The main focus of DFID’s new HIV/AIDS Strategy published in June 2008 was £6 billion in funding for strengthening health systems in developing countries. While this substantial funding is welcome, some of the essential components of universal access to HIV/AIDS support, particularly long-term care in the community, may not benefit from this funding, because they are provided informally by families and communities. Prevention is another vital area that may suffer if funding is not properly targeted.
The Chairman of the Committee, Rt Hon Malcolm Bruce MP, said:
"Prevention work is most effective if it is targeted at marginalised groups where HIV is spreading most rapidly. These include sex workers, drugs users and men who have sex with men. Civil society organisations are often better able to undertake prevention work with these groups because they can reach people who feel that they are excluded from government health services or who are unwilling to use them because of fear of stigmatisation. Supporting these organisations in their essential work requires DFID staff time and expertise. We are concerned that staff reductions mean that DFID is not as well-equipped to do this as it used to be."
The report points out that the 2010 target of universal access to HIVAIDS treatment will be missed by a wide margin and warns that this must not be compounded by failure to maintain the levels of support for HIV/AIDS programmes agreed by the international community.
The Chairman said:
"We are pleased that the UK Government has made clear that it will honour its commitments on HIV/AIDS funding. But the global downturn has cast doubt on whether other donors’ pledges will be met. DFID must continue to put pressure on other countries to maintain their focus on the crucial development challenge which HIV/AIDS presents."
Social protection is another key element in DFID’s AIDS Strategy. However, only £80 million of the £200 million pledged to social protection programmes is new money, additional to existing commitments. This funding is also part of DFID’s broader support for vulnerable households rather than being specifically aimed at those affected by HIV/AIDS. Marginalised people, particularly those engaged in activities deemed to be illegal, are often unwilling or unable to come forward to receive financial support and their children may not therefore be reached by general social protection programmes. DFID needs to ensure it can track its social protection funding, to ensure that it is reaching the people who most need it: children and other vulnerable people affected by HIV and AIDS.
The report says that treatment for women and children, and particularly prevention of mother to child transmission services, should be prioritised by DFID. Access to anti-retroviral treatment has increased but more resources need to be made available to meet the increasing demand and to ensure people living with HIV have access to the more effective “second-line” drugs. Patent pools can help to make these drugs available more widely and cheaply in developing countries.
The publication of DFID’s recent White Paper indicated that its focus is now shifting to fragile states. Lead responsibility for HIV/AIDS programmes in middle-income countries, where DFID no longer has a presence, but where prevalence rates are often high, will be taken by the Foreign and Commonwealth Office.
The Chairman said:
"We are not convinced that the Foreign Office has the necessary resources or expertise to take lead responsibility for the UK’s HIV/AIDS strategy in middle-income countries. We have particular concerns about its ability to do this in relation to marginalised and vulnerable people. Effective mechanisms need to be in place to ensure that DFID provides FCO officials with the necessary advice and assistance."