HIV care and support

This speech was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government


Speech by International Development Minister Stephen O’Brien at the HIV Care and Support: A Roadmap to Universal Access by 2015, International Conference, hosted by UK Consortium on AIDS and International Development.

First of all I would like to thank the UK Consortium on AIDS and International Development for organising this conference. It is great to see so many partners from around the world here today.  

The Consortium brings real value to the issues we all care so passionately about.  Part of their strength is the way they bring together so many different organisations to work towards a world free of AIDS. Of course, I am a part of a coalition as well, so I know how creative and energising collaboration like this can be.   

I’d like to spend a few moments on the Coalition Government’s approach to International Development before I turn to the specifics of HIV and the care and support of those affected.

We’ve just seen a historic moment.  As part of the Spending Review announcement, the Chancellor set out how we will spend 0.7% of our Gross National Income on overseas aid from 2013, helping the billion people in the world who live in extreme poverty.  I am proud that - even in these difficult times - the UK has chosen not to balance the books on the backs of the world’s poorest.   I hope you are too. 

Against the backdrop of the deficit, this ring-fenced budget puts a huge responsibility on Government to spend the money wisely.  As we ask people to made hard choices at home, we have to be able to demonstrate that our aid programme represents the most effective use of taxpayers’ money.  That’s why we have recently established the IACI, which will provide rigorous independent evaluation of our aid programme and ensure accountability and transparency in what we do.  Now more than ever we need to be focused on where we add value and on what delivers results - and account for every penny we spend. 

That is why our Secretary of State has instigated a series of reviews of the DFID aid programme to determine how we can achieve best value for money for the British taxpayer and accelerate progress towards the MDGs.   I know that many people in this room have already fed views into this process and thanks you for the contributions you have made.  

This is not a new agenda for people in this room.  People living with HIV - and the organisations working in this area - have led the way in mobilising communities and holding Governments to account.  Now I hope other parts of the international development community can learn from your experience and success. 

Because we have seen success.  A decade ago, who would have imagined that we would have over 5 million people on treatment?    Or that the epidemic would have stabilised in most regions, with a 17% reduction in the number of new infections in 2008 compared to 2001?  Or that the price of first line AIDS drugs would have fallen by 99% from 2000 to 2008.  That is testament, in part, to the efforts of people in this room.  

But there is - of course - also a tremendous way to go: over 33 million people are living with HIV.  Globally, AIDS is one of the leading causes of death among women of reproductive age - and a major cause of maternal and child mortality and ill health in high prevalence settings. More than 2.1 million children are infected and, under new WHO treatment guidelines, at least 14.6 million are now in need of treatment.  In Sub-Saharan Africa, the epidemic has orphaned more than 14 million children.

That is why the Coalition Government has made improving the health of poor people in developing countries - including curbing the spread of HIV and AIDS - a top priority.   In June at Muskoka, the G8 reaffirmed its commitment to come as close as possible to universal access to HIV prevention, AIDS treatment, care and support.   Progress against these targets will be reviewed at a UN General Assembly special session in June next year.  The Coalition Government will play its part in taking this forward.   

I know that many of you want to know what the Coalition government is going to do on HIV and AIDS; whether we will continue to show the international leadership on this issue that UK government and organizations have become renowned for.   Well, we will review the UK Government’s forward approach to HIV and AIDS in the light of findings from the bilateral and multilateral aid reviews.   But today, I want to suggest three areas where efforts must undoubtedly focus:

Firstly, we should focus on empowering people - especially marginalised groups and women and girls - to protect themselves from HIV and to access the treatment, care and support they need.  The Coalition has been clear that women and children’s health are at the centre of what we do.  As well as being disproportionately vulnerable to HIV in sub-Saharan Africa, women and girls bear much of the burden of care and support, usually unpaid. This intensifies poverty. Gender inequality and gender based violence are significant factors fuelling the epidemic.

Women and children affected by HIV and AIDS will benefit from the Government’s prioritisation of reproductive, maternal and newborn health.  The UK is committed to doubling the number of lives of women and babies saved through UK aid by 2015. As a result, at least 50,000 more women and 250,000 babies will survive pregnancy and childbirth and 10 million more couples will get access to family planning.  DFID is developing a new business plan, which will set out how the UK will achieve its contribution towards achieving MDG 5 to improve maternal health.  This will also make an important contribution to reducing child mortality (MDG 4) - particularly through improving the survival chances of newborn babies.  We have had a fantastic response to our public consultation. Thank you to those of you who contributed. Later this year we will publish a summary of responses of all the feedback submitted.

Second, we have to focus on the underlying drivers of the epidemic such as poverty, gender-based violence and inequality, stigma and discrimination.  Here as elsewhere we need greater evidence on which interventions have impact, and more imaginative ways of measuring that impact. 

Finally we should be innovative - both in leveraging resources for the response and in ensuring the money we spend reaches those in most need.  For example cash transfer programmes have been shown to be highly effective in reaching vulnerable children, including those affected by HIV, and promoting their access to basic services. In Kenya for example, the National Cash Transfer Programme for Orphans and Vulnerable Children reached around 70,000 households by the end of 2009. And in Malawi, cash transfers targeted to help girls stay in school reduced the risk of HIV infection.  That’s why my department will explore using cash transfers more often, where appropriate, combined with a stronger focus on evaluation.

Care and support has for too long been the neglected sister in the universal access family.  In order to achieve MDG 6, more focus is needed on the broader care and support needs of adults and children living with, and affected by, AIDS.   This includes prevention of, and treatment for, opportunistic infections; nutrition; palliative and home-based care; as well as broader support services.   Quality care is important to maintain the health of a person living with HIV before they require treatment, and to secure the benefits of treatment once they are on ARVs - including minimising the risk of them developing resistance to their drugs.

The impact of AIDS, especially in sub-Saharan Africa, is enormous and individuals, families and communities need to be supported to be able to cope with its consequences.  And an effective response to HIV and AIDS must include the protection of human rights, action on stigma and discrimination, support for orphans and vulnerable children, wealth creation and community-wide responses to the epidemic.

Home-based caregivers and community organisations led some of the earliest responses to HIV in many countries, and continue to play a key role in settings where health services are overstretched or unavailable.   Palliative care should be an integral part of the AIDS response - not only the best possible end-of-life care, but also relief from pain. That is why DFID is currently supporting efforts to improve access to pain control medicines.

This is a complex agenda - we should be wary of anyone who offers us a silver bullet.   The way forward is harder than that.  We will keep making the case for prevention as the sustainable response, but we will also continue to push for increased access to treatment and, crucially, for the care and support that will remain necessary for years to come.  And this must be underpinned by innovative approaches, allowing those affected by HIV to take charge of their health, their lives, their future. 

That’s the way to an AIDS-free world.   I look forward to working in partnership with you as we continue to work towards it.