Zachary Ochieng
6 November 2007
opinion
UNDERSTANDING BOTH UPstream and downstream interactions between Aids and poverty is critical to analysing its local and global epidemiological trends and patterns. This is, in turn, vital to the development and implementation of effective strategies to prevent and treat HIV/Aids.
Growing awareness of the economic aspects of the epidemic has helped catalyse greater political action on Aids in recent years. For example, Aids is the only health issue ever to become the subject of a United Nations Security Council debate or a special session of the UN General Assembly. It has been featured regularly at G8 meetings and regional summits in Africa, the Caribbean, and elsewhere. In more than 40 countries, national aids programmes are led by the president, vice-president, or prime minister.
Political action has fuelled financial investment. Global expenditure on Aids in low- and middle-income countries increased from $250 million in 1996 to an expected $10 billion in 2007. Reults? Fewer people are becoming infected with HIV in almost all the East African countries, for instance. Almost 2.5 million people are now on antiretroviral therapy in developing countries - up from 100,000 five years ago.
To build on this progress and ensure that it is sustainable, however, some six elements are key.
First, Aids money has the most impact when strategies are based on the concept of "know and act on your epidemic." UNAids' Practical Guidelines for Intensifying HIV Prevention provide practical guidance to tailor national HIV prevention responses so that they respond to the epidemic dynamics and social context of the country and reach populations who remain most vulnerable to HIV infection.
Second, a growing number of small-scale activities indicate the value of combining HIV programmes with poverty reduction initiatives. In Malawi, for instance, NGOs integrate HIV prevention into village banking programmes for women, and combine Aids education with the provision of microfinance to groups of women through community banking programmes.
Third, the provision of HIV treatment can help prevent poverty - and indirectly contribute to HIV prevention as well - by helping to break down stigma. This requires action in four key areas: increased investment in antiretroviral treatment; a reduction in the cost of antiretroviral drugs; improved HIV service delivery systems; and better services for the poor.
FOURTH, DEVELOPMENT PLANS (whether they concern the development of productive sectors or the provision of social safety nets) must "pass the Aids test."
Development initiatives must contribute to Aids prevention and treatment in the communities they work in. Social protection programmes must also include specific measures to address the economic and social needs of households that are directly affected by Aids.
Fifth, poverty reduction programmes and Aids strategies must reduce vulnerability to HIV- particularly for women and the young. This involves protecting human rights and tackling issues around social marginalisation and stigma.
Sixth, addressing Aids in the world's poorest countries and communities depends on increased and sustained international support, driven by high-level political will.
Although it is ultimately the responsibility of all states to provide HIV prevention and treatment for all citizens, and to mitigate the impact of Aids on the poor, many countries require international support to live up to these responsibilities, and are likely to do so for some time to come. Failure by donors to prioritise the provision of such support is likely to undermine the effectiveness of current and future efforts, and could also lead to the unravelling of progress already made.
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