Committee of Public Accounts

Press Notice No. 14 of Session 2004-05, dated 6 April 2005


Mr Edward Leigh MP, Chairman of the Committee of Public Accounts, said today:

"The global HIV/AIDS epidemic is horrifying in scale, tragic for affected individuals, families and communities, and impedes development for the world's poorest countries. Through DfID, the UK is the second largest donor on HIV/AIDS after the United States but DFID's response has been far too slow, as has the response of the international community as a whole.

Many multilateral institutions supported by DfID spend little of their budgets addressing HIV/AIDS and DfID should exert more pressure through its funding to influence priorities. DfID needs to give higher priority to tackling the wider social and economic impacts of the epidemic, including household poverty.

It seems unfair that some countries with lower HIV prevalence rates attract priority status over those with higher prevalence rates. DfID needs to develop clear criteria to strike the balance between developmental and humanitarian considerations in allocating funding, and between funding other organisations to provide support and responding itself.

DfID should also look at why the prices of antiretroviral drugs have fallen only half as much in some developing countries as in others and help to negotiate reductions."

Mr Leigh was speaking as the Committee published its 14th Report of this Session, which examined the UK's contribution to the global response to the HIV/AIDS epidemic led by the Department for International Development through: its own country programmes; funding of multilateral development institutions; and support of relevant research and knowledge generation programmes.

The Department is the second biggest donor on HIV/AIDS having spent some £270 million in 2002-03. In 2004 it announced that the United Kingdom would spend at least £1.5 billion over the next three years on bilateral and international efforts to combat the disease.

The Committee found that over the last two decades at least 65 million people have been infected and 20 million have died of HIV/AIDS. Whilst committed to tackling HIV/AIDS, the Department's overall response has been slow, as has that of the international community. The Department now has a strategy to help deal with the epidemic. But the strategy is unclear, amongst other things, on the balance between the development and humanitarian aspects of the epidemic. This distinction affects which countries receive DFID bilateral support to combat HIV/AIDS.

The new strategy is also unclear on the balance between bilateral and multilateral programmes. The Department provides nearly half of its aid budget to multilateral development institutions, but these organisations often have different priorities and the Department has little direct control over how multilateral partners use the funding it provides. In 2002-03 only 4% (£57 million) of its multilateral funding was spent on HIV/AIDS. The Department seeks to influence the policies and plans of its multilateral partners. Most of its plans for dealing with multilaterals do not refer to HIV/AIDS, however, including the plan for the European Commission, which receives 60% of the Department's multilateral funding. The Department has no control over the use to which the majority of the funds it provides to the Commission is put and only 2% of the Commission's aid budget is spent on HIV/AIDS. Where the Department does have discretion it is reluctant to withdraw or reduce funding even though it considers its own bilateral HIV/AIDS support to be more effective.

The Department's bilateral programmes at country level have to operate against a dynamic background. Social, cultural, economic and political factors; the national capacity to respond; and the work of other donors can all affect the shape and focus of the Department's HIV/AIDS support. However, country plans often lack a considered assessment of the environment in which country teams have to operate. The Department's 2004 HIV/AIDS strategy recognises the importance of helping vulnerable groups, such as women and children, as central to its response. But, at country level, an assessment of the impact of prevailing cultural, political and social conditions on the vulnerability of different groups is often lacking.

More generally, HIV/AIDS undermines the capacity of developing countries to cope with the epidemic because of the impact it has on their workforce and economy. But between 1997-98 and 2002-03 only 1% (£3.6 million) of the Department's country-level expenditure was spent on mitigating the social and economic impact of the disease. The impact in the health sector has been exacerbated by the migration of doctors and nurses to work in developed countries, including the United Kingdom.

Country HIV/AIDS programmes are seeing a shift in emphasis in the balance between prevention and treatment. In the past, the Department spent four times more on prevention than on support for treatment. The fall in antiretroviral drug prices has been a key factor in the Department seeking to increase support for treatment. However, prices have not fallen uniformly across developing countries, and may not have fallen enough to enable the poorest countries to afford effective treatment programmes.

The continued effectiveness of the Department's country-level HIV/AIDS programmes will depend, in part, on knowing what works in tackling the epidemic, and why. The Department supports HIV/AIDS-related research and knowledge generation programmes, but country teams have found difficulty in receiving information about the knowledge generated, and they often feel overwhelmed by the large amount of information available globally.

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