Wednesday 7th June 2006

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Battle for HIV/Aids funds

Encourage other donors to provide additional resources to low and middle income countries for the strengthening of HIV/Aids programmes and health systems and for addressing human resources gaps, including the development of alternative and simplified service delivery models and the expansion of community-level provision of HIV/Aids prevention, treatment, care and support, as well as other health and social services—political declaration of the UN General Assembly Special Session on HIV/Aids.

The declaration comes out of last week’s UNGASS and is in response to the several impassioned and logical appeals of ministers, prime ministers, presidents and kings from developing countries classified by international financial agencies as “middle income” states.

As pointed out at every turn by Prime Minister Dr Denzil Douglas, who addressed the assembly in his role as spokesman on health issues for Caricom, the middle income categorisation has meant that the majority of Caricom countries have not been able to access grant funding from The Global Fund on HIV/Aids, TB and Malaria.

The fund was established in 2001 out of the first UNGASS on HIV/ Aids to help the poorest of countries counter what UN Secretary General Kofi Annan says is “the greatest challenge of our generation.” Sixty-five million people worldwide have contracted the virus, 25 million have died, 15 million children have been orphaned by the disease.

Last year, more people contracted the virus and more people died from Aids than any previous year, stated Annan.

Moreover, and as argued at the assembly, increasingly, there is the trend to increasing “feminisation” of HIV/ Aids, a result of older men taking advantage of the vulnerability of young females.

But let us get back to the issue of the funding or the lack of it based on our status in the Caribbean as middle income countries. Up till now, only the poorest states of the region, Haiti, Guyana, Suriname, have so far been able to access grants from The Global Fund.

And according to the declaration, the leaders have agreed to have the fund continue “according to its policy framework,” ie, focus on the poorest of states and ask other donors to fund the needs of the middle income countries.

In the circumstances of the situation facing the fund—having to mobilise US$18 billion in 2007 for distribution, that figure reaching US$23 billion in 2008, as stated by UNAids executive director Dr Peter Piot, and with a projected US$900 million shortfall in the immediate—it is quite unlikely that there will be any leftovers upon which Caricom can depend.

The question is would Caricom and other similarly placed countries be able to persuade these “additional donors” to their cause based on the political declaration made last week at the UNGASS?

The financial criteria have been established by agencies such as the World Bank and the IMF. This is not a new battle for Caricom which has been on the offensive to have the criteria changed in other fora on development and environmental issues. There has been little success to date.

Caricom, through the Pan Carib-bean Partnership Against HIV/Aids (Pancap), has been pointing out that because of the free movement of people under the Caricom Single Market and Economy, there is really no difference between Haiti’s rate of infection, as high as 13 per cent, and the lowest in the region, just over one per cent, or the Dominican Republic at nine per cent and, say, T&T at two per cent.

Caribbean people of this generation, much like the original Amerindian inhabitants, do not recognise national boundaries in seeking out jobs, better living conditions. They have been “going with the flow” long before the CSME and will continue to do so, HIV/Aids notwithstanding.

One other Pancap argument for assistance of the middle income countries of the region is based on the migration of large numbers of health personnel to the North, such people having been trained at public expense in the Caribbean. The requirement therefore is for some form of compensation for the utilisation of human resources that would have been used to counter the HIV/Aids pandemic.

The developed world has been notorious in failing to meet its commitments to development assistance to the underdeveloped world. The declaration commits them to establish timetables to achieve the targets of 0.7 per cent of gross national product for official development assistance by 2015 and to reach at least 0.5 per cent of their GNP by 2010.

It will take combined, intensive and continuous lobbying and pressing of regions such as Caricom in every possible fora to achieve the declaration goals aimed at achieving universal access to testing, treatment, care, support and prevention work for the Caribbean and other similarly-placed developing regions of the world.

And if there is any need for reminding, universal access for the Caribbean must be considered in the context of the region being second only to sub-Saharan Africa in infection rates amongst the adult population.

There were a few other significant elements of the declaration:

One, “the encouragement of pharmaceutical companies, donors and multilateral organisations, and other partners to develop public-private partnerships in support of research and development and technology transfer.

Two, the encouragement of bilateral, regional and international efforts in promoting bulk procurement, price negotiations, and licensing to lower prices for HIV prevention products, diagnostics, medicines and treatment commodities, while recognising that intellectual property protection is important for the development of new medicines...”

Developing countries such as India and Brazil have gone some distance in producing generic products from the patented medications of the large pharmaceuticals. Guyana, among Caricom countries, has started production and would obviously need assistance to develop the industry further. In this regard Guyana can seek assistance from The Global Fund, given its categorisation among the poorest countries.

Notwithstanding the reality of an international community with a variety of religious and cultural practices, the declaration was able to “encourage responsible sexual behaviours, including abstinence and fidelity,” at the same time that it advocates “expanded access to essential commodities, including male and female condoms and sterile injecting equipment,” the latter to reduce infection rates among drug users.

Significantly for the Caribbean, the declaration requires that there be a transformation in the culture and institutional norms that foster the sexual exploitation of women and girls.

If we are truthful to ourselves we will admit that such practices exist here at home, in schools, on the job and in institutions such as government, the church, the police service, literally everywhere. We cannot shirk this responsibility.






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