Washington Times
4 March 2002

Funding shortage hinders global fight against AIDS

U.N. and World Health Organization officials last year called for $10 billion a year to fight AIDS, but Washington and other donors gave only $2 billion despite a major overhaul of aid-delivery systems, say health officials.

"The U.S., like every other donor, will need to do more if the world is to respond effectively to AIDS," Congress was told last month by Peter Piot, executive director of UNAIDS, the joint United Nations program on HIV/AIDS that is fighting the worldwide pandemic.

"We are currently far from having secured the $10 billion required for a comprehensive response in the world's low- and middle-income countries in 2002," he told the Senate Foreign Relations Committee last month. He said a little more than $2 billion was pledged.   

Sixty million people have been infected with AIDS since it was discovered in the early 1980s, and 20 million have died, he said. Life expectancy in sub-Saharan Africa fell from 62 years to 47 years, and societies are disintegrating as nurses and teachers die faster than they can be replaced.  

There are 14 million orphans who have become "desperate and easy prey for militias and warlords," Mr. Piot said.   

The shortage in expected funding comes despite major changes in the way foreign aid for health is delivered, officials say.    

New, transparent and effective ways to avoid corruption and deliver aid were devised, in part because of the demands by conservative Republicans who took over Congress in 1994 and called for accountability in foreign aid, said one health official, who asked not to be identified.  

The business savvy of new billionaire donors such as Microsoft's Bill Gates and media mogul Ted Turner as well as health foundations also spurred reforms in health aid, said Kraig Klaudt, a senior World Health Organization (WHO) adviser in Geneva.    

Changes included "leapfrogging" ineffective governments and cutting off funds to ineffective or corrupt health ministries and instead giving aid directly to nongovernmental organizations, businesses or private civil-society groups.    

India, for example, recently was denied a huge health grant because it failed to produce a plan to increase the use of the latest technique in fighting the spread of tuberculosis — "DOTS" or directly observed treatment short course — in which monitors ensure that patients receive complete treatments.  

But while "the stage was set" by these reforms for a huge assault on the biggest killers of mankind, the Global Fund remained badly underfunded, health officials say.    

"We need to see a roughly 50 percent increase in funding each year, in each of the next four years," Mr. Piot told the Foreign Relations Committee.     

Last year, U.N. Secretary-General Kofi Annan and Gro Harlem Brundtland, a physician and former prime minister of Norway appointed director-general of the WHO in 1998, initiated the Global Fund to Fight AIDS, Tuberculosis and Malaria — the biggest preventable killers of people in the world.  

In 2001, TB killed 1.66 million, malaria killed 1.08 million and AIDS killed 2.94 million, the WHO reported.

U.S. and European efforts to fight AIDS have lost political support in recent years as improved anti-viral drugs have reduced the death rates in wealthy countries for those infected with the AIDS virus, human immuno-deficiency virus (HIV), and increased public awareness about how to minimize the chances of transmitting it sexually has reduced the rate of new infections.   

The battle against AIDS won a powerful ally last year when Secretary of State Colin L. Powell visited Mali, South Africa, Kenya and Uganda.

Mr. Powell and his wife visited Africans infected with HIV and heard them describe their struggle to obtain anti-AIDS drugs and to cope with ostracism, declining health and the lack of adequate prevention or health measures.

Despite that up-close encounter with AIDS — in some parts of southern Africa 36 percent of adults are infected — U.S. contribution toward the Global Fund and efforts to combat AIDS have not met the expectations of health officials.     

The administrator of the U.S. Agency for International Development, Andrew Natsios, told the Senate recently that the U.S. budget for AIDS/HIV care and prevention was $433 million in 2001 and $535 million in 2002. President Bush has requested $640 million for 2003, he said.   

"This does not count additional funds that other branches of the U.S. government are spending on programs and research," he said.    

Mr. Natsios also said last month that "our annual condom distribution and social marketing activities probably avert a half a million infections every year."

But days later, Mr. Powell's MTV message advocating condom use to fight AIDS stirred up conservative critics who favor only abstinence to prevent the sexual transmission of HIV.

Mr. Natsios went a step further and told the Senate committee: "We are also in the process of creating a central condom fund to consolidate our acquisition, save money and get them to the field more quickly. This should allow us to double the number of condoms we purchase."     

He said the United States was the first contributor in May to the Global Fund and has pledged $300 million so far. He said Mr. Bush requested another $200 million for the next year.     

Meanwhile, health officials continue to hone their plans to deliver aid and to ensure that corrupt governments don't simply slash their health budgets when foreign help arrives.   

Thomas Schoenemann, managing director of Medvantis, a private health-management firm of the bank Credit Suisse, which is the first private firm to donate to the Global Fund, described some of the new programs that use the public sector to fight diseases and avoid corruption.    

Speaking by phone from Geneva, he said that European aid programs promote social movements and media coverage of health issues and help fight poverty in Kenya and other countries — all of it linked to screening for AIDS, TB and even diabetes.     

The new health aid also requires that local governments and users put in cash to match seed money from foreign aid.     

But like other health officials, Mr. Schoenemann stressed the need for donations.  

"We need to mobilize resources needed to stop these killer diseases," he said.

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