Speech
Douglas Alexander speech: “Achieving Universal Access” – the UK’s strategy to tackle AIDS in developing countries
2 June 2008
Douglas Alexander, Secretary of State for International Development, gave a speech to launch the new AIDS Strategy at Lancaster House, London, on Monday 2 June 2008. The strategy builds on the United Kingdom’s previous strategy for tackling AIDS in the developing world – entitled “Taking Action” – which was launched just four years ago.
Good afternoon and thank you for coming here today, and indeed for your
participation in contributing to our new strategy for advancing global action on
AIDS – we could not have done it without you.
It is a personal privilege for me to launch this strategy – entitled “Achieving Universal Access”. It builds on the United Kingdom’s previous strategy for tackling AIDS in the developing world – entitled “Taking Action” – which was launched just four years ago.
That landmark strategy, the work of the people at the Department for International Development and indeed the work of everyone here in this room, I believe, helped to galvanise international political leadership, increase funding, and achieve better results in the global fight against HIV and AIDS.
Through the Presidencies of the G8 and EU in 2005, the United Kingdom led the way to the international commitment to Universal Access to comprehensive HIV prevention, treatment, care and support.
Global funding to tackle AIDS has increased from $6 billion back in 2004 to some $10 billion last year. One out of every ten dollars spent on development assistance is today being spent on HIV and AIDS.
This step-change in political leadership and commitment has lead to real progress on the ground. The World Health Organisation, UNICEF and UNAIDS have today confirmed that there are now some 3 million people on anti-retroviral treatment. Compare that to just 100,000 people who received treatment back in 2001 – it is a thirty-fold increase. The price of first-line AIDS drugs has halved since 2003 and the percentage of adults living with HIV has now thankfully started to level off.
More to do
Yet all of us in this room know that the scale of the challenge facing us remains vast – and that, despite these advances, not enough people have access to the services they so desperately need.
More than 33 million people around the world are living with HIV, and fewer than a third of those who need antiretrovirals have access to them.
Nearly 7,000 people are infected with HIV every single day, and a man in Africa has access to just three condoms a year.
A pledge from the United Kingdom
All of us in this room are gathered because we share the same goal – to deliver on the international commitment to Universal Access to comprehensive HIV prevention, treatment, care and support.
The question that each of us therefore needs to answer is: how can we best contribute to the global effort to reach that global goal? And that question was at the forefront of my mind when considering our priorities as set out in this new strategy.
Today, the task is to build upon the strong foundation of the last strategy that we launched, and the increased international focus, political will and resources for the global fight against AIDS that followed its publication.
I am determined that the United Kingdom should remain at the forefront of the global fight against AIDS. Which is why, within months of becoming International Development Secretary, I made a pledge that the United Kingdom would provide £1 billion to the Global Fund – providing it with long-term, predictable funding until 2015.
Yet if we are to achieve universal access to the services people need, and not merely halt but also reverse the spread of AIDS, I believe we need to expand this long-term approach across the range of health systems and services.
For the current global under-investment in health in developing countries is fundamentally compromising our efforts to tackle AIDS. Because in the real world, we cannot provide sustainable prevention or treatment of AIDS without more and better equipped doctors and nurses in more communities, giving people better access to prevention, treatment, care and support.
That analysis is shared by UNAIDS, the World Health Organisation and UNICEF, and is underlined in their new report on achieving Universal Access, published today. The authors of that WHO report warn that weak health systems and services are likely to slow the future expansion of access to antiretroviral treatments.
That is why UNAIDS argues that a quarter of the world’s resources to reach Universal Access should go towards strengthening health systems and services.
And that in turn is why, in addition to our £1 billion commitment to the Global Fund, I can announce to you today that the United Kingdom will invest £6 billion over seven years to strengthen health systems and services. This quite unprecedented long-term pledge signals the level of our commitment as part of the international effort to reach universal access.
Health systems and services
Our £6 billion investment will enable us to expand our efforts to get more health workers where they are most needed. That means more of the kind of work we are already doing in Malawi, where we are providing £100 million over six years to boost the number of health workers in that country.
This kind of long term, predictable funding gives the Government of Malawi the security it needs to double the number of nurses, triple the number of doctors, and retain them through better pay and conditions.
By expanding our investment we will help to meet the urgent shortfall of some 800,000 health workers in the 36 worst-hit African countries.
Our £6 billion investment will also enable us to increase our support for sexual and reproductive health services, and particularly family planning. Indeed we will lead international efforts to halve unmet demand for family planning by 2010, to pave the way for universal access by 2015.
Just last autumn I announced that the UK Government will provide £100 million over the next 5 years to the United Nations Population Fund - to provide better health care, advice and male and female support and contraception. We know that £1 million invested in this way could save the lives of 1,600 mothers and 22,000 infants. I want our investment of £100 million for family planning to have an impact on hundreds of thousands of more lives.
Our £6 billion investment for health systems and services will enable us to work with developing countries to improve antenatal care to prevent HIV from being passed on to babies in the womb. Right now only a third of women have access to such services. We will play our part in helping to get eight out of ten HIV-infected pregnant women, in the countries most affected by AIDS, on to antiretrovirals by 2010.
And our £6 billion investment will also support the integration of health systems and services in developing countries. For we know that we can and must do more to link up different health services, to reflect the reality of peoples’ needs within those countries.
In Africa, where tuberculosis is the leading cause of death among people living with HIV, our support will help efforts to improve rates of TB diagnosis among people living with AIDS – and HIV diagnosis among people with TB.
Supporting the vulnerable
Strengthening health systems will help more of the most vulnerable people to access the services they need. Yet as this strategy sets out clearly, the scale of our ambition in tackling AIDS is not limited to our focus on health systems and services. People affected by AIDS don’t just need access to health care – they need the support of social protection, education and indeed the law.
And while HIV is an infection that can affect any man, woman or child, rich or poor, we know that those who are marginalised in society are of course today most affected by AIDS. These groups will vary from country to country, yet we know globally that they are women, children and young people, men who have sex with men, injecting drug users, sex workers and prisoners.
So we will continue to support services that reach those most at risk, are tailored to the realities of their lives, and address the discrimination that makes them more vulnerable.
Women and girls
As AIDS continues to spread, it is women who are of course most widely affected. In sub-Saharan Africa young women are three times more likely to be HIV positive than young men. And therefore the test of leadership on HIV and AIDS must be investment in women and girls.
So today I can announce that the United Kingdom will double our funding for research into both vaccines and microbicides to combat HIV and AIDS, in order to give women a chance of better protecting themselves against infection.
We are investing to increase women’s rights, with real effect. In Sierra Leone, a country I visited in January, our support helped to change the law to make domestic violence illegal, set a minimum age for marriage and give women greater property rights.
We know the positive impact that educating girls can have on preventing HIV. In Swaziland, two-thirds of girls who are in school are free from HIV - compared with two-thirds of girls out of school who have HIV. The United Kingdom is investing £8.5 billion to support countries’ own 10 year plans to get all children – boys and girls - into school.
Orphans and vulnerable children
Some of those children will have been either orphaned or left vulnerable by HIV/AIDS. These children, deprived of the people who protect and care for them, are often the least well served by their communities. Our last strategy helped to increase global funding for orphans and vulnerable children – but we must now ensure that their needs are better met by national plans on health, education and social protection.
So I can further announce today that the United Kingdom will invest £200m over three years to expand social protection in at least eight African countries. This investment – which is in addition to the £6 billion for health systems and services - will significantly increase the number of orphans and vulnerable children who have access to better child nutrition, health and education.
In Zimbabwe alone, we aim to reach 400,000 orphans and vulnerable children by 2010 – more than doubling the number of children currently receiving support. We will work with UNICEF and NGOs to review the impact of social protection to ensure that it is the most effective way of meeting the needs and rights of orphans and vulnerable children.
And more must also be done to meet and respond to the needs and rights of other groups. Leaders all over the world need to respond to the AIDS epidemic as it exists in their countries. That will mean open and frank discussion and policymaking in areas that may be social taboos - such as drug use, people having sex at a young age, with same-sex partners or for money.
We will work with our partners to reduce stigma and increase the coverage of HIV prevention and AIDS services for injecting drug users, men who have sex with men and of course prisoners.
We will extend the kind of programmes we support in Malang, in East Java –where providing condoms and HIV services to sex workers has reduced the prevalence of sexually transmitted infections from a third to a fifth in just three years.
Improving effectiveness and value for money
Because donors need to ensure that we are solving problems, not creating them, this strategy continues our commitment to work for better coordination and effectiveness.
That will include increasing the benefits from the International Health Partnership, which I launched together with our Prime Minister, Gordon Brown, and representatives from other donor countries, international institutions and developing countries, just last autumn.
We will work with international partners to help bring down drug prices. In this strategy we estimate that by simplifying the market for antiretrovirals, and thereby increasing demand for particular drugs, enough money could be saved to pay for medicines for an extra 1 million people each and every year.
Last month I launched the pilot stage of the Medicines Transparency Alliance, which brings together governments, companies and civil society to publish information on the procurement of medicines. This transparency can also help to bring down prices, drive up quality and increase availability of drugs for those who need them most.
We will take innovative approaches to improving cost effectiveness and getting value for money by investing in new technologies and research. Two months ago I launched the Department for International Development’s new research strategy, committing to spend £1 billion on research – with health as one of six identified research themes.
And our greater focus on prevention will not only benefit the lives of those who are vulnerable to AIDS, but is also far more cost effective than a life-long course of antiretroviral treatment.
Indeed, a study of Thailand’s AIDS programmes showed that for every dollar spent in the 1990s on HIV prevention, 43 dollars were saved a decade later by avoiding the need for those expensive AIDS treatments. And that saving will go on into the next decade, and we hope the one after that.
So we will increase our efforts to prevent the spread of HIV and AIDS. I can announce today that the Department for International Development will provide £100 million over the next six years to help improve Nigeria’s national response to HIV. Up to £30 million of that investment will be specifically allocated to provide condoms – indeed this funding will provide 7 out of 10 condoms in Nigeria over the next six years.
Closing remarks
I believe that this strategy – and indeed its very title of “Achieving Universal Access” – shows clearly this Government’s unwavering commitment to universal access to AIDS prevention, treatment and care.
The truly terrible spread of AIDS shows just how interconnected our lives are at the beginning of the twenty-first Century.
Since it was first identified back in 1981, AIDS has moved around the world at quite astonishing and horrifying speed. It has reached every corner of the globe, bringing destruction to lives and communities on all continents.
A disease which just twenty five years ago was commonly misperceived as affecting European men, is now cutting down a generation of African women.
Yet if the disease itself shows just how close we are in this interconnected world, then I believe our response to the disease can show the same.
That we stand together in solidarity, united by a common cause. For universal access to prevention, treatment and care will only be found by common endeavour.
This strategy sets out this Government’s commitment to that shared action, and our efforts in that shared endeavour.
