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Africa: Backsliding on AIDS Funding

AfricaFocus Bulletin
Jul 28, 2009 (090728)
(Reposted from sources cited below)

Editor's Note

"Why is it not possible to allocate sufficient money for every aspect of global health, of which AIDS is but a part, and in so doing, meet the Millennium Development Goals - money which is but a fraction, a miniscule fraction of all the public dollars that have found their way, in one short year, into the bottomless pits of greed and avarice?" - Stephen Lewis, speaking at the opening of the International AIDS Society conference in Cape Town

Both scientists and health activists gathering for the conference applauded the strong language from Lewis, who served as the United Nations Special Envoy for HIV/AIDS in Africa from 2001 to 2006. Numerous reports and statements stressed the danger that the momentum of the war against AIDS was being allowed to fade, with increased funding of both HIV/AIDS and health in general being sacrificed with the world economic downturn or presented as mutually exclusive alternatives.

That danger is increased by waning public attention, fueling the misleading impression that the war against HIV/AIDS is being won. A Google trends search for "aids africa" (http://www.google.com/trends?q=aids+africa), for example, shows a marked decline in volume of searches between 2004 and this year.

Yet, despite very significant progress in recent years, those on treatment in developing countries are still only 30% of those needing it, and the majority of those receiving treatment are beginning treatment too late, noted a paper earlier this year in the New England Journal of Medicine (see reference below).

This AfricaFocus Bulletin contains excerpts from the speech by Stephen Lewis in Cape Town; a statement and link to a youtube video from AIDS and Rights Alliance for Southern Africa (ARASA), focusing on the unmet responsibilities of African leaders; a summary article by Anso Thom from the Health-E news service in South Africa, and a statement released at the conference by a wide range of health groups demanding support both for HIV/AIDS and for other basic health needs included in the Millennium Development Goals.

For previous AfricaFocus Bulletins on health issues, visit http://www.africafocus.org/healthexp.php

The official conference website is at http://www.ias2009.org, and the conference blog is at http://ias2009live.blogspot.com

Additional recent related reports include:

UK All Parliamentary Group on AIDS, "Treatment Timebomb," on the need to expand treatment to those not covered as well as to continue it for those already receiving treatment, particularly the problem of expensive "second-line" treatment.
http://www.aidsportal.org/repos/APPGTimebomb091.pdf

Kaiser Foundation report on Donor Funding for Health In Low- & Middle- Income Countries, 2001-2007, July 2009 http://www.kff.org/globalhealth/upload/7679-03.pdf

HATIP report on HIV scale-up in a global recession, June, 2009
http://aidsmap.com/cms1324435.pdf

International Treatment Preparedness Coalition, "Failing Women, Failing Children: HIV, Vertical Transmission and Women's Health", May 2009
http://www.aidstreatmentaccess.org

Nathan Ford, Edward Mills, and Alexandra Calmy, "Rationing Antiretroviral Therapy in Africa - Treating Too Few, Too Late", New England Journal of Medicine, April 30, 2009
http://content.nejm.org/cgi/content/full/360/18/1808

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

Speech by Stephen Lewis, co-Director, AIDS-Free World, delivered at the opening of the International AIDS Society Conference on Pathogenesis, Treatment and Prevention, Cape Town, South Africa, July 19, 2009

[Excerpts only, full text of speech available at
http://www.ias2009.org/admin/images/upload/774.pdf]

...

[Your work as scientists] is of inestimable value. We need you to unravel the secrets of the science ... But we need the scientific community as well to speak clearly, and unequivocally, boldly and evocatively to the power-brokers of this world, telling them of the risks and the benefits, and what will happen if they make the wrong choices. ...

So when, as now, there's a backlash against funding for AIDS, with mindless charges against AIDS exceptionalism, you should find a way, collectively, to shoot down the pinched bureaucrats and publicity-seeking academics who advocate exchanging the health of some for the health of others - who propose robbing Peter to pay Paul rather than arguing, in principled fashion, that money must be found for every imperative, including maternal and child health, and sexual and reproductive health, and environmental health as well as all the resources required to turn the tide of the AIDS pandemic.

It can never be an either/or. We're talking about human lives for God's sake, not about the phony parsing of balance sheets. The Treasuries of the western nations are very artful at the divide and conquer route. We must never allow them to play one part of the health sector against the other. HIV/AIDS, for all the horrendous human consequences, has objectively strengthened health systems, has brought together all the sectors of government from agriculture to education, has integrated private and public initiatives, has exponentially raised awareness of the consequences of gender inequality, has spawned remarkably novel ideas for raising resources - all of it inevitably improving human health overall.

...

And when the G8 won't renew its 2005 commitment to universal access; when the G8 cynically uses the financial crisis to threaten cutbacks to AIDS funding; when the G8 once again, yet again, always again subverts its own promises and in so doing compromises the health of millions, then it's time for science to speak with one powerful voice of accusation. And when the Global Fund faces a shortfall of several billion, you would do the world a tremendous service by simply finding a way, collectively, from your positions of authority, to remind the political leadership of how they used precious public money to bail out the banks, so that Goldman Sachs could make a profit of $3.4 billion in the second quarter of 2009, JP Morgan Chase could make a profit of $2.7 billion in the same period, and with obscene contempt for the human condition, pay bonuses, yet again, beyond the dreams of hyperactive wealth. ...

And there's one other matter I must raise. The epidemic of domestic sexual violence that lacerates the soul of South Africa is mirrored in the pattern of grotesque raping in areas of outright conflict from Darfur to the Democratic Republic of the Congo, and in areas of contested electoral turbulence from Kenya to Zimbabwe. Inevitably, a certain percentage of the rapes transmits the virus. We don't know how high that percentage is. We know only that women are subjected to the most dreadful double jeopardy.

The point must also be made that there's no such thing as the enjoyment of good health for women who live in constant fear of rape. Countless strong women survive the sexual assaults that occur in the millions every year, but every rape leaves a scar; no one ever fully heals. This business of discrimination against and oppression of women is the world's most poisonous curse. Nowhere is it felt with greater catastrophic force than in the AIDS pandemic. This audience knows the statistics full well: you've chronicled them, you've measured them, the epidemiologists amongst you have disaggregated them. What has to happen, with one unified voice, is that the scientific community tells the political community that it must understand one incontrovertible fact of health: bringing an end to sexual violence is a vital component in bringing an end to AIDS. The brave groups of women who dare to speak up on the ground, in country after country, should not have to wage this fight in despairing and lonely isolation. ...

...

Pause for a moment to think what we're dealing with. AIDS exceptionalism is a perfectly defensible and descriptive concept. Why do you think the world created an organization called UNAIDS? AIDS was exceptional. AIDS is exceptional. I tramped the highprevalence countries of Africa for more than five years; if I wasn't viewing the most exceptional communicable disease assault of the twentieth century, then the word "exceptional" needs to be redefined. As a consequence of that exceptionality, and the
tremendous campaigning of grass-roots advocates, AIDS received funding, a lot of funding - never enough to be sure, but enough to recognize the exceptionality.

Then along come the detractors, driven by resentment, resentment at the success of the AIDS movement. These arithmetic arguments alleging that AIDS is getting too much money at the expense of other health imperatives - this is simply naked academic and bureaucratic envy. I know I'm not supposed to say that, but it's got to be said. Why? Because the critics know that it's not a matter of pitting one aspect of health against another. The critics know that it's a matter of measuring the resource needs of global health against the crazy expenditures that the world makes on other things. ...

I urge the scientists and activists here assembled not to fight on the terrain of the poseurs. ... You just can't permit an intellectual contrivance --- an argument in favour of accepting the size of the pie and slicing it differently, rather than demanding a larger pie --- you can't allow that to be used to justify a terrible reversal in public policy. People infected with HIV or at risk of infection, are suddenly tossed onto the landscape of treatment ambiguity, and the gains we've made and the momentum we've achieved are put at risk.

Is my naivet‚ showing? Why is it not possible to allocate sufficient money for every aspect of global health, of which AIDS is but a part, and in so doing, meet the Millennium Development Goals - money which is but a fraction, a miniscule fraction of all the public dollars that have found their way, in one short year, into the bottomless pits of greed and avarice?
...


African Leaders Challenged to Meet Their Commitments to Health

http://www.youtube.com/watch?v=MkWoKgLhDVs

http://www.arasa.info

Press Statement

Cape Town, 27 July 2009 -- The AIDS and Rights Alliance for Southern Africa (ARASA), a Namibia-based partnership of health and human rights groups from the Southern African region, today launched a YouTube video clip entitled "Lords of The Bling", linked to a public petition that presents a moral challenge to African leaders regarding their commitments to funding health. The clip highlights the cost of lavish expenditure and corruption among various African leaders and calculates how many people could, for equivalent sums of money, have received life-saving treatment for HIV and TB - which jointly claim almost 2 million African lives every year.

HIV, TB and numerous other health crises such as malaria, malnutrition and poor maternal health services combine to create the deplorable state of public health that is witnessed across the sub-Saharan African region. The context of the regional health crisis is an extreme deficiency of public sector resources for health, resulting in limited availability of and access to healthcare services, frequent stock-outs of essential medicines and diagnostics, and overall poor quality of services in public healthcare systems. Additionally, many countries in the region are not only facing massive shortages of health care workers, but immense dissatisfaction among the remaining health workforce with regards to inadequate remuneration and austere, over-burdened working environments. The past three months have seen the public health sector destabilized by health care worker strikes in at least four different African countries: Burundi, Nigeria, South Africa and Zambia.

The economic recession has compounded the woes faced by health systems in sub-Saharan Africa, with stagnation or reduction in donor funds threatening the stability and sustainability of health programs. The impact of this on access to HIV and TB treatment is already being felt - on 21 July, international humanitarian group Medecins Sans Frontieres held a press conference calling for urgent attention to increasingly frequent stock-outs of anti-retroviral drugs (ARVs), which have the potential to generate drug-resistant HIV epidemics. Countries such as South Africa and Uganda have already begun to turn away HIV patients who are in need of treatment, effectively suspending their right to life pending availability of resources. Given the fact that adequate treatment has been proven to decrease the transmission of HIV, failure to provide ARVs also indirectly escalates the spread of infection.

The World Bank and UNAIDS have warned that the next 12 months could see access to ARVs further threatened, potentially affecting more than 60% of people who are currently on treatment. At the International AIDS Society (IAS) conference in Cape Town last week, prominent scientists and advocates from around the world sounded the alarm on inadequate financing for health, and condemned the "AIDS backlash" school of thought, which has propagated the fallacy that the response to HIV is excessively resourced and has destablised healthcare systems in developing countries - despite the fact the response to HIV has been a proven vehicle for health systems strengthening, but treatment still fails to reach 2 out of 3 people in need. The backsliding of the G8 and other high-income countries on their commitments to funding universal access to HIV prevention, treatment and care by 2010 has rightly provoked outrage in the international health community.

However, a glaring but relatively less highlighted challenge remains the lack of domestic political commitment to - and corresponding investment of resources in - advancing health as an essential human right, as is the case in many countries in sub-Saharan Africa. As the video clip illustrates, various heads of state such as King Mswati of Swaziland, President Museveni ofUganda and President Mugabe of Zimbabwe, squander millions of dollars on unnecessary luxuries while health systems in their countries stagger and fail to meet people's most basic needs, let alone their right to the "highest attainable standard of physical and mental health", as committed to in various international human rights agreements to which these countries are signatory. The skewed priorities of these and many other leaders in the region and around the world suggest a grotesque disregard for the value of human life.

In 2001, African heads of state made a commitment to allocating 15% of their national budgets to health. Data from a 2009 African Union paper shows that almost all countries have not met this target, with a regional average of 7% budget allocation to health. SADC, the Southern African inter-governmental body, has expressed difficulty in monitoring domestic health expenditure as countries do not routinely report on it - a fact that only serves to emphasise the lack of prioritization of this essential indicator.

At the International AIDS Conference in Cape Town from 19-22 July, health and human rights advocates united to call on global leaders to invest the resources required to meet all of the Millenium Development Goals for health. ARASA strongly supports this call, and highlights the imperative on African leaders to do the same. The video clip and petition are intended to serve as an awareness raising campaign and a platform for solidarity on holding African governments accountable for their commitments to health.

ARASA is seeking sign-ons from organisations and individuals, which will be presented to leaders on International Human Rights Day in December 2009. Together with partners across the region, we are committed to building up a movement that will intensify country-level scrutinisation of and advocacy on health expenditure, and will mobilize civil society around this critical issue so that we can jointly claim our right to health.

The video clip (Lords of the Bling, Vol 1) is available at: http://www.youtube.com/watch?v=MkWoKgLhDVs

The petition is available at: www.arasa.info/healthmoney

Contact:
Paula Akugizibwe, Cape Town, paula@arasa.info. Tel: +27 83 627 1317
Gillian Parenzee, Windhoek, gillian@arasa.info. Tel: +264 61 300 381


Africa: Moves to Decrease AIDS Funding Slammed

http://allafrica.com/stories/200907220200.html

http://www.health-e.org.za

Anso Thom

22 July 2009

Cape Town - Voices warning against moves to decrease and limit spending on health - blaming the financial crisis - are increasing in volume at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009).

Yesterday (Tuesday) a media conference and a special session spoke about the lack of funding for health programmes and HIV/AIDS interventions, in the light of successful efforts to in a short space of time gather billions of dollars to bail out banks or money to boost military spending in so-called low and middle-income countries.

Dr Eric Goemaere of Medecins Sans Frontieres in South Africa recalled a meeting in Uganda in September 2001 where they pushed for Africa to be given ARVs. "People were asking whether we are crazy and asked whether we were really serious about putting people in Africa on ARVs," he said. Today, four million people have been initiated onto ARVs, however threats of funding shortages are now endangering the sustainability of these programmes, condemning poor people to die.

"People are coming in masses because they have believed what we have promised," said Goemaere.

He revealed among others that:

  • Tanzania's HIV budget had been reduced by 25%;
  • Swaziland has reduced its 2011 treatment coverage target from 60% to 50%;
  • Uganda has sent an instruction to stop enrolment in some Pepfar (US government) funded NGOs;
  • Malawi is expecting a national drug shortage and is devising an emergency contingency plan;
  • South Africa has already reported stock-outs and revealed that there is a financial ceiling in terms of what can be done to reach to the National Strategic Plan targets.

Professor Robin Wood of the University of Cape Town warned against "backsliding".

He shared data from a suburb in Cape Town where they were achieving 90% ARV coverage which has in turn seen a 20% decline in tuberculosis rates and a mortality rate that is similar to HIV negative people with TB.

"What message are we sending to patients who have been told about adherence and the lifetime commitment to treatment when we inform them we no longer have drugs," he asked, cautioning that interrupting people's treatment would lead to viral suppression and the need to move patients to second line treatment at six times the cost.

Paula Akugizibwe of the AIDS and Rights Alliance said that the money was available, but that it was not being spent on people's health. "The African Union has estimated that U$148-billion has been lost to corruption, that's pretty much the funding gap we face."

"If you limit the money you spend on health, you are prescribing how many people get to live. If you are pitting one Millennium Development Goal against another, you are prescribing how they die. It may be different MDGs, but it's the same people," she said.

Akugizibwe handed out fake dollar notes calling to "Show us the money for Health" with pictures of African leaders on the flip side and the money they have wasted. Uganda President Yoweri Museveni is accused of spending U$48-million on a private jet which is more than his country spends on HIV/AIDS.

Zimbabwe President Robert Mugabe is accused of spending U$250 000 on his birthday bash - enough for 10 501 treatment courses for TB.

"We need to understand why the social determinants (access to clean water and good sanitation) are getting worse while the world is getting rich," said University of Western Cape professor and People's Health Movement representative David Sanders.

He cited diarrhea, a common killer of people living with HIV. "We will not kill that problem unless we address water and sanitation," he said.

Statistics show that between 1990 and 2004 the number of people without access to water increased by 23% and those without access to sanitation by 30%. Over 40% of people in sub-Saharan Africa have no access to water and sanitation.

Sanders said he wanted to warn the AIDS fraternity that the world has a track record of departing from comprehensive primary health care to selective primary health care. "There was a big increase in oral rehydration therapy and immunization in the 80s, but it changed when the donor fashion changed and now only 50% of children in Africa are being immunized. So you need to ask where we are heading if they so easily deserted basic and simple programmes while we know ARVs are much more complex," said Sanders.

Stephen Lewis of AIDS-free World called for people to fight the good fight over enlarging the pie "or everyone will lose".


Advocates for Health Millennium Development Goals Unite to Demand World Leaders Honor Funding Commitments

Found: Hundreds of Billions of Dollars to Save the Wealthiest Corporations Lost: Billions of Dollars of G8 Commitments to Save Millions of Human Lives

July 21, 2009

Contacts: Gorik Ooms in Cape Town, gooms@itg.be or + 27 (0) 727634603 Gregg Gonsalves, gregg.gonsalves@gmail.com or +1 203-606-9149 Kay Marshall, kaymarshall@mac.com or +1-347-249-6375

[Excerpts, full statement available at http://tinyurl.com/lz5oyx]

Cape Town -- In an unprecedented and historic show of unity, advocates for all the health Millennium Development Goals (MDGs) have charged the leaders of G-8 countries with reneging on their commitments to health by chronically underfunding programs for AIDS, TB, maternal and child health, sexual and reproductive health, and health systems strengthening across the globe.

The coalition of advocates demands that world leaders make the health of men, women, and children around the world as important a priority as the health of banks, Wall Street investment firms, and auto companies and calls on donor governments to partner with civil society to strengthen accountability from recipient countries.

"We are already seeing people die and families forced further into poverty by healthcare costs as a direct result of this global economic crisis," said Dr. Lola Dare, Executive Secretary of the African Council for Sustainable Health Development (ACOSHED). "The fickle policy decisions of world leaders and national government are further compounding these problems. The global health community is speaking with one voice on this urgent need. We can no longer permit the world to be distracted by false choices - between one disease and another, between a mother's life and that of her children, between treating sick people now, in their home communities, and building sustainable health systems for the future to deliver basic health care that can save lives." "Investments now in HIV and health broadly are fundamental prerequisites for global development," said Julio Montaner, President of the International AIDS Society.

The global economic downturn is leading to significant backsliding in governments' commitments to funding for health programs in developing countries. "The rhetoric by heads of state at this year's G-8 summit was, as usual, noble and righteous. They produced statements about their support for health systems strengthening, maternal and child health, and integrated health service delivery," said Gregg Gonsalves, a co-founder of the International Treatment Preparedness Coalition. "But, as has come to be the unfortunate pattern, the financial commitments made by the most powerful of the world were unacceptably low or worse, not made at all."

...

"We estimate that to meet the promised health needs of less developed countries would take an increased investment by high income countries and developing country governments of around $150 billion a year . The AIG bailout alone was $170 billion," said Brook Baker, Professor of Law at Northeastern University and Policy Analyst for the US-based Health GAP. "Or to look at it another way, for 36% of what countries have spent in one year on direct bailouts of corporate and financial interests, rich countries alone could fully fund the additional $944 billion that we estimate is needed from now through 2015 to meet all MDG and health systems strengthening needs in less developed countries." Developed countries have so far contributed over $2.5 trillion in direct bailouts and over $6 trillion in 'guarantees.'

...

The coalition of global health advocates demands that each G-8 country pays 100% of the commitments they have made for 2010 including: for Universal Access to AIDS treatment, prevention, and care; full funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria; as well as additional commitments made for maternal child health and health systems strengthening.

"The fact that governments have quickly passed legislation to bailout the banks and companies that created this global financial crisis proves that there is sufficient capital to support those whose lives have been most affected by the crisis. What is needed is sufficient will," said Donna Barry of Partners In Health in the USA.

The U.S. President's Emergency Fund for AIDS Relief (PEPFAR) has been flat funded for three years; the G-8 countries have underfunded the Global Fund for AIDS, Tuberculosis and Malaria by $4 to 9 billion; donor country promises to fund maternal and child health and sexual and reproductive health programs are wholly insufficient to the task; and no G-8 country has made sufficient commitments to contribute significantly to expanding and strengthening the health workforce, to supporting community-based prevention and care, or to strengthening health systems and health infrastructure.

...

Leaders representing advocates for more than 25 organizations focused on AIDS, TB, maternal and child health, sexual and reproductive health and primary health care came together in Stony Point, New York in May 2009 to initiate a partnership devoted to advocating for the universal right to health. A Declaration of Solidarity for a Unified Movement for the Right to Health was drafted at that meeting, and is being endorsed by health and human rights organizations around the world . This growing union of advocates, many of whom are signed on to this document, is now working in solidarity to hold the powers of the world accountable.

"We are all health and human rights advocates and we refuse to be pitted against each other," said Paula Akugizibwe of the AIDS and Rights Alliance for Southern Africa, "MDGs are simply categories of different needs that exist within the same human being. The same mother who needs ART to prevent the transmission of HIV to her infant also needs adequate nutrition and her children need clean water and immunizations. The same community that needs infection control for TB also needs it for influenza; and insufficient financial and human resources for health may prevent them from having any of these rights fulfilled."

For the initial group of health organizations supporting this statement see http://tinyurl.com/lz5oyx


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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