AFRICA: Action needed now on HIV/AIDS, June 27 2001

NEW YORK, 27 June (IRIN) - Down in the basement of UN headquarters is where the anti-AIDS militancy is brewing. It is here, among the civil society groups attending the three-day UN Special Session on HIV/AIDS, that the loudest and most insistent calls for action are being made.

On Tuesday, crowded into a tiny conference room, a coalition of campaign groups demanded that Western governments and pharmaceutical companies shoulder their responsibilities in the fight against the epidemic. To the shaking of money tins, activists chanted "Treatment Now" and "Pills Cost Pennies - Greed Costs Lives".

For the Global Treatment Access Campaign, the issues are stark. They revolve around the funding and control of the UN's Global AIDS and Health Trust Fund, the immediate availability of affordable drugs in the developing world, and the burden of poverty most especially affecting African countries.

UN Secretary-General Kofi Annan launched the Global Health Fund initiative in April. He called for US $7-10 billion from wealthy countries each year for the next decade for the care, treatment and prevention of HIV/AIDS, tuberculosis and malaria in the developing world. The first and largest contribution so far has come from the United States with US $200 million.

Washington has promised more, but has set no date. Oxfam contends that, based on gross national product, the US contribution to the fund should be in the region of US $4 billion a year. And rather than for just a decade, allocations need to be stretched over 20 years.

That sounds an awful lot of money. But, according to the Drop the Debt pressure group, Nigeria with 120 million people and facing an exponential growth in HIV rates, is expected to pay creditors US $1.2 billion a year in debt servicing. Zambia, where one in five adults have HIV, is spending US $176 million annually on debt, compared to US $76 million on health.

The US $200 million that the United States has so far promised the fund is equivalent to the sum paid by sub-Saharan Africa each week in debt.

[For more information visit: www.dropthedebt.org]

"We want total debt cancellation, we will only know that the world is serious about HIV/AIDS when they give us another chance to start with a clean sheet," Sheila Kibuka of Kenya's Society for Women with HIV/AIDS told the treatment access campaign meeting.

Meanwhile, contributions to the global fund are running at only around US $500 million. Even with expected pledges in July at the G-8 summit, total contributions are not expected to reach US $1 billion by the end of the year, according to the 'New York Times'. That, by default, would force treatment and care initiatives off the agenda.

A concern among activists is that Western governments would be far happier to spend on cheaper preventive programmes - condoms and AIDS education - rather than the provision of treatment for the 36 million people infected with HIV worldwide. Inadequate health infrastructure and complicated antiretroviral regimens are frequently cited to justify a prevention-focused strategy in developing countries.

But, the US-based Health Gap Coalition points out that "vast numbers of people with AIDS are dying (or within reach of) hospitals and clinics that can dispense prescriptions, but lack the medications necessary to save their lives". It can typically take just three pills, swallowed in one gulp twice daily, to keep somebody infected with HIV alive.

[For more information visit: www.globaltreatmentaccess.org]

What is increasingly being recognised at the UN Special Session is the need for an "integrated approach" involving both treatment and prevention. "Treating patients plays a crucial role in preventing infection, and hope of treatment in turn is an incentive for those infected to seek diagnosis and advice," an Oxfam report said. "The fund should be designed to support a range of health needs - both preventive and treatment. It should also be available to support the development of infrastructure and service delivery systems where their absence prevents the poor from accessing health services."

[To access the report visit: www.oxfam.org.uk]

The Oxfam report also urges that anti-AIDS drugs be procured under competitive tender, open to generic drug manufacturers, rather than just the major pharmaceutical companies. Bulk buying through regional governmental organisations would also help reduce prices. In a challenge to patent monopolies, the Oxfam report champions the use of compulsory license and parallel imports to enable countries to access drugs from the cheapest source.

"In most African countries I am confident that the leadership has woken up to the threat of HIV/AIDS," Kibuka told IRIN. "It is not just poor people who are affected, it also effects people in government."

What is urgently needed, she argued, is to begin. "We cannot wait for these bureaucracies," she said, in reference to the fund. "Let's just start and move on. We have mission hospitals in the villages, all this talk of lack of infrastructure are just lame excuses."