Focusing on Aids alone destroys health systems

In the next two weeks, the world commemorates yet another World Aids Day under the theme “Universal Access and Human Rights”.

Each year comes with a special message and the theme for this year urges global leaders who have pledged to work towards universal access to HIV and Aids treatment, prevention and care to recognise these as fundamental human rights.

The campaign acknowledges the significant progress made so far in increasing access to HIV and Aids services, but with a strong belief that greater financial commitment is needed in order to achieve the goal of universal access.

The message behind the theme presents two key fundamental issues.

Firstly, there are inadequate financial resources to improve access to HIV and Aids services; and secondly, the HIV pandemic is growing despite the declining HIV prevalence in countries such as Uganda, Kenya, Rwanda, Malawi and, most particularly, Zimbabwe.

Perhaps these are forgivable considering that the HIV and Aids industry has grown used to demanding accountability and transparency from others without something that is yet to be demanded of them. I will pursue that another day.

In October this year, the Global Fund To Fight Aids, Tuberculosis and Malaria announced a three-year budget of $11,7 billion — an increase of $2 billion over the previous three-year budget.

This is more than 50% below the $25,1 billion needed to achieve the Millennium Development Goal six — to achieve universal access to prevention, treatment, care and support by end of 2010.

The UNAIDS projects that by 2015, the annual resource needs will reach $54-57 billion (a total of approximately $172 billion in three years) which could avert 2,6 million new infections and 1,3 million deaths. Still this is not enough to cater for the 33 million people living with the virus today.

As a result of the presence of such huge financial figures, the HIV and Aids industry has uncontrollably grown in size and budget, thanks to the generous donors who can finance anything or anyone as long as there is an HIV and Aids dimension in the proposals.

However, what concerns some experts is that the impact of this colossal and resource-guzzling industry is not parallelled by results on the ground, in addition to the damage it has caused on the public health sector especially in Third World countries.

Most of these countries have fallen for the donor-driven problem-specific problems such as HIV and Aids interventions which attract more funding.

Aids, a disease, has become glamorous and more profitable, which puts into question the intentions of those involved in this industry.

The public health sector, especially in Africa, has suffered so much neglect as donors channel resources towards Aids neglecting that Aids is a public health issue.

Aids is primarily a public health issue which can be effectively managed within the context of a good infrastructure and a strong human resource base.

The Aids industry has created parallel financing, employment and organisational structures; weakening national health systems.

Third World governments are struggling to maintain their health infrastructure and keep skilled health personnel who are lured by better paying jobs elsewhere especially in non-governmental organisations.

William Easterly, the author of Whiteman’s Burden, reports of multimillion-dollar Aids hospitals that turn away the mothers who come with babies who have non-Aids-related problems such as measles, dehydration or malaria.

He calls for the reallocation of these funds towards the public health system in order to cater for non-Aids-related problems.

Of what value is it spending millions of dollars circumcising men (who could easily abstain or use condoms) when 50% of rural women can’t access maternal care? What does that say of women and children’s rights?

It is impossible to separate HIV and Aids treatment and prevention from the issue of reproductive, maternal, newborn, and child health.

The basic human right to life is at stake with respect to HIV and Aids as it is the basic human right to public health care.

Public health, especially women’s and education, are the foundation of development.

HIV and Aids currently takes more than a quarter of global health aid even though it causes only 5% of the burden of diseases in poor and middle-income countries.

Some experts suggest that diverting just 15% of the Aids funds into the public health system will transform the global health delivery system by almost 100%.

It would benefit both HIV positive and negative people if all the health services are integrated at one well-equipped, staffed and resourced community health centre without giving emphasis on just HIV and Aids.

As Aids activists prepare for the World Aids Day commemorations, they should note that having more money in Aids programmes alone is a self-defeating approach unless it is built on a strong public health system.

Anti-retroviral treatment is a medicinal issue which is administered through, mainly government systems such as clinics and hospitals which are highly understaffed and under-equipped.

In addition, health is not only access to treatment in the context of HIV and Aids, but availability of social health services for everyone.

Tapiwa Gomo is a development consultant based in Pretoria, South Africa.

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