HIV/AIDS: Whose Agenda?

March 10, 2009

With the comprehensive media coverage exploring the issue of HIV/AIDS, and the endeavor of HIV lobbies and activists in promoting the disease, many nations, be they highly-afflicted ones or the seemingly less-afflicted ones, have fully understood the contention of “A threat to one is a threat to all…” and recognized their responsibility in combating against this overwhelming battle. As a result, international HIV/AIDS assistance, in form of funding via bilateral, regional or multilateral mechanisms, has surged. Undoubtedly, massive funding dedicated to HIV and countries plagued by HIV/AIDS is a good attempt in mitigating the deadly impact of the epidemic. The question is, are we funding the right health care problem and in a right amount?

As a matter of fact, though HIV causes 3.7% of mortality, it receives 25% of international healthcare aid and a big portion of domestic expenditure. Among the annual aid of 9 billion, questions have arisen over whether has the relief been used effectively and allocated sensibly.  What about other diseases such as infant deaths or heart disease in developing world which cause more deaths than HIV/AIDS? Are we diverting resources from interventions against other diseases? Who should have a say in our agenda to ensure sensible and effective use of resources?

Apart from the above, we should step forward to think about what receiving countries want actually. We incorporate the issue of HIV/AIDS in our agenda and prioritize resources based on our perspective. Yet, are our plans precisely catering for the needs of the recipients? Could money alone address the problem? Mozambique’s health minister once stated that, “The reality in many countries is that funds are not needed specifically for AIDS, tuberculosis, or malaria. Funds are firstly and mostly needed to strengthen national health systems so that a range of diseases and health conditions can be managed effectively”. Developing countries have also expressed their concerns that they need skills and human resources which further empower their national governments and improve the general health services. This in turn enables them to handle crisis more effectively and have their own discretion on setting actual disease priorities. After all, they, countries plagued by HIV/AIDS, may not be as dependent as perceived and we, human security advocates, may not be as helpful as imagined either.

By Selena,Wong Sai Yin & Tiffany, Cheung Hiu Wai

Reference

England Roger (2007). Head to head, Are we spending too much on HIV? Available online at: http://www.bmj.com/cgi/content/full/334/7589/344?ijKey=3db765e6f768256fe1bc48fc644a7bb6051ad8b1&keytype2=tf_ipsecsha, accessed March 9, 2009.

England Roger (2008). The writing is on the wall for UNAIDS. Available online at: http://www.bmj.com/cgi/content/full/336/7652/1072, accessed March 9, 2009.

Laurie Garrett, “HIV and National Security: Where are the Links?” Council on Foreign Relations: 2005.

UNAIDS (2008). 2008 Report on the global AIDS epidemic. The Joint United Nations Programme on HIV and AIDS.

World Bank Operations Evaluation Department. Committing to results: improving the effectiveness of HIV/AIDS assistance. http://www.worldbank.org/oed/aids/?intcmp=5221495, accessed March 9, 2009.

Advertisements

6 Responses to “HIV/AIDS: Whose Agenda?”


  1. Thank you Selena and Tiffany for a very interesting post. It did prompt me to think about what exactly are the problems in the funding program of HIV/AIDS.

    I think no one would doubt the pandemic situation of HIV/AIDS across the globe, especially in the sub-Saharan African, neither would one doubt about the potential threats the spread of HIV/AIDS could bring to the developing countries and even the globe. But I do agree with both of you that wiser funding program is needed in order to make the best and most effective use of the money.

    I have a few concerns over the “seem-to-be” huge sum of money to be spent on HIV/AIDS program but yet not being able to yield proportionate outcome. Firstly- the possible substantial amount of administrative cost for those NGOs or organization in carrying out the program. As you have mentioned, I wonder what proportion of the funding is in deed being spent directly on the victims. I am in deed shocked to know that out of the 2.9 million victims nowadays, only 1.5 million people are given anti-retroviral drugs. Where then did the money go? Possibly some to the operational cost, some, as mentioned in England Roger( 2007) article, to the social activity rather than to the more down-to earth and practical solutions which can directly benefit the victims.

    Secondly, England Roger (2007) also brought out the UN agencies, international organizations, regional concerned groups’ “tripping over each other for funds and influences”. I am of the view that somehow when people are paying more attention to the HIV/AIDS problem (which should be something good initially), more organizations tend to involve in addressing the problems and without much strategic cooperation between them, the programs initiated by each separate groups tend to yield little results. I believe more collaboration and coordination is needed between the involved actors so as to achieve the maximum effect with the sum of money.

    You have quoted the statement of Mozambique’s health minister and I do agree that when solving disease problems, different short term and long term objective should be set. By short term, it means that money should be spent in program which can yield quick, specific and direct results to victim ( e.g. buying of anti-retroviral drugs for AIDS patients). However, in the long run, funds should be better spent in addressing the root problem. As most diseases are not separated from other problems and often coexist and inter-link with other issues (like poverty, poor education system, poor family planning, unstructured health care system etc) in a vicious cycle, I do believe that money should be spent in tackling those issues. Overhauling the health care system in those poorly developed countries would definitely be a more sustainable and effective solution to tackle the problem in the long run.

    Cheers,
    Veronica

  2. Tong Yui Wa Andy Says:

    Thank you for sharing your view of us, Selena and Tiffany. HIV/AIDs is undoubtedly a global threatening issue. It can be depicted by the 6th millennium development goals which is “Combat HIV/AIDs, malaria & other diseases”. Its target is to “Have halted by 2015 and begun to reverse the
    spread of HIV/AIDS” (Millennium Development Goals Report 2008, 2008) It is undoubtedly an ambitious target. It requires collaboration among various actors so as to achieve it.

    You have raised an important notion of the effectiveness of aids/reliefs. If the aids/reliefs are not used effectively, it is unlikely that the target of millennium development goals are going to be met. It has indeed already raised international awareness. European Union aid effectiveness initiatives is an illustration of it. In its report, it has raised of an important notion which is “collaboration of donors”. It is important in the sense that it tells us the effectiveness of aid has to be improved not just by the receivers but also the donors. As stated by Center for Global Development, “Donors spend billions of dollars to fight HIV/AIDS in developing countries, but poor integration between donors and host country health systems risks undermining international efforts to prevent and treat AIDS.” (Seizing the Opportunity on AIDS and Health System, 2008)

    HIV/AIDs is the whole world’s agenda. It is an agenda of local governments, national governments, supranational governments, NGOs, INGOs and even us as global citizens. The aids/reliefs by the donors can be effective only if there is a collaboration among actors.

    Cheers,
    Andy

    Reference:
    Millennium Development Goals Report 2008. (2008). Retrieved on 11th March, 2009 at http://www.un.org/millenniumgoals/pdf/The%20Millennium%20Development%20Goals%20Report%202008.pdf

    Seizing the Opportunity on AIDS and Health System. (2008). Retrieved on 11th March, 2009 at
    http://aideffectiveness.developmentgateway.org/Content-item-view.10976+M5f8afc2d6e0.0.html

  3. Becky Says:

    Thanks for your meaningful post. I think the main focus of your article is that funds and donations should be use to strengthen national health systems so that money will be spent in efficient and effective way. This arouse me an advertisement of Orbis in MTR stations – don’t donate to the blind young girl; let’s donate to the doctor, to train him and save more and more patients. Yup, many people around the world are willing to donate, but it is a big question that how to use that limited amount of money and do as much thing as possible.

    Sharing the same view, a report of WHO stated out “recent estimates indicate that the health sector alone represents at least 55% of the resources required for the global response to HIV/AIDS”. And further mentioned “In many high-prevalence and resource-limited settings, health systems are weak, inequitable, and unresponsive. WHO helps countries to build health system capacity and fully mobilize the health workforce for the expansion of HIV treatment and care”. Hence, in order to deliver much-needed HIV services, obviously all aspects of the health sector are needed to be strengthened especially in less developed states like African countries. It is not limited in the HIV/AIDS, but also other epidemics. With a better health system within a state and the good co-operation between different sectors like the government, NGOs, health service providers and patients, would be the fastest road to deliver timely aids and helps.

    In my opinion, in the era of globalization, health issue should be the agenda of all of us. All countries should do something to deal with global health issue but their roles can be different. For more developed countries, they can work on raising fund and help less developed countries to develop a good health system in order to ensure all donations will be use efficiently. For less developed countries, their roles can be work closely with charities and NGOs to strengthen their health sector in order to provide better health facilities to local people.

    Both money and good health sector are the same essential to those African countries.

    Ref:
    The HIV/AIDS Programme at WHO, view online through http://www.who.int/hiv/mediacentre/Who_we_are_A4_en.pdf

  4. Michelle Ren Says:

    You do make an interesting point about other diseases that take more lives but do not receive as much “attention” as HIS/AIDS. And yes, to a certain extent, I do agree that money is not going to solve the problem. However, my reasons are different. Whether by coincidence or if there is a correlation, the region that is most inflicted with HIV/AIDS happens to consist of countries that are somewhat politically unstable and where corruption is rampant. Thus, there is a high possibility that funds are siphoned away from its intended use, that is to treat those who are infected. That said, my point is that efforts towards alleviation of this endemic should not be decreased. Rather, it should be restructured. For example, aid in the form of medicine and treatment. Also, according to UNAIDS, the percentage of estimated adult HIV prevalence has been declining since 2001 both globally and in sub-Saharan Africa. I find that this somewhat justifies the funds that have been directed towards the treatment of the disease.

    Michelle Ren

    Ref: http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2007/default.asp

  5. pfpolidori Says:

    hi there,

    I like the focus of your post and I think you come up with interesting ideas. However I want to point out that the percentage of money spent on HIV is not neccessarily a factor in effective spending. HIV drugs are expensive, more than a flu vaccine even though more people are affected and therefore needs mre money.

    On the other hand I do agree that money is not spent efficiently. Moreover a lot of people have argued that there enough money, just not the right aproach on how to spend it efficiently. Among those is Bill Clinton who said new ideas are needed. i can only agree with that. We need to find more efficient ways of buying and getting what is needed.

    Let’s see what we can do to improve that. Maybe we should try to track where the money goes. What are we being? does it get to the peope who need it? to we have the logistics and roads to get to the people who need it? are there enough doctors to properly diagnose? Maybe we need to ask differentquestions.

    Paul-François

  6. miuyim Says:

    Dear Selena and Tiffany,

    Thanks for your illustration on a practical issue– whether the international donations of fund and resources are effectively used responding to the need of recipient countries.

    This reminds me on a reading on fragile states earlier. It outlines that international aids are usually ineffective and focusing on short-term projects. In case of HIV/AIDS I believe that a broader implementation framework should be set up at international level to divert certain fundings to co-ordinated long-term projects like strengthening national health system as the Mozambique’s health minister suggested, with local governments to help confront the root cause.

    Moreover, I agree that stakeholders, including the recipient countries, should be involved in the planning process on the use of fund and resources, though, accountability of the government should be taken into account to avoid deception and more ineffective use of resource.

    Miu

    Reference
    DFID (Department for International Development, UK) (2005). Why do we need to work more effectively in fragile states. London: DFID.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s