On Thursday last week, at a special parliamentary event in the run-up to World AIDS Day, Lynne Featherstone MP, the Parliamentary Under-Secretary of State for International Development, formally launched the update of the DFID HIV Position Paper “Towards Zero Infections – Two Years On”The paper examines the 2011 Position Paper after an extensive review process led by Oxford Policy Management with huge support from StopAIDS and its member organisations.

DFID - Towards Zero Infections: Two Years On
DFID – Towards Zero Infections: Two Years On

The position paper is clearly important for HIV-focused organisations, but also for any organisation in the UK working on TB. This is for two reasons: 1) TB and HIV are inextricably interlinked, TB accounts for one in five HIV-related deaths, whilst the explosion of HIV throughout the 80s and 90s drove the resurgence of TB around the world and 2) DFID’s response to TB as a global epidemic comes primarily through its investments on TB/HIV or as a consequence of investments in multilaterals that address TB, Malaria and HIV.

Before diving into the detail it is important to note that the UK’s continued focus on HIV should be applauded. The UK is right at the forefront of the global response to HIV and that is something for which we should be proud. The Position Paper is a clear statement of the continuing importance of HIV to the UK and to DFID, even if the content, for TB, is somewhat disappointing, the ambition and commitment on HIV clearly remains.

Looking more specifically at what the paper says about TB, it starts with a statement that the “integration of the HIV-response within…TB” is a policy priority, and outlines the UK’s “strong commitment” to the 2011 UNGA HIV/AIDS declaration which targets a 50% reduction in deaths from TB/HIV. Unfortunately, for people who work on TB, this is perhaps where it peaks, and there is very little of actual substance within the paper in regards to TB/HIV. In the section entitled: “Future Priorities” TB is mentioned only three times in passing.

For RESULTS’ particular areas of work there is good and bad news. DFID note that they are putting the final touches to a project on TB & Mining in association with the World Bank. This is a welcome demonstration of leadership on a key issue in relation to the epidemic in sub-Saharan Africa, and can be traced back to our “Dying for Gold” campaign.

The  contributions to the Global Fund and to UNITAID are also important focuses of our work and critical to the global response to TB, these have been, and should continue to be, applauded. There is also mention of product development, another area where DFID can rightly claim to be a global leader.

On the other hand, however, DFID notes the importance of UNAIDS and the Stop TB Partnership, yet it only provides relatively limited funding to STBP despite repeated statements of the importance of the Partnership. In terms of RESULTS’ work on vaccines, IAVI is noted, but the paper omits the detail that their funding received a significant cut for the next funding period.

All of which, more or less, comes together to draw a picture of a lack of strategy in relation to TB and TB/HIV. DFID’s major interventions for TB itself are through product development, small contributions to STBP and (hopefully) TB and Mining in the near future. Bilateral programming comes primarily through support to CSOs who do HIV/TB work and the multilateral funding is due to investments in HIV and Malaria control, with TB receiving funding as a result. This, in itself, isn’t a bad thing, we should be proud of the UK’s commitments to these multilaterals, but what we end up with is a series of largely disjointed interventions with no driving strategy or thought behind how they interact or play into the broader TB epidemic.

DFID could be a global leader on TB, in many ways it could already claim to be. Perhaps more than anything else, global leadership is required to make TB a priority across the globe and inspire the coordinated response needed to quell the epidemic. Unfortunately, that leadership is lacking, which is especially disappointing given that DFID continues to focus on a Value for Money agenda and the Prime Minister himself co-chaired a High Level Panel whose report detailed that TB represented the greatest value for money of all the health interventions studied.

When the Global TB Programme launched the Global TB Report in October, they identified the scale-up of the response to TB/HIV as a key necessary action to control the TB epidemic. At present 57% of people with TB/HIV are on treatment for ARVs, and the Global TB Programme, quite rightly, have said that efforts should be made to reach 100% coverage. Although DFID state TB/HIV is a priority, the paper’s only real reference to dealing with co-infection is to state that their efforts in this area will be led by the Global Fund. This is not the committed, leadership from a globally lead development agency that we need.

If DFID were to look holistically at its TB interventions, where the gaps are, and how its commitments could be leveraged with relatively small investments in programmes like TB REACH it could scale-up its impact and, ultimately, save more lives – as well as achieving the best value for money for the British taxpayer. We welcome the continued commitment to the HIV epidemic, but DFID needs to demonstrate that it will back up its ‘prioritising’ of TB/HIV with a clear vision for the future and concrete actions, simply handing responsibility to the Global Fund is not sufficient.

Our recommendations for DFID:

1)      Continue and expand the work focussing on TB and HIV in the mining sector.

2)      Match the Global Fund’s mandate that all countries with high burdens of TB and HIV should submit applications for funding that will address both diseases.

3)      Formulate a strategic vision that will tie together DFID’s TB interventions and explain how this will lead to a reduction in global cases.