Global Development: Views from the Center
« Happy Trails, Yosemite Sam (Bye Bye Bolton) | Main | Donors Back Index of Aid for Microfinance »
December 04, 2006
HIV/AIDS Control May be Crowding Out Other Health Initiatives
Posted by Jeremy Shiffman at 02:44 PM
HIV/AIDS control is now receiving enormous attention in global health circles. This is reason both for celebration and concern. It is reason for celebration because the disease has been neglected in the past and the tide may be turning against this humanitarian crisis. It is reason for concern because there is growing evidence that the extensive focus on this one disease is crowding-out resources and policy-maker attention for the many other causes of death and illness of the poor in the developing world.
In an editorial that appeared in the Bulletin of the World Health Organization on December 1, World AIDS Day, I provide evidence (pdf) of possible crowding-out effects.
For instance, over the years 1998 to 2003, as funding for HIV/AIDS grew from 9 percent to 43 percent of overall U.S. foreign assistance for health and population, funding in the health sector strengthening category nearly vanished, declining from 20 percent to just 1 percent. Aggregate funding for all other major causes stagnated, save for infectious disease control. We see similar trends among other donors and within developing countries.
Given its high burden HIV/AIDS clearly deserves special attention. I argue that this attention should not come at the expense of other health initiatives, however. Deaths due to HIV/AIDS, after all, comprised around 5 percent of total mortality in low and middle-income countries as of 2001 according to a recent study in the Lancet (subscription required), and the 2006 UNAIDS report indicates that this figure has not likely increased since. This is a high but not overwhelming figure, and on epidemiological grounds cannot justify HIV/AIDS' large command of the limited resources wealthy and developing countries provide for health.
A core problem is the insularity of many HIV/AIDS advocacy campaigns and programs. I note that:
Some organizations that work on HIV/AIDS - including UNAIDS and the Global Fund - are aware of these problems and issue warnings of possible displacement and call for support of health sector strengthening. However, most HIV/AIDS champions have been so impassioned about their own fight that they have lost sight of possible adverse effects on other health initiatives.
In the editorial I offer three suggestions to re-orient HIV/AIDS advocacy so that this agenda is sustained, without harming, and ideally benefiting other health causes.
- First, health sector strengthening should become a central rather than peripheral element of the HIV/AIDS agenda, a change that will benefit the control of this disease and many other conditions.
- Second, HIV/AIDS advocates need to avoid insularity, be sensitive to the effects of their rapidly growing political power on other politically weaker health initiatives, and build bridges to other initiatives.
- Third, it is worth considering the greater good. Presumably health advocates share a commitment to reducing death and illness of the world's poor, whatever may be the cause. This principle may provide the underpinning for moving HIV/AIDS away from its insularity and toward linkages with other health initiatives, a shift that would benefit the poor of the developing world immensely.
Trackback Pings
TrackBack URL for this entry:
/mt/mt-tb.cgi/714
Comments
Quite great thoughts about HIV/AIDS and its increasing funding at the 'would be' expense of other health threats.
Uganda has had a landmark in the fight against HIV/AIDS, there is no doubt about this fact. This landmark has arisen out of the urgency, dedication and resource allocation to the fight against HIV/AIDS. When looking at the HIV/AIDS funding, one should avoid looking at the box but the box and its surrounding, a thing that Jeremy get entangled into. Its true that HIV/AIDS is getting much funding but how much of this is going into OVC support, Orphan training, ARV treatment,Home Based Care support [see www.christianchildrensfund.org ], among others.
How susceptible is an HIV/AIDS client to other infections as malaria and TB?. What about the reduction of PMCT process in which thousands of children born of HIV/AIDS postive mothers can be saved? Once we get these facts and realities right, then we can think of what Jeremy calls as establishing Linkages with other health initiatives. Am sure this is something that has happened in many places, countries and programmes.
The fight against Malaria, TB is intwined in the HIV/AIDS strategy. Probably what we can ask is whether these funds being received are exactly doing what they are meant to do. This has been the challenge of a number of countries-using such funds for palace politicking, security ammunition purchase or voter rewards. However, if we disire to see another generation, much of the funding still to go PMCT, OVC support and Livelihood initiatives for the affected families.
Paul Mayende-Graduate Student, International Relations.
Kampala-Uganda.
Posted by: Paul Mayende at December 6, 2006 08:15 AM
I do agree with a lot that has been mentioned however, I feel that the bottom line is the fact that the only way forward especially for the developing countries is to fix the country health system into functional and sustainable systems that can cope with any disease epidemic. This can in today’s context be done indirectly with the current tremendous HIV/AIDS funding, directly with other funds earmarked for health system strengthening or better still with both sources of funding. Otherwise all the presently perceived gains are bound to crumble as is evident from the hand writing on the wall with respect to inadequate supply chain management and insufficient human resources for health amongst so many others. No matter how politically powerful the insular HIV/AIDS movements are, weakened health systems infrastructure cannot support all the funding they can raise. It does not stop here though as more strategic focus should be placed on the socio-economics and political challenges to addressing health systems strengthening globally.
Posted by: Ugo Amanyeiwe at August 14, 2007 03:01 PM
AIDS Prevention Spotlighted by Gender Mainstreaming
Anirudha Alam
The spread of HIV/AIDS results in the risk of losing forms of social and economic protection. There is no doubt that the onslaught of HIV/AIDS is closely associated with gender inequality and poor respect for the rights of women. So to mitigate the multiple impacts of the epidemic, gender mainstreaming should be significantly integrated into HIV/AIDS prevention programs. Eventually, HIV prevention and impact mitigation policy will be able to make the realization of gender equality one of the most important strategies.
Gender mainstreaming for HIV/AIDS ensures gender equality in all policies, programs and activities could possibly keep the epidemic at bay. It is the most efficient and equitable means for using existing resources with a view to combating HIV/AIDS internalizing need based approach. At a rough estimate since the beginning of the epidemic, over 10 million women have died from HIV/AIDS-resulted illness. 48 per cent of adults newly affected by HIV/AIDS in 2001 were certainly women. The fact that lack of gender mainstreaming along with domination of social stigma and discrimination creates a tremendous barrier to women making them unable to adopt HIV risk-reducing behavior.
Social stigma and gender discrimination engulf a series of possibilities to reduce vulnerability to HIV/AIDS successively. The enhanced poverty and developmental decline nourished by gender inequality may make women and girls engaged in risky sexual behavior in lieu of getting money, food and other facilities. Having lack of enough access to quality treatment and care, then they fall into enormous vulnerability to sexually transmitted diseases (STIs) one after another.
As per the finding of Rainbow Nari O Shishu Kallyan Foundation, 95 per cent adolescent girls of Bangladesh are drastically vulnerable to HIV/AIDS because of their paltry access to necessary information for protecting their reproductive health. Due to their poverty at the levels of awareness, skill, knowledge, attitude and practice all along, they are being more vulnerable consecutively. They are not able to ensure their role as potential manpower in planning, implementing, monitoring and evaluating pro-gender programs and projects.
Considering all the situations related to sexual behavior, social attitudes and praxis, financial empowerment and so on, there are in-depth differences between men’s and women’s access to information, prevention, treatment and care-giving supports. It is much more common in all cultures that commitments for guiding sexual behavior and sexual health are being threatened by gender discrimination. If women and girls do not have qualitative reproductive health literacy HIV/AIDS will be turned into the greatest social problem in developing countries. According to the findings of UNAIDS, as of December 2000, ninety five per cent of all AIDS cases have occurred in developing countries.
Through promoting, facilitating and supporting the implementation of gender mainstreaming, AIDS prevention should be brought about under the spotlight of womens empowerment. Gender mainstreaming and womens empowerment are obviously complementary strategies. So the strategy of gender mainstreaming within HIV/AIDS prevention should be outlined that womens empowerment is ensured.
Ref: UNAIDS, World Bank, Commonwealth Secretariat, UNESCO
Anirudha Alam
Deputy Director
(Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.
Phone: 8801718342876, 88028050514 (res.)
E-mail: anirudha.alam@gmail.com
Posted by: Anirudha Alam at September 6, 2007 04:18 AM