Washington, DC — President Bush in his 2003 'State of the Union' address to US Congress announced the Emergency Plan for AIDS Relief initiative that will "commit 15 billion dollars over the next five years, including nearly ten billion dollars in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean." According to a White House Fact Sheet, the initiative will fund antiretroviral therapy for at least 2 million people, and, help prevent 7 million new infections within the next five years in the following countries: Botswana, Ivory Coast, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, South Africa, Tanzania, Uganda and Zambia.
Today, nearly 30 million people live with HIV/AIDS in Africa. More than 3 million Africans will likely become infected this year and more than two million are likely to die. For Africa, the president's pronouncement has multiple implications in the evolving battle against HIV/AIDS in the continent.
More money will likely be available to fight HIV/AIDS.
If Congress approves and funds the Emergency Plan for AIDS Relief, it is likely that Europe will raise its contributions to AIDS remedial efforts in Africa to match or exceed U.S. contribution. Consequently, an outlay of $2 billion in U.S. backed AIDS relief can easily translate into Europe's commitment of $2 billion or more. UNAIDS estimates that Sub-Sahara Africa will require at least $3 billion for AIDS care/support and another $1.5 billion for prevention.
Boost in AIDS funding may not materialize in 2003.
The Emergency Plan for AIDS Relief is expected to take off in 2004. Consequently, there may be no major increases in US financial support for 2003. Meanwhile, the AIDS epidemic and its destructive effects in Africa does not respect funding plans or orderly appropriation process.
Where will "old" money come from?
As at the time of writing this article, we are unaware of the source of $5 billion in "old" money out of the projected $15 billion for the new initiative. We hope the "old" money will not lead to the sunset of current international HIV/AIDS programs. We also hope that the Millennium Challenge Account, whereby U.S. is pledging to spend $5 billion dollars in development aid to the poorest countries, is not in jeopardy.
The future of the Global Fund for AIDS, TB and Malaria is up in the air.
The new initiative will set aside $200 million a year for five years ($1 billion) for the Fund. Richard Feachem, the executive director of the Fund recently stated at the January 2003 World Economic Forum meeting that his organization needs about US$ 6 billion by 2004 to meet anticipated commitments. The election of Tommy Thompson, US Secretary of Health and Human Services as the new Chair of the Fund does not basically change the fact that the organization faces an imminent financial crunch.
Imminent end to the battle on access to cheap drugs.
This may represent one of the most significant ramifications of the new initiative. By an unambiguous commitment to provide low cost anti-retroviral treatment to 2 million individuals, President Bush, in principle, wittingly or unwittingly, ended the dichotomy between access to generic and non-generic HIV/AIDS drugs. The combination of U.S. and Europe money for antiretroviral drugs in Africa will likely reduce the cost of these drugs to levels way below current cost of generic versions. We do not foresee a situation whereby research pharmaceutical companies or their lobby will stop a global effort led by the United States to provide the most cost-effective medical treatment to millions of individuals living with HIV/AIDS.
Prevention programs will be kick-started.
Information, education and communication campaigns against HIV/AIDS in Africa will receive a significant boost from the new initiative for two main reasons. First, improved and sustained access to life-saving medicines will shatter the current myth that AIDS is a definitive death sentence in Africa. Second, individuals who feel they are at risk will likely come forward for testing and counseling once they receive assurances that medical care is available.
Africa must deliver.
If U.S. and Europe come through with massive financial outlays for AIDS remedial efforts, African leaders and their citizens must do everything humanly possible to facilitate quality care and preventive programs in the continent. Africa will have to deliver on logistics of care, governance issues, community mobilization, monitoring and evaluation. To succeed in the fight against AIDS, Africa and its external friends must become indispensable partners, with each partner holding up its own end of the bargain. It is also crucial for Africa to mobilize its own resources (financial, technical, cultural) to complement international remedial efforts.
African professionals in the West should take the initiative.
Closely tied to more resources for AIDS remedial efforts in Africa and African governments getting their act together, is the need for thousands of talented African professionals living and working in the West to answer the call for duty in the continent. A successful campaign against HIV/AIDS in Africa will require deployment of significant expertise in healthcare, development, politics, human rights and gender equity issues. We believe that African professionals living in the West will be crucial to any massive global campaign to stop AIDS in Africa.
Civil society in the West may need to shift tactics.
Although the new initiative is far short of the $10 billion a year needed to effectively tackle HIV/AIDS around the world, President Bush dramatic announcement suggests that Western leaders are on the threshold of addressing the greatest development tragedy of our time. The passive/aggressive response of civil society to the new initiative suggests that it may be time to begin a strategic adjustment of priorities. First, the civil society should have a contingency plan for next steps if their financial or program targets are met. Second, civil society may need to put more emphasis on strengthening the capacity of their counterparts in Africa to provide effective monitoring and evaluation of funded programs in the continent. Third, civil society may now set their targets on comprehensive reforms of delivery mechanisms such as multilateral agencies to remove the last vestige of refuge for Western politicians and policy makers who cite implementation weaknesses of these agencies in their refusal to commit more resources for development emergencies.
Politics may creep into AIDS remedial efforts in Africa.
The list of African countries slated to benefit from the Emergency Plan for AIDS Relief is commendable. However, we are struck by the absence of other heavily affected countries such as Zimbabwe (33.7% adult prevalence according to UNAIDS), Swaziland (33.4%), Lesotho (31%) and Malawi (15%). We hope that emergency AIDS remedial efforts will continue to be based on the epidemiology of the disease rather than international politics.
What happens to countries with current low rates of infection?
The new initiative is focusing on heavily infected countries. However, the ultimate goal of remedial efforts is to prevent new infections or ensure that those already infected do not transmit the virus to other people. We hope that African countries with low rates of infection such as most countries in North Africa, Senegal and Mauritius (2% or less) and others will not be forgotten in international remedial efforts.
Corporations will now be in the spotlight.
A major plank of the initiative is 'public/private' partnerships. Multinational corporations that do business in Africa are now in the spotlight regarding HIV/AIDS programs for staff and families that live in their operational areas. International oil companies, mining/extraction companies, service organizations, and agricultural conglomerates will have to do more on HIV/AIDS in Africa. We commend the current efforts of the giant mining conglomerates in South Africa and Botswana to provide HIV/AIDS care and support services for their workers. However, as reluctant Western governments commit more money for AIDS remedial efforts in Africa, corporations will come under increasing scrutiny.
Foundations/Philanthropic organizations will have to come through.
As HIV/AIDS remedial efforts gathers momentum in Africa, foundations with deep pockets will have to come through to complement public and private sector activities. Foundations have major roles to play in funding comprehensive prevention programs; enhancing the capacity of communities struggling to take care of their infected sons and daughters; providing care and support for AIDS orphans; training community-based health workers; and supporting independent African-based research efforts on HIV/AIDS.
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Can U.S. end the link between poverty and HIV/AIDS?
The Emergency Plan for AIDS Relief does not have any anti-poverty plank to the best of our knowledge. However, the linkage between abject poverty and transmission of HIV is well known. According to Africa Action of Washington, DC, African countries pay more than US$15 billion a year to international creditors every year. These debt payments sabotage genuine efforts to checkmate HIV/AIDS in heavily infected countries. We believe that debt relief for Africa tied to verifiable investments in HIV/AIDS programs will reenergize remedial efforts in the continent. We hope that President Bush will once again confound his critics by making another dramatic proposal on ending the draconian debts of African nations as part of the fight against HIV/AIDS.
Conclusion
President Bush Emergency Plan for AIDS Relief is a step in the right direction. However, like all bold pronouncements, the devil is in the details. Advocacy organizations, private entities, governments around the world, and individuals living with or affected by HIV/AIDS will be watching with keen interest the action of Congress in the next few months. As the appropriation process takes its course, it is important to note that nearly 10, 000 Africans contract HIV every day, and almost 7,000 die of AIDS. For the millions clinging on to life, including 4 million that will benefit from immediate antiretroviral therapy, every day we delay our assistance, it may be too little, too late for them and their families.
Dr. Chinua Akukwe (cakukwe@att.net) is a member of the Board of Directors of the Constituency for Africa, Washington, DC and a former Vice Chairman of the National Council for International Health (NCIH), Washington, DC now known as the Global Health Council. Melvin Foote is the President/CEO of the Constituency for Africa (CFA), Washington, DC.
