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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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