BY VIVIEN MILEY
"A multi-billion dollar investment in the battle against AIDS, tuberculosis and malaria will save millions of people. Those already hit by these diseases would be able to live longer and healthier lives. Even the worst affected countries could be able to regain the ground lost in their fight against poverty and inequality." From the United Nations web site.
While long acknowledged as a global health crisis, little has been done to stem the spread of HIV/AIDS. While the United Nations and various non-government organisations have launched campaigns to combat its severity and spread, lack of financial commitment from First World governments, global financial institutions and the private sector has meant that such programs have been largely ineffective and have made very little impact, especially in countries of the global south.
Since its establishment in 1996, the United Nations body, UNAIDS, set up to try to find solutions to the global HIV/AIDS epidemic, has struggled for funding. While it was promised billions of dollars from the World Bank, the World Health Organisation, UNICEF and others, when the time came to cough up, the money never eventuated.
In April, addressing a summit of the Organisation of African Unity in Abuja, Nigeria, UN secretary-general Kofi Annan called for the establishment of a US$10 billion global HIV/AIDS fund.
Financed by pledges from developed nations and corporate and private donors, the fund would ensure proper resourcing for health programs to combat the pandemic.
At a June 25-27 special session of the UN General Assembly, the call received almost unanimous backing from world leaders. The assembly endorsed a declaration of commitment on HIV/AIDS, Global Crisis, Global Action, a 20-page, 103-point document which outlines a plan to better help those suffering from AIDS and to combat the further spread of the virus.
Finally, it seemed possible that the HIV/AIDS epidemic would receive the attention it deserves.
Problems emerge
But problems have emerged almost immediately. So far only France, Britain and the United States have made pledges, and while more pledges are expected to be made at the G8 summit to be held in Genoa, Italy in late July, the estimated funds needed to really begin to tackle the epidemic look a long way from being met.
The involvement of giant corporations in the global HIV/AIDS fund has also proved enormously contentious.
Also looming is a controversy over the policies of the World Bank, the Washington-based multilateral institution which both provides funds for development in the Third World and polices poor countries' debt repayment schedules.
The World Bank has stepped into the front ranks of those institutions charged with tackling the HIV/AIDS pandemic on a global scale — a part of efforts by its president, James Wolfensohn, to expand the bank's mandate into areas of "global public goods".
But while the World Bank is seeking to cultivate an image that it is giving with one hand by helping to administer the global HIV/AIDS fund, it is taking away with the other.
Support from world leaders for action against HIV/AIDS is growing, at least in words. But support for the cancellation or even major relief of the Third World's debt burden, long considered a precondition for poor countries combatting the crisis, appears to have vanished from the global agenda altogether.
Poverty and inequality are two of the major contributing factors in the spread of the virus. Unsurprisingly, the region where HIV/AIDS is hitting the hardest is also where the debt crisis is most acute: in sub-Saharan Africa.
Figures from UNAIDS suggest that of the 36.1 million people in the world infected with HIV/AIDS, 25.3 million live in sub-Saharan Africa. Thirty-four out of the 41 countries eligible for Heavily Indebted Poor Countries (HIPC) debt relief are in sub-Saharan Africa. While collectively paying creditors $40 million a week, sub-Saharan Africa still owes US$170 billion.
The limited debt relief which has already been granted under the HIPC initiative, jointly administered by the World Bank and International Monetary Fund, has produced some positive results in the fight against the HIV/AIDS epidemic.
The sums provided have been far too little at the G7 summit held in Cologne in 1997, the world's leaders promised US$100 billion in debt relief, but so far only US$12 billion has been delivered.
Results, though, have been tangible. In Uganda, debt relief has cut the annual debt servicing burden from US$151 million to around US$88 million. Debt relief has allowed more money to be channelled through Uganda's Poverty Action Fund into health and education sectors and spending on primary health care has increased by 270%.
But despite this progress, debt relief, let alone debt cancellation, has been dropped as part of the solution to the HIV/AIDS crisis.
In September 1999, two NGOs, World Development Monitor (WDM) and MedAct, released a report called Deadly Conditions which warned that "the conditions attached to desperately needed debt relief may be nourishing the canker of HIV/AIDS epidemic".
In its latest report, The Vicious Circle, released on June 25, WDM confirms its earlier warning, stating "The AIDS epidemic in sub-Saharan Africa is inextricably linked to the debt crisis. The vicious circle between debt and AIDS can only be broken by a serious international commitment to tackling both crises simultaneously. WDM believes that more and faster debt relief and cancellation are a vital and effective way of helping developing countries combat HIV/AIDS."
The report points out the ways in which debt is exacerbating the spread of HIV/AIDS.
The first way, the WDM report argues, is by imposing a heavy repayment burden. In order to repay the loans at the rate demanded by the World Bank, indebted governments spend a large proportion of their national budgets each year on servicing their debts, sometimes as much as 50%.
To do so, funds are drawn from all aspects of health and education services, such as training staff and investing in infrastructure, resulting in a severe deterioration in service.
According to the Human Development Report 1999, of the 41 countries eligible for HIPC debt relief, 30 spend more on debt servicing than on health care. Countries in sub-Saharan Africa are currently spending almost twice as much on servicing debts as they are spending on either education or health care.
The second way in which debt exacerbates HIV/AIDS is through the conditions which the World Bank and IMF attach to new loans and to debt relief.
Conditions for loans have usually come in the form of Structural Adjustment Programs (SAPs), which require governments to focus on reducing government spending and increasing export earnings.
This has a two-fold effect: first, decreased government spending has meant that public services, including health care and education, have been slashed, putting more people at risk of infection through lack of education and basic health care. Secondly, focusing the economy on export earnings, rather than subsistence agriculture, impoverishes many poor farmers and socially dislocates them by forcing them to emigrate to the cities to look for work, assisting the spread of the virus.
Since December 1999, SAPs have been formally replaced by Poverty Reduction Strategy Papers, which are a precondition for entry into the HIPC debt relief scheme. While PRSPs have been shown to direct more resources into health and education than SAPs, in most other respects there is little difference between the two. The model of economic growth promoted in PRSPs is still export-oriented.
The third way in which World Bank policies have exacerbated the pandemic is through the bank's encouragement and enforcement of "user fees" for public services.
In theory, user fees are supposed to be a way to raise revenue for public health and education, with people using the services paying a fee. The extra money is supposed to make up for shortfalls caused by debt repayment.
However, user fees have had the opposite effect. Instead of providing greater funds to public resources, the fees are driving away the people that most need the services and at the same time reducing the number of people able to use them. The result is a much greater deterioration in public health and education services than would otherwise have occurred.
If the World Bank was truly serious about "relieving poverty" (as it claims in its mission statement), or was serious about stopping the further spread of HIV/AIDS, it would drop the crippling debts owed to it, so as to make money available for HIV/AIDS and health care programs.
That it doesn't is a proof of the lack of seriousness with which it, like the world's major governments, is approaching a crisis which last year killed 2.4 million people in sub-Saharan Africa.