WASHINGTON, 29 December (IPS): American rights groups are describing President Bushs new plan to commit 30 billion US dollar (150 milliarder DKR) to HIV/AIDS issues and increase treatment coverage for 500.000 people worldwide is woefully inadequate.
Health worker shortages in sub-Saharan Africa and a disproportionate HIV/AIDS burden on women in the region necessitate an increase in funding for the Presidents Emergency Plan for AIDS Relief prior to a congressional vote next week, the advocates said.
First introduced by President George W. Bush in 2003, the Presidents Emergency Plan for AIDS Relief (PEPFAR) is now up for reauthorization by the US Congress.
The five-year PEPFAR I initiative committed 15 billion dollar to providing HIV/AIDS treatment to 2 million people worldwide – or one-third of those in clinical need – by the end of the 2008 fiscal year. Bush wants PEPFAR II to entail 30 billion.
– Under the rhetorical guise of doubling, President Bush is setting us back in the fight against AIDS by proposing to flat fund the flagship program of his administration, said Jose de Marco, a board member of the US-based Health Global Access Project network.
Since PEPFAR I spending climbed to 6 billion dollar in its last year, allocating 30 billion for the project over the next five years is the equivalent of a zero increase in funding, Physicians for Human Rights pointed out.
– The current level of funding means that less than 25 percent of the people who should be on treatment are on treatment – and in some countries, it is less than 10 percent, said Mardge Cohen, a Physicians for Human Rights adviser who founded WE-ACTx, an organization serving HIV-infected women and children in Rwanda.
Rights groups instead are calling for a commitment of 59 billion dollar over the next five years to address HIV/AIDS, tuberculosis and malaria in vulnerable populations around the globe, but also to invest in parallel initiatives to reduce these populations’ vulnerability.
In particular, rights groups point to the lessons learned from PEPFAR I as compelling evidence for building the capacity of local health services.
– Getting drugs on the ground is not the only answer. Making treatments available is not the only answer. We need health care workers to deliver the treatments, said Pat Daoust, director of Physicians for Human Rights Health Action AIDS Campaign.
According to Physicians for Human Rights Web site, in sub-Saharan Africa 3 percent of the worlds health care workers serve 24 percent of the planets HIV/AIDS-infected population. It is estimated that an additional 1 million health workers are needed in the region in order to fully meet the needs of the population.
One successful initiative currently in place utilizes mobile health testing services, in which clinics travel by caravan directly to isolated communities, then follow up with home visits by nurses and peer counselors.
Aside from building capacity for local health professionals, rights groups and activists are advocating for a more comprehensive approach that uses health and social services in HIV/AIDS treatment and prevention, which they refer to as “wrap-around programs.”
One wrap-around program consists of incorporating testing and treatment into routine primary care visits.
Offering free primary education may also play an important role. Pauline Muchina, who serves in the UN Global Coalition for Women and AIDS initiative, and who is originally from Kenyas Rift Valley Province, said the HIV/AIDS rate dropped in her country when the Kenyan government made primary education free for all children. She now is an advocate of free secondary schooling.
Many rights groups recognize education and economic empowerment for women and girls as a successful HIV/AIDS intervention, and they have argued that PEPFAR II must incorporate these initiatives in order to confront the epidemics disproportionate impact on women in sub-Saharan Africa.
Among youth in the region, 75 percent of those living with HIV/AIDS are young girls, Muchina said. Worldwide, women account for approximately 50 percent of HIV infections but represent 61 percent of HIV infections in sub-Saharan Africa.
Current prevention approaches rely on the “A-B-C model,” which refers to abstinence (seksuel afholdenhed), being faithful and using condoms, yet persistent gender inequality in many sub-Saharan African countries makes it difficult for women to demand that their partners use condoms.
“These three are all important, but we need to look beyond” the A-B-C model, Muchina said. “We need to look to prevention options that are in women’s hands.”
Activists argue that PEPFAR II should shift its prevention efforts away from abstinence-only programs to providing prophylactics that are within womens control, such as antimicrobial foams.
The wide range of approaches proposed by advocates and experts point to the complexity of the HIV/AIDS epidemic in vulnerable regions – a complexity that many hope will be more effectively addressed with increased funding for comprehensive services in PEPFAR II.
Kilder: IPS og The Push journa
