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The Department for International Development responds to the international HIV/AIDS epidemic on a wide number of fronts, and has increased its expenditure in this area in recent years. It has also recently announced an intensified effort to address the epidemic, one of the major threats to international development goals. A National Audit Office report has identified DFID’s broad-based approach, its flexibility of response in-country, and its role in supporting research as strengths. Difficulties remain, however, in adequately embedding HIV/AIDS across DFID’s planning systems; in securing information both to plan and monitor effective interventions; and in making best use of HIV/AIDS expertise and knowledge.

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The epidemic, particularly devastating for poor countries, jeopardises achievement of the Millennium Development Goals which have the overall aim of halving by 2015 the proportion of the world’s population living in extreme poverty. The United Nations Development Programme estimates that in Burkina Faso, Rwanda and Uganda, the proportion of people living in absolute poverty will, as a result of HIV/AIDS, increase from 45 per cent today to 51 per cent in 2015.

Today’s report to Parliament by head of the National Audit Office Sir John Bourn points out that DFID’s HIV/AIDS strategy compares well with HIV/AIDS strategies developed by like-minded donors. It provides a starting point for country staff to develop programmes suited to local circumstances. But it could have provided further guidance on the relative merits of different approaches, responding to demand from country teams for guidance on the most difficult issues – such as the merits of funding anti-retroviral drug treatments. DFID plans to produce a new strategy in July this year which it intends will address these and other issues.

The broad-based and multi-sectoral nature of DFID’s HIV/AIDS response makes associated expenditure difficult to isolate. DFID estimates, on the basis of projects which targeted HIV/AIDS to any degree (including reproductive health programmes), that it spent £274 million in 2002-03. When reproductive health is excluded, DFID estimates that its bilateral HIV/AIDS expenditure in 2002-03 was between £103 million and £169 million, depending on the estimation method used. And a new system to estimate the proportion of DFID’s funding of multilateral institutions relevant to HIV/AIDS has produced an estimate of £57 million for 2002-03. In addition, a proportion of DFID’s general support to a nation’s budget can be channelled to HIV/AIDS programmes but, in common with other donors, DFID has had difficulty in identifying how much and is developing a system to address this issue.

Effective development interventions require good analysis of the context and potential responses prior to project implementation. The autonomy afforded to country teams has enabled DFID to adopt a flexible approach to HIV/AIDS programming. Today’s report found that assistance plans for countries targeted for HIV/AIDS action provided coverage of HIV/AIDS issues, particularly those relating to Africa, where the proportion of the population affected by HIV/AIDS is higher. But plans often did not link the approach proposed with resourcing and expected impacts. At project level, country teams often took key decisions on areas for intervention at an early stage in the design process, based on their judgement and experience – followed up later by more formal technical, social, institutional and risk appraisals.

The extent to which HIV/AIDS features in planning documents gives an indication of the perceived importance of the disease. However, eight of 14 Institutional Strategy Papers which set out DFID’s relationship with multilateral development institutions fail to mention HIV/AIDS. Furthermore, monitoring of progress against the objectives set out in these documents has been variable.

The development of a safe, effective vaccine would reduce significantly the trauma and cost of the disease. DFID led the donor community in funding innovative research into AIDS vaccines. DFID has also funded other research which has in some cases helped to shape global opinion on the disease. Disseminating the results of this work to partner countries and organizations has made solid headway in changing the climate of opinion and promoting evidence based decision making. More could have been done, however, to disseminate the results to DFID’s country teams – who, as practitioners, could benefit from it to help craft cost-effective country responses to the epidemic.

"The HIV/AIDS epidemic has a devastating effect on the lives of poor people in developing countries. The Department for International Development has a clear commitment to respond to HIV/AIDS. The Department should put in place management systems sufficiently robust to ensure that people affected by HIV/AIDS gain the greatest possible benefit from the increasing resources allocated to the epidemic."

Sir John Bourn

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