by Tsitsi Singizi – SANF 04 no 88
As southern Africa moves towards comprehensive regional integration and its people migrate within the region, the wisdom of sidelining individual countries in accessing the global AIDS fund has potential to do more harm than good.
Botswana has kicked off its treatment campaign by providing free anti-retroviral (ARV) drugs through its public health system, the first country on the continent to do so. This is due to unprecedented financial support from donors, including the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The support follows a plea to the UN General Assembly by the country’s president, Festus Mogae, three years ago in which he sought assistance to deal with the pandemic, which he described as “… a crisis of the first magnitude.”
Mozambique has also qualified to receive resources from the global fund, with a two-year approved funding of US$51 million to boost its efforts in the fight against HIV and AIDS. Lesotho, Namibia and Zambia are also beneficiaries from the global fund.
Both Botswana and Mozambique are also beneficiaries of various international funding sources, the largest being the recently unveiled United States of America President’s Emergency Plan For AIDS Relief (PEPFAR). Other sources of funding for HIV programmes are the Clinton Foundation and the Bill and Melinda Gates Fund.
International aid funds are often described as being conduits of ideological hegemony to the developing world. The PEPFAR fund has received global criticism for providing funding programmes that would perpetuate their domestic health policy.
For instance, the fund has provided US$15 billion to programmes that will promote abstinence as a priority method for prevention of HIV and AIDS, despite the fact that research has proven it as an unrealistic method. The 5-year fund will also not fund any programmes that encourage abortion.
Zimbabwe’s application to the global fund for US$218 million was recently turned down, despite an estimated adult HIV prevalence of 25 percent.
The emerging furore on the allocation of resources underscores the need for concerted global resources and a need to separate humanitarian concerns from political issues.
The fight against AIDS has sometimes been reduced to bilateral deals with the developing countries being made to give up their right to produce affordable generic drugs in return for favourable ARV deals.
In the global fund’s framework document, “political commitment of a country, as measured by various indicators, ” is cited as a condition for eligibility, viewed as a subjective restriction to accessing the fund.
The rejection of the Zimbabwe proposal triggered debate on the selection criteria for the allocation of the much-needed resources. The argument of donor politics was resuscitated as the country, which is faced by international criticism but has need for additional funds, was denied funding. An injection of funds would have assisted the country in its plans to scale up the provision of treatment care and ARVs
Opening the national AIDS Conference in Harare in June this year, President Robert Mugabe acknowledged that lack of financial resources by the government was a hindrance in the provision of care for people living with HIV and AIDS.
“Regrettably, the current drug costs mean we can only reach 10,000 patients. Clearly, there is a need to mobilise more resources and build sustainable partnerships, so that we can reach more patients.”
Former Zambian president, Kenneth Kaunda and several ministers from the Southern African Development Community (SADC) countries concurred that while there are widespread calls for provision of antiretroviral drugs (ARVs), the lack of basic necessities remain enormous challenges, including food, clothing, shelter and access to health services.
“We cannot fight AIDS if we do not tackle the poverty in our region,” Kaunda said. “The drugs are not as useful as when taken by someone who can afford good food… We have seen frail men in our clinics, almost dead but recovering fully after being well fed.”
Statistics show that families who have chronically ill patients are concerned about the availability of food more than anything else.
“Malnutrition affects 90 percent of HIV and AIDS patients … it is also responsible for 60 to 80 percent of AIDS deaths,” nutritionist Percy Chipepera told the conference, which also highlighted the need for co-ordination of interventions both locally and regionally.
The director-general of the central board of health in Zambia, Ben Chirwa, applauded Zimbabwe’s level of coordination in the response to HIV and AIDS adding that such synergies needed to be replicated in the region.
“We are very impressed by Zimbabwe’s concept of one national strategic plan, one coordinating body and one monitoring and evaluating framework. This shows coordination, even the formation of the national AIDS council through an act of parliament. This is something you take for granted as Zimbabweans, but we are grappling with in Zambia and other countries in the region,” he said.
“In SADC, the concept is that if one country has made progress in one particular area, others should support it. There are many lessons to be learned from the Zimbabwean experiences,” Chirwa said, adding that Zambia had rolled out ARVs countrywide and others could learn from their experiences.
Access to ARV drugs for patients in poorer nations was a central theme at the XV International HIV and AIDS Conference in Thailand this year, that attracted almost 20,000 delegates. Speaking at the conference, the UN Secretary-General, Kofi Annan called for “global solidarity” in the provision of funds. (SARDC – SADC Today)
