building bilateral donor
relations also risks undermining the coordinated approach promoted
by multilateral agencies and instruments, such as UNAIDS and the
Global Fund to fight AIDS, TB and Malaria. The Committee recommends
that DFID maintains its "very lively dialogue with the US"
on the issue of HIV/AIDS, and does all it can to support
national governments to maintain ownership of their individual
country plans to tackle HIV/AIDS. In any situation where evidence-based
policy is not being implemented, we expect DFID firmly to express