Thursday 16:30:12
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Visit the UNAIDS section, included here in the
" ...[the] Special Session of the General Assembly of the United Nations (25 to 27 June 2001) considers an expanded response to HIV/AIDS. This policy forum estimates that by 2005, that response will require about US$9 billion annually, with half of these resources needed in sub-Saharan Africa. About US$4.8 billion is required for prevention including interventions focusing on youth, workplace programs, mother-to-child transmission and condom distribution. US$4.4 billion is needed for palliative care, treatment and prophylaxis of opportunistic infections, support for orphans, and antiretroviral therapy. One-third to one-half of these resources can come from domestic sources, both public and private, with the remainder needed from international sources...." from Resource Needs for HIV/AIDS.
To generate support for the "AIDS Initiative", Dr. Jeffrey Sachs (Harvard) made an impassioned plea, echoed by other AIDS policy makers, that "...the United States is pledging $200 million rather than the $2 billion that we ought to be pledging, which after all would be about $8 per American per year, $200 million is about 75 or 80 cents per American per year. It's not a meaningful contribution yet..."
However, faced with shrinking "federal surplus" if not outright deficit and a world economy that does not seem to be getting out of its doldrum, it is unlikely that the United States, or for that matter any country in the world could afford to be as generous as Dr. Sachs want the Western nations to be.
So far, just slightly more than $1 billion have been pledged to the initiative -- barely more than 10% of the targeted annual budget. If other funds controlled by international organizations and governments are included in the tally, the total AIDS funds may amount to several billion dollars, but still a far cry from the fund-raising goal of the "UNAIDS Fund Initiative". Considering that this is the first year of the initiative, when the the most enthusiastic support is most anticipated, it is unlikely that the goals of the initiatives will ever be met annually for the next 15-20 years.
The changed geopolitical and security priorities of the United States (as well as other Western countries), as a result of the "September 11, 2001 incident", may have sealed the fate of the "UNAIDS Initiative".
Also, not only will the $9-10 billion annual budget unlikely to be met, the actual annual cost of combating the AIDS epidemic worldwide is several fold higher than the targeted UNAIDS fund initiative, once the total cost of patient care, education, AIDS drug, health infrastructure, etc. have been considered. [Visit "
Dividing a small cake. Most AIDS policy makers, without publicly acknowledging the situation, tacitly accept that there will be some money, but there won't be sufficient resources to fund the worldwide AIDS initiative, as envisioned by many of the top policy makers. This realization raised the issue on whether the "limited resources" available through the UNAIDS Funds Initiative be better spent in "prevention programs" or "treatment subsidies". [Subsidy for treatment, rather than just providing access to treatment, is assumed here because it is unlikely that people living with HIV/AIDS will have the income to pay their own medicines.]
Policy makers like Dr. Sachs, as well as international organizations like "Medecins Sans Frontieres (MSF)" raised a very important moral issue:
- "You cannot simply write off millions of people by saying the treatment is not available. Prevention alone will not solve the problem." -- Dr. Anne-Valerie Kaninda of MSF (from BBC).
In an attempt to placate all groups, the UNAIDS Declaration of Commitment on HIV/AIDS emphasizes prevention measures but aim also to subsidize condoms, antiretroviral drugs, medications to control opportunistic infections, etc. (see abstract quoted above from Resource Needs for HIV/AIDS).
AIDS subsidy by numbers.The UNAIDS Fund Initiative is expected to apportion the funds raised based on the AIDS cases in each country or region. By this criterion, Sub-Saharan Africa is expected to receive the lion's share of the UNAIDS Fund Initiative. [Read quote above from Resource Needs for HIV/AIDS.] While there is some logic to this criteria, in "
Limits of the United Nations, as an instrument for change. During the negotiations for the final version of the "Declaration of Commitment on HIV/AIDS", several countries and the Vatican were successful in having certain language -- considered to be offensive by certain cultures -- removed in the previous draft of the declaration; specifically,
- " ... children in especially difficult circumstances, men who have sex with men, sex workers and their clients, injecting drug users and their sexual partners, persons confined in institutions and prison populations, refugees and internally displaced persons and people separated from their families due to work or conflict; ..." (from Draft Declaration of Commitment on HIV/AIDS ).
because the above language recognizes the existence of certain groups, e.g., "men who have sex with men", not acknowledged or considered illegal in some countries. The language "men who have sex with men" was replaced with "risky and unsafe sexual behavior" in the final "Declaration". Other euphemisms were used to camouflage "sex workers", injecting drug users, etc.
While the language changes were very subtle, some AIDS activists charged that the language changes emusculated the final version because the final "Declaration" failed to recognize the most important targets of the AIDS Initiative. This protest from some countries raises the issue whether these countries are ready to fight AIDS within their borders.
Solomon's choices. Clearly, more bold, concerted and innovative initiatives are needed to combat the world AIDS epidemic in a world of limited resources. Difficult choices will have to be made, essentially deciding who will live and die.
Please click on AIDS Primer, if you do not see the A-Z navigation links, specific for this section. This page is a part of a much larger website -- "Treasures of the Internet" -- that includes other health-related sections, as well as other more general sections on the arts, literature, science, etc. If this is your first visit, please read "navigating this site", for further guidance.