Public Sector Management Essay

HIV/AIDS – An International Concern November 16th 2009 Abbreviations and acronyms AIDS: Acquired Immunodeficiency Syndrome ARV :Antiretroviral (drug) CDC:Centers for Disease Control G8:Group of Eight GFATM:The Global Fund to Fight AIDS, Tuberculosis and Malaria HIV:Human Immunodeficiency Virus NGO :Nongovernmental Organization TERG:Technical Evaluation and Reference Group UN:United Nations UNAIDS:Joint United Nations Program on HIV and AIDS UNESCO:United Nations Education Scientific and Cultural Organization OECS:Organization of Eastern Caribbean States

PEPFAR:President’s Emergency Plan For AIDS Relief USAID :United States Agency for International Development “It is estimated that 33 million people worldwide are infected with HIV, 95 percent of whom live in developing countries. In 2007, approximately 2. 5 million people were newly infected with the virus. HIV/AIDS has killed more than 25 million people worldwide. More than two million people died of AIDS-related causes in 2007. AIDS is the leading cause of death in sub-Saharan Africa and the fourth-leading cause of death worldwide. (The GFATM) The documentary by Renata Simone entitled “The Age of Aids” gave a very concise record of the origin of AIDS to organizations and agencies around the world that scale up prevention and treatment programs in the fight to stop the spread this deadly disease. During the early 1980s doctors reported a case of a rare type of pneumonia and further publications in medical journals of this rare type of pneumonia unearthed over 100 more reports of this mysterious disease to the CDC. The first recognized case of

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AIDS as reported in the documentary occurred in the United States in the early 1980s. A number of gay men in New York and California suddenly began to develop rare opportunistic infections and cancers that were resistant to any form treatment. During this time, AIDS did not yet have a name, but it quickly became obvious that all the men were suffering from a common syndrome. The discovery of the Human Immunodeficiency Virus (HIV) was made soon after by Dr. Luc Montagnier of France. This discovery was controversial as an American Scientist Robert Gallo claimed he discovered HIV.

However, the scientific community agreed to credit Dr. Montagnier with the discovery. HIV was confirmed by the CDC to be a virus and more specifically a lentvirus which means “slow virus” because they took a long time to produce any adverse effects in the body. [1] Many scientists report different theories to explain the origin of the AID virus. Theories such as the Oral Polio Vaccine theory, which were given to over one million people in Congo, Ruanda and Urundi in the late 1950s was accused of being developed or cultivated from local infected chimps.

There is also the Contaminated Needle theory, the Colonialism theory and the Conspiracy theory. Regardless of the theory, the deadly disease reached alarming numbers in adults and children and according to the UNAIDS Report of 2008, there are 33 million globally with Sub Saharan African having 22,000,000 cases. [2] In part three of the documentary “The Age of AIDS” it was highlighted that the virus HIV did not remain dormant but replicated by the “billions everyday and mutated”.

World leaders such as Nelson Mandela and President Clinton did not approach the epidemic directly at first which lead to political unrest in the United States. In Africa however, the continent reporting the highest number of cases was focused on fighting Apartheid and no emphasis was placed on the growing issues surrounding this disease. In 1996 in a Global AIDS Conference in Vancouver, researchers announced the results of their clinical trial and revealed the anti-retroviral drug which no longer made HIV a “death sentence”.

However, the cost of this drug was not affordable by majority of infected persons especially Africans which brought up another issue of affordability. It was agreed that HIV and AIDS should become part of the political agenda as by the end of 1996, there were over 20 million Africans affected with HIV. Many other countries such as China and Haiti continued to report growing numbers of HIV/AIDS infected patients. It was believed according to the documentary, that AIDS was transferred to Haitians that traveled to Africa as teachers after the Europeans left when Congo gained independence.

Haiti’s main area of development and source of foreign investment and income tourism was “killed” because of growing AIDS rumors. AIDS was declared a development crisis by the World Bank in 2000 and per capita growth in half of the countries in sub-Saharan Africa is falling by 0. 5 per cent to 1. 2 per cent each year as a direct result of AIDS. Uganda became the first country in the world to start an HIV Prevention Programme. The epidemic began to hinder social systems and development globally.

The United Nations in addressing HIV/AIDS stressed the need for coordinated efforts of all relevant organizations to address the pandemic and assist wherever possible in global efforts against it. Resolution 1308 passed January 2000 by the UN Security Council emphasized the roles of the General Assembly and Economic and Social Council in HIV/AIDS. The Resolutions pointed out that if “unchecked the disease may pose a risk to stability and security”.

The UN Security Council expressed concern over the potential impact of HIV/AIDS on the health of international peacekeeping. Given the opportunity to virtually interact with colleagues of the technical team from the Organisation of Eastern Caribbean States HIV/AIDS Project Unit (funded by The Global Fund) on the topic of the legitimacy of the HIV/AIDS pandemic in international relations many key issues were raised. It was pointed out that HIV/AIDS is a great concern not only in Sub Saharan African but also for the Caribbean.

The Caribbean is an important area of study they reported and the issue of security continues to become very problematique as globalization continues to open up the region and our already vulnerable economies to high levels migrants, tourists and even sex workers. The killer effects of AIDS reduces the size of the ‘market’ for the purchasing of a host of goods and services and for attracting external investments; even local investment opportunities are compromised and must be directed away from developmental goals to meet the costs of the health care to address the AIDS epidemic.

The disease reduces the size of the labour force and this impacts negatively on the production capacity for external export and trade as well as earning of foreign exchange; and importantly because the ‘Research and development’ of effective treatment for AIDS are in the hands of a few countries, who can not only set the procurement prices but can use the technology as a bargaining tool in international and trade relations. For example a country in which 75% of its military are HIV infected will not be able to refuse to purchase arms if the purchase is tied to antiretroviral drug procurement.

Conversely, since ‘dead’ people cannot pay debts, it is in the interest of certain international financial institutions and lending countries to provide assistance to debtor countries. The Global Fund is a unique multilateral agency which provides assistance to both public and private organizations, governments, civil societies (NGOs in both developed and developing countries), private sector groups and also affected communities. The organization’s approach to combating HIV and AIDs is through financial assistance on health related issues internationally and works in close collaboration with the United Nations AIDS program.

The Global fund was established January 2002 at a G8 conference in Okinawa, Japan where countries recognized the need for greater funding to fight against HIV/AIDS, Malaria and Tuberculosis. This venture was supported by the former UN Secretary-General Kofi Annan and with the UN’s approval and contribution to the Fund; the board approved the first round of grants to 36 countries. Since its creation it has provided a quarter of all international financing for AIDS. “The Global fund has become the main source of finance for programs to fight AIDS, tuberculosis and malaria, with approved funding of US$15. billion for more than 572 programs in 140 countries”. [3] The official aim of the Global Fund is to “attract, manage and disburse additional resources through a new public-private partnership that will make a sustainable and significant contribution to the reduction of infections, illnesses and deaths, thereby mitigating the impact caused by HIV/AIDS, tuberculosis and Malaria in countries in need and contributing to poverty reduction as part of the Millennium Development goals. ” [4]

The mission or goals of the fund are to deliver effective financial aid to create policies which impact against AIDS, Malaria and Tuberculosis. The goals of the Global Fund are administered according to the principles of the Paris Declaration of February 2005. This was an agreement taken by many other organizations on improving their effectiveness in areas of ownership, alignment, harmonization and accountability. [5] The Global funds effectiveness has been monitored based on the different rounds of funding provided. To date, there have been few official reports presented on the Global Funds effectiveness.

The Technical Evaluation and Reference Group (TERG) of the Global Fund presented a report in 2007, presenting a five-year evaluation of the organization and its overall efficiency and effectiveness. The report identifies areas for improvements for the Global Fund and also highlights areas in which the Fund has had exceptional achievements. The success of the fund lies within its ongoing relationship with over 134 countries and have forged international, private, public and civil society partnerships. Over 120 countries have benefited from Global Fund money.

In the round of grants approved in November 2007 about 57 per cent of the money was planned to go to Sub-Saharan Africa, 12 per cent to East Asia and the Pacific, 9 per cent to Eastern European and Central Asian Countries, 8 per cent to Latin America and the Caribbean, 8 percent to South Asia and 6 per cent to the Middle East and North Africa. [6] However, the evaluation finds that the Global Fund has not fully defined its exact role and “does not have in place the systems, structures and policies required to efficiently disburse an anticipated US$ 6 billion to US$ 8 billion annually and to rovide focused leadership in the fight against HIV/AIDS…”[7] Recommendations coming from the report were the need for Global Fund to change their strategies and focus on issues such as partnerships and disease impact. Too many of the Global Fund’s area of focus only on funding but not much quoting “less that 5 per cent on issues such as delegation and encourage the participation of all groups. One a positive note the evaluation highlighted that the Global Fund’s mobilization efforts were very successful.

From a Caribbean perspective, The Organization of Eastern Caribbean States, a recipient of Global Funding to fight HIV/AIDS in Eastern Caribbean commented on the GFATM’s overall effectiveness. The Global Fund ranks amongst the most effective agency for combating HIV and AIDS in several countries. However, under the Global Fund arrangement, not all ‘deserving’ countries are eligible for assistance and this can have very negative consequences for neighboring states where people migrate for better health care.

The assistance is purely in the form of money and most of the severely affected countries are short of the required human resource capacity to deliver the needed services and importantly to meet the stipulations within the Grant Agreement. The funding is also too prescriptive too often the process from planning to receipt of the funds require more than one year. Despite the problems, the financial assistance provided by the Global Fund has had positive results. Over 1. 7 million HIV/AIDS orphans have been provided with care and support through AIDs programs.

Two million people living with HIV have received antiretroviral treatment showing an increase of 43 per cent from previous years. (Global Fund Press Release, 24th February 2004) The interventions by the Global Fund has allowed for poor countries to gain significant responses to an overwhelming epidemic. They have also enabled the better management of health resources through some local systems and have encouraged the emergence of ‘best’ practices and new technologies which have far reaching application for public health example ‘Rapid’ testing.

Many however, contend that the response to the HIV/AIDS epidemic requires international action as disease does not specify gender, age or cultural background. The sexual behaviors of many have still not changed. What is needed most importantly is for individuals to consciously make drastic changes in their behaviours and attitudes and practice better living. Organizations such as Global Fund, UNAIDS or PEPFAR and other such bodies will not always exist to speak on prevention and care, individual action is needed.

Groups, communities and small organizations need to support bilateral or multilateral organizations in the fight against this deadly disease. HIV/AIDS has become the fourth highest cause of death in the world, “we must commit ourselves to not simply continuing our efforts, but intensifying them. ”(Piot, 2008) In an article entitled “Engaging Culture for effective responses to HIV/AIDS” the writer speaks of the use of culture in the education, prevention, treatment and care of HIV/AIDS. Research indicates that social trends contributed to HIV/AIDS and in turn has an impact of people’s lives. (UNAIDS, 2000)

The global financial crisis and H1N1 like AIDS have removed any doubt of the interconnectivity between countries, and lend credence to the adage that ‘we are our brother’s keeper’. Unless the AIDS epidemic is brought under effective control in all countries the risk of resurgence or re-emergence of an epidemic or pandemic in a more virulent form of the virus is a distinct possibility, given the movement of large numbers of people, the persistence of pockets of poverty and stigma and discrimination on the basis of gender, migration and minority status, sexual preference and disease condition.

Reference List Aidspan; Independent watchdog of the Global Fund and publisher of Global Fund Observer www. aidspan. org . Allen, C. R. Mc Clean et al; The Caribbean HIV/AIDS and Security: Caribbean Security in the Age of Terror, Ivelaw Griffith edition. Ian Randle Publishers, 2003. Averting AIDS Website; http://www. avert. org/global-fund. htm. Averting AIDS Website; The Origins of AIDS and HIV and the first cases of AIDS: http://www. avert. org/origin-aids-hiv. htm Cohen, John; The Hunt for the Origin of AIDS: The Atlantic, October 2000, Volume 286, No. 4, pages 88-104.

Global Fund Press Release; Global Fund signs letter of intent to re-launch Ukraine HIV/AIDS grant, 24th February 2004. Lu, Chunling PhD et al; Absorptive capacity and disbursements by the Global Fund to Fight AIDS, Tuberculosis and Malaria: analysis of grant implementation. Miskelly, Von Clodagh; Engaging Culture for effective responses to HIV/AIDS http://www. medicusmundi. ch/mms/services/bulletin/bulletin113_2009/chapter1/22. htm New York Times Editorial; “Preserving the Global AIDS Fund”, 19 May 2005. Oxfam; False Hope or New Start: The Global Fund to Fight HIV/AIDS, TB, and Malaria, Oxfam Briefing paper no. 24, 2002.

Piot Peter; 25 Years of AIDS in Africa: Past and Future, 2008. Shakow, Alexander; Global Fund – World Bank HIV/AIDS Programs: Comparative Advantage Study,Global Fund Website, 19 January 2006. The Global Fund Website; www. theglobalfund. org. [pic][pic] ———————– [1] (accessed November 2009) Kanabus, Annabel & Allen, Sarah Updated by Bonita de Boer. Avert: Averting HIV and AIDs. October 26, 2009. http://www. avert. org/origin-aids-hiv. htm [2] UNAIDS 2008 Report on the global AIDS Epidemic: HIV and AIDS Estimates and Data, 2007 and 2001 www. unaids. org [3] (accessed 6th November, 2009) The Global Fund Website: ttp://www. theglobalfund. org/EN/whoweare/? lang=EN [4] (accessed 11th November, 2009)  The Framework Document of the Global Fund to Fight AIDS, TB, and Malaria [5] (accessed 10th November 2009) Paris Declaration on aid effectiveness, ownership, harmonization, alignment, results and mutual accountability: http://www. oecd. org/dataoecd/11/41/34428351. pdf [6] (accessed 15th November 2009) Global Fund website (February 2009) Distribution of Funding for Round 7 [7] (accessed 15th November 2009) TERG: The Global Fund Five Year Evaluation: http://www. theglobalfund. org/documents/terg/TERG_SA1_Summary. pdf