HIV/AIDS in the developing world

30 November 2008

The Department for International Development has failed to make clear how its new strategy will deliver results for the millions affected by HIV/AIDS.

A report released today by the International Development Committee says that DFID’s new HIV/AIDS Strategy is strong on rhetoric but lacks the necessary details on how it will deliver results on the ground and assess impact.

The Committee welcomes the £6 billion funding commitment to strengthen health systems in developing countries. It believes this expenditure will be effective in building up the capacity of health services in low-income countries to provide the prevention, treatment, care and support which people living with HIV/AIDS desperately need. The Committee acknowledges that this substantial funding reinforces DFID’s position as a global leader in tackling HIV/AIDS.

However, the Report highlights that the Strategy contains few measurable targets for how the money will be spent or how its effectiveness in achieving the desired outcomes will be measured. Rt Hon Malcolm Bruce MP, Chairman of the Committee, said:

"We very much welcome the substantial funding DFID has allocated to support health services in developing countries. But it is not yet clear to us whether this £6 billion is new money or simply a redirection of existing commitments. We have asked the Department for a full breakdown of where this sum will come from and how it will be spent on the ground in developing countries."

One of the eight internationally agreed Millennium Development Goals is to halt and reverse the spread of HIV/AIDS by 2015 and a further commitment has been made to provide universal access to comprehensive HIV prevention and treatment by 2010. Yet there are 33 million people living with HIV in the world today; nearly 6,000 people die each day and around 7,000 become infected.

Gender-based violence and lack of empowerment are key factors in the disproportionate impact which HIV/AIDS has on women and girls. But the Strategy lacks details on how the UK will tackle these challenges. The Chairman said:

"We were shocked to learn that young girls in some countries in Africa are more likely to be raped than to learn how to read and write. Sexual violence is a major factor in the spread of HIV. We need to know what programmes DFID intends to support to tackle gender-based violence. There are examples of effective projects which the Department has funded, but DFID has not yet made clear how it intends to replicate and build on this work."

The Committee acknowledges that DFID has been a lead donor in working with “marginalised groups” including drugs users, sex workers, prisoners and men who have sex with men. Members of these groups often suffer stigma and discrimination and are often unable or unwilling to use state-provided services. Effective prevention work is key because epidemics in marginalised groups spread to the general population. The Strategy recognises the need to ensure services are made available to these groups but fails to specify how DFID will achieve this. Civil society organisations have a crucial role to play here because they can reach people that governments cannot. The Strategy acknowledges this, but gives few details about how non-government organisations will be involved in its implementation.

DFID’s main instrument for assisting children orphaned or made vulnerable by HIV/AIDS will now be through social protection programmes for which £200 million has been allocated. But the Committee is concerned that providing money to households is not a sufficiently targeted way of addressing the particular needs of children affected by HIV/AIDS.

DFID will shortly publish a Monitoring and Evaluation Framework which the Committee hopes will contain the hard targets and indicators which the Strategy currently lacks. The Chairman said:

"The Strategy is best seen as laying the foundations for a new UK approach to tackling HIV/AIDS. DFID needs to build on this and to make clear how its plans will be implemented on the ground. The target for achieving universal access to HIV/AIDS services is only two years away. DFID has yet to provide us with evidence that it has specific measures in place to achieve the aims of its Strategy by 2010."

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