UN reports admits to failure. As the departure of UNAIDS former director Peter Piot was the occasion of a flurry of praise for the ‘achievements’ of the man and the organisation, it is instructive to read the dark reality of failure as written in the UN report on the Millennium Development goal to combat HIV/AIDS.
Report of the Joint Inspection Unit on the review of the progress made by the United Nations system organizations in achieving Millennium Development Goal 6, Target 7, to combat HIV/AIDS
Prepared by Muhammad Yussuf, Joint Inspection Unit, Geneva 2007
Objective: To assess the progress made in the achievement of Goal 6, target 7, to have halted by 2015 and begun to reverse the spread of HIV/AIDS, and to provide Member States with an objective assessment of the efficiency and effectiveness of the policies and programmes implemented and the bottlenecks in achieving this target.
Key issues, main findings and conclusions:
By the end of 2006, more than 25 million people had lost their lives to AIDS, and an estimated 39.5 million were living with HIV/AIDS. In 2006 alone, there were 4.3 million new infections and 2.9 million deaths due to AIDS. There is an upward trend in the prevalence of HIV infections since the adoption of the target. There has been an increase of approximately 28 per cent in the number of people living with HIV in 2006 as compared to the 2000 estimates. The future course of the disease and its real magnitude remain unknown.”
(..) The Inspector discusses what appears as a tendancy for UNAIDS not to coordinate anything among the co-sponsors, with each agency doing its own thng. Those of us sitting as Observers for Civil Society in 1996 when UNAIDS was establish with that INITIAL MAIN PURPOSE of COORDINATION appreciate the notes of UN Inspector Yussuf)
Further down in the document Inspector Yussuf discusses initiatives for access to ARV. The 3 by 5, it will be remembered was launched by J.W.Lee then Director general of the WHO, with Dr Jim Kim. At the time the 3 by 5 was sharply criticised by both UNAIDS and the Global Fund against AIDS, TB, Malaria. Governments refused to finance the 3 by 5 (with few exceptions like Canada and Korea). In view of the fact that countries, especially but not solely those with low income, were unable to file in the paper work to apply to the GFATM. G.W.Lee then decided to send a very large team from WHO headquarters to the low and middle income countries for several months to help with the GFATM paper work.
J.W. Lee insisted that the combat against AIDS and for treatment could not be won if the issue of lack of health sector staff in LMIC was not addressed. He went so far as to say: No vertical disease program can ever work if there are no health systems and personnel in countries… Yet my staff reports retrenchments for thousands of nurses in TB/HIV affected countries at the request of macroeconomic institutions.
The thinly veiled critique of International Financial Institutions while made publicly at the Macroeconomic and Health Ministerial Summit in Geneva, (with over 40 Ministers in attendance, and at the subsequent press conference) was not in the official WHO report.
Here is what the Inspector says. He points to the growing gap between MDG pledges and the reality of AIDS:
”The “3 by 5” initiative has achieved only a limited amount. It was estimated that by December 2005, only 1.3 million people were under antiretroviral therapy or antiretroviral treatment (ART) as opposed to the targeted 3 million. The major achievement of the initiative was that it showed that with significant mobilization of resources and efforts from various stakeholders, antiretroviral therapy could be provided in even the most resource constrained settings like, for example, in sub-Saharan Africa. However, the striking differences between regions in the percentage of ART coverage of the needy population underscore the fact that many countries are far from containing their growing AIDS pandemic.
Universal access to care and treatment for all those who are in need by 2010 is an ambitious goal that provides lifelong support. The scaling-up towards universal access should be equitable, accessible, affordable, comprehensive and sustainable. In other words, it faces many challenges. The national health systems in most of the affected Member States are increasingly facing an unprecedented challenge due to a lack of investment in health services and the rapid scale-up of ART. The national health systems that are delivering maternal and child health services are under enormous strain, catering for large numbers of people living with HIV in need of lifelong care for chronic disease.
Inadequate numbers of health workers are a major constraint to the rapid scaling-up of ART programmes. The expansion in labour markets has intensified professional concentration in urban areas and migration within regions and from developing to developed countries. There is an exodus of skilled health workers from the public to the private sector due to attractive pay and working conditions. Most of the public health services suffer from low pay, poor occupational health and safety conditions, lack of training and prospects for career advancement, poorly supplied medical facilities, an acute shortage of staff, and poor management and overall health system governance.
The scaling-up of ART has shifted the focus onto treatment and considerably weakened prevention efforts. The challenges posed by universal access to treatment are formidable and need resources. As a result, many of the civil society partners that were traditionally involved in community mobilization and prevention have shifted their focus to treatment support activities, resulting in greater reduction in the scaling-up of prevention activities. Furthermore, a major part of donor funding is earmarked for treatment and the affected Member States are not able to allocate a matching share of domestic funding to prevention efforts.
The financial resources needed for HIV/AIDS show an increasing trend due to the increase in the numbers of people living with HIV and the expansion in HIV/AIDS programmes to serve more of those in need. The financial resources available for HIV/AIDS fall far short of what is needed to scale up towards universal access. UNAIDS estimates that the amount needed for an expanded response in low and middle income countries will be US$ 18.1 billion in 2007, US$ 22.1 billion in 2008 and US$ 30.2 billion in 2009. Against this, the money received, the existing pledges, commitments and trends indicate that the available funds are US$ 10 billion for 2007, i.e. a resource gap of US$ 8 billion in 2007. To meet the goal of universal access by 2010, available financial resources for HIV must quadruple by 2010 compared to 2007 – up to US$ 42.2 billion and continue to rise to US$ 54.0 billion by 2015.”
The Inspector identifies the gap between prevention and treatment. If there are 5 new persons contaminated for every person put under treatment, the world is obviously not making much progress.
And what Inspector Yussuf does not see, because UNAIDS always put it in small print, and only the 2003 WHO World Health report said it outright “HIV IS A BLOODBORNE VIRUS which also transmits through health care in resource poor countries”, that is HIV transmits through blood contact with dirty sharps, dirty injections in health care, etc.
To quote Bernard Kadasia, Senior Manager, Regional Development, at the International AIDS Socety “UNAIDS PREVENTION OF HIV IS ONE EYED”, meaning, it’s counselling on sexual transmission or mother to child, but BLIND to blood exposure.
Unfortunately, the international scientific board which oversees the selection of session, speakers, for the huge international conferences on AIDS, have so far systematically blocked proposals to discuss blood related exposure of HIV.
Perhaps recent data (250 children contaminated with HIV in health care as demonstrated by outbreak investigations in Kyrgystan and Kazaksthan in 2006, 2007) and the identification that 25 to 70% of patients may contract a nosocomial infection in West Africa (RIPAQS seminar 2008), could lift the fog on this issue, all the more so that PLWA in need of treatment can ill afford to contract a hospital acquired infection such as TB, hepatitis, or an ARV resistant HIV while in treatment.
