4 March 2002
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
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
"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
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
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
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.
also said last month that "our annual condom distribution and
social marketing activities probably avert a half a million infections
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
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.
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
But like other health officials,
Mr. Schoenemann stressed the need for
"We need to mobilize resources
needed to stop these killer diseases," he said.