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Date: Fri, 18 Jun 1999 23:12:10 -0500
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Subject: Africa: HIV/AIDS Updates

Africa: HIV/AIDS Updates
Date posted (ymd): 990618
Document reposted by APIC

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide
Issue Areas: +economy/development+
Summary Contents:
This posting contains a speech by UNAIDS Executive Director
Peter Piot to the May Meeting of African Ministers of
Finance and Ministers of Economic Development and Planning,
hosted by the Economic Commission for Africa. It also
contains a recent posting from the HIVNET forum on recent
protests by AIDS activists against U.S. Vice-President Gore,
for his involvement in U.S. pressures on South Africa over
policies on imports of AIDS drugs.

+++++++++++++++++end profile++++++++++++++++++++++++++++++

[Debt Update: Eurodad, a coalition of European non-
governmental organizations, has produced a new series of
background briefings on debt prior to the Cologne G7 summit
taking place this weekend.  Although it is not yet available
on their website at http://www.oneworld.org/eurodad,you can
obtain copies of the briefs by writing to [log in to unmask]
The briefings document the inadequacy of the terms likely to
be agreed by creditor nations at the summit.]

*********************************************************

Economic Commission for Africa

[For more information visit the ECA web site at
http://www.un.org/depts/eca]

Meeting of Ministers of Finance and Ministers of Economic
Development and Planning

Addis Ababa, Ethiopia, 7 May 1999

By Peter Piot, Executive Director, UNAIDS

On behalf of all cosponsoring organizations of UNAIDS, I
welcome the opportunity you have given me to speak about a
subject that concerns me very much in a continent where I have
strong ties of friendship and work, I am talking about AIDS.

It is encouraging to hear in this meeting that overall
economic growth rates are up in Africa over the past couple of
years - but a continuation of this improvement will be
seriously jeopardized by the AIDS epidemic. I feel that it is
no means an exaggeration to state that, along with armed
conflict, the AIDS epidemic has become the greatest threat to
development in much of sub-Saharan Africa.

In this presentation, I would like to raise four issues:

1. THE SITUATION TODAY

AIDS now affects every country in the world, but it is
sub-Saharan Africa that today is the most affected.

By one conservative estimate one-quarter of the population of
Africa, 150 million people, has been personally affected by
the epidemic. The nine most heavily affected countries in the
world are all in Africa.

Let me give you just five shocking figures:

a. At least 9 million Africans have already died of AIDS, and
AIDS is now the first cause of death - last year alone, 2
million died.

b. Over 22 million Africans are currently living with HIV or
AIDS.

c. There are almost 8 million African children under the age
of 14 who have lost their mother or both parents to the AIDS
epidemic. Today in many communities, there is not a family
that has not lost someone because of AIDS. ...

2. THE IMPACT OF AIDS IN AFRICA

Unfortunately, many in Africa and elsewhere still view AIDS
purely as a health problem - and of course it is a disease.
But in fact, it is much more than this. AIDS is at the heart
of the development agenda for Africa. Let me explain why.

First: impact on Households. Those who suffer the consequences
first are families. There is, of course, the emotional impact
of seeing a loved one die. At the same time families must cope
with significant economic loss.

For example, surveys show that one-third of rural households
affected by AIDS experienced a 50% reduction in agricultural
output.

Income loss like this leads to painful choices. Education can
become a luxury. One study, in Cote d'Ivoire, showed that in
families where someone had died of AIDS school expenditures
went down by half. That means that one-half of the children
left behind when someone dies of AIDS cannot realize their
full potential.

Second: impact on Economic Sectors. These cruel effects on
families are also cruel to countries' economies. As income
declines so does purchasing power. Unschooled children mean
growing social problems and a loss of competitiveness in a
global economy increasingly dependent on knowledge. Food that
is not grown must be imported or cuts down on that which can
be exported.

In Zimbabwe today half of the in-patients in hospitals are
there because of AIDS-related illness. Models show that by
2005, basic AIDS treatments costs will be over 60% of the
Ministry of Health Budget -- and this does not even include
the very expensive therapies used in high income countries.
Zimbabwe is not alone. In Kenya by 2005 AIDS treatment costs
will be over 50% of the Ministry's budget.

Studies show that in some countries, the military is two to
five times more likely to be infected by HIV than the general
population. What are the implications for national security?
Teachers are dying of AIDS - for example, one teacher a day in
Cote d'Ivoire, not even the most affected country. What are
the implications for the education of your youth and for the
future of your children? How will these teachers be replaced?

Third: impact on the Private Sector. Several recent studies in
Africa show that company profits decreased by up to 20 percent
as a direct result of AIDS.

What are some of those costs? HIV and AIDS absenteeism make up
52% of the costs. Recruitment and training of replacement
employees made up another 17%. Add to this the hidden impact
-- of children not educated because their parents have died
and therefore of a reduced pool of skilled labor to replace
those lost, and it is easy to see that the costs to the
economy will be high.

Projections for South Africa suggest that employee benefits,
as a percent of salary, will rise from seven percent to
nineteen percent by 2005 because of AIDS. These extra costs
and the loss of skilled labor have obvious implications for
the efforts to attract high-quality foreign investment.

Fourth and finally: macroeconomic Impact. While we are still
working to capture in our models the full effects of the AIDS
epidemic on macroeconomic performance, there is no doubt that
AIDS is having a significant negative impact in the most
severely affected African countries. The keynote paper
prepared for this meeting suggests that to meet the goal of
reducing poverty by half by the year 2015, Africa needs growth
rates of 7 percent per annum. The World Bank has
conservatively estimated that countries with high HIV
prevalence will lose one percent of GDP growth per capita
annually. The cumulative expected loss in Kenya, for example,
is expected to be 15% over the next decade. Broader measures
of human welfare, such as the UNDP's Human Development Index,
are also projected to decline dramatically in the Southern
Africa countries because of AIDS.

WHAT CAN BE DONE? THE ANSWERS LIE IN AFRICA

I do not want to leave you with the idea that nothing can be
done. I would not even be here if I did not believe we can
turn the tide of the epidemic. We are not powerless. Much can
be done, and some of the answers are already present within
Africa. We have growing evidence from at least two African
countries - Senegal and Uganda - that a combination of strong
political support, broad institutional participation, and
carefully selected program interventions can actually lead to
declines in the number of new HIV infections and improved care
for those who are ill.

This experience shows us that no amount of dollars can make a
difference if there is not concerted leadership, at all levels
from the head of state to the district level, involving
government, in partnership with non-governmental
organizations, communities, and the private sector. I see a
growing momentum of such political commitment in the region,
as evidenced by an increasing number of heads of state
speaking up.

There must be openness about the disease and how it is spread.
AIDS cannot remain "the disease with no name". People are
dying because of ignorance and because of the stigma,
humiliation, and fear of retribution that surrounds AIDS.
Let's not forget that people lose their job, are out of
school, are even killed - only because they have HIV.

We now have many of the essential tools for a successful
national AIDS programme - scaling up investing in what we know
that works.

One of the most important lessons is that national success in
the fight against HIV/AIDS depends on people like you --
Ministers of Finance and Planning - getting centrally and
personally involved. Allow me to suggest seven things I
believe we can do:

First, to speak out strongly and publicly about the threat
that HIV poses to your countries' futures. Such outspokenness
will help to mobilize political support and human and
financial resources in the struggle against AIDS, your voice
on HIV/AIDS will send a powerful message to others.

Second, to help to mobilize more resources for AIDS
prevention, treatment, and mitigation activities. A recent
study found that in 1997, only $150 million a year was spent
in African countries on AIDS prevention. We are currently
estimating that well over a billion dollars needs to be
devoted to AIDS programs in Africa now, if we are to come to
grips with the epidemic.

Where will such a sixfold increase in spending come from? It
will come in part from committing a larger share of domestic
public funds to AIDS. The study mentioned above found that
only a tenth of the reported spending on AIDS prevention in
Africa in 1997 came from governments, an average of $0.03 per
capita in the countries included in the study. If governments
increased their spending on AIDS activities to an average of
$0.35 per capita - less than one tenth of one percent of GDP.

Another source can come from redirecting to AIDS existing
project resources that are not currently going into fighting
the epidemic. There are billions of dollars programmed for
upcoming social funds, education and health projects,
infrastructure, and rural development, that could be channeled
into AIDS activities to support those sectors. This is fully
justified, as the AIDS epidemic is undermining the very goals
of these other investments.

Third, to shape the resources going to AIDS by indicating to
the bilateral and multilateral partners that this is a top
priority and a key element in successful development and
poverty alleviation. They need to hear this from you.
Unfortunately, these same partners are telling us that in
their programming discussions, many governments are indicating
that they assign AIDS a low priority.

Fourth, to also insist that all sector ministries plan and
budget for meaningful AIDS activities. Experience demonstrates
clearly that in successful national AIDS programs, education
ministries send powerful AIDS messages to pupils and teachers;
youth and sports ministries help organize AIDS clubs and
counseling centers; transport and construction ministries
mount prevent services aimed at truck drivers, migrant
construction workers, and others at highest risk of being
infected with HIV; the defense and interior ministries
actively offer testing and counseling services to those in the
armed forces; and so on.

Fifth, to assess impact of economic and social policies as
they may increase or decrease the societal vulnerability to
HIV.

Sixth, to bring in new partners - NGOs, religious, PWAs,
companies - yesterday, in South Africa, 100 million dollars
were initiated by the Secretary General of the UN.

Seventh and finally, you are uniquely placed to support the
development of a single, powerful national AIDS plan that
involves a wide range of government departments, NGOs, the
commercial sector, and the international development
community. Without this plan, the efforts of the many partners
against AIDS in your country will be fragmented, and their
impact in halting the epidemic will be lower.

The "bottom line" is that AIDS is a development challenge and
must be treated as one. It is as important than any of the
other challenges outlined in the keynote paper presented to
you for this meeting. And increasingly, we have the tools to
meet this challenge.

My last point:

INTERNATIONAL PARTNERSHIP AGAINST HIV/AIDS IN AFRICA

Acting upon a resolution of the OAU at its summit in
Ouagadougou last year, the debates at TICAD II in Tokyo, and
many bilateral discussions in recent months, UNAIDS and its
seven Cosponsors - the World Bank, UNICEF, WHO, UNESCO, UNDP,
UNFPA, and UNDCP - have recently come together in an
International Partnership against HIV/AIDS in Africa. All have
pledged to work harder, in a more coordinated fashion, with
each other and with you, to combat AIDS in Africa.

The vision of such a Partnership would be to ensure that
within the next five years, the majority of African countries
are implementing large-scale AIDS programs that reduce
dramatically the number of new infections, provide care for
those already infected, and help to mitigate the impact of the
epidemic on individuals, families, communities and nations as
a whole.

What are the key features of such a partnership? (1) actions
to raise high level political support for intensified national
AIDS programs; (2) develop strong national action plans; (3)
mobilize greatly increased financial resources for these
plans; and (4) develop strong country-based and regional
technical platforms to assist program design and
implementation.

To be effective, such an international partnership against
HIV/AIDS needs to go beyond African governments and UN
agencies, to include the NGOs, the private sector, and the
international donor community.

Much work needs to be done in the coming months to further
develop the partnership and the ownership. But without strong
action on the part of everybody in this room, the partnership
cannot succeed. As the paper prepared for this meeting says,
it is you who must set the agenda for African development. And
that agenda must prominently include AIDS.

International development organizations have told us that
they, too are ready to be part of the Partnership against
HIV/AIDS in Africa.

I am not standing here today to make promises about what we
can achieve in fighting the terrible AIDS epidemic.

What I am committing today is to working with you as key
partners against HIV/AIDS. Mr Chairperson, Ladies and
Gentlemen, AIDS is not just another new problem that the
world, including Africa, is facing. It is severely undermining
development, with millions of lives in the balance. It is
becoming a true "development emergency" for Africa. The time
for action to confront this emergency is now. AIDS must become
everybody's business. We need a broad coalition if we are to
succeed. We are ready to join this coalition with you. Let us
begin immediately so we can win this fight.

Thank you.

***********************************************************

Excerpt from a posting to [log in to unmask]
To read previous postings from the forum visit:
http://www.hivnet.ch:8000/treatment-access/tdm

Hivnet also hosts other forums on HIV/AIDS, including AF-AIDS
(http://www.hivnet.ch:8000/af-aids/tdm).

For an extended background article on the issue, see John B.
Judis, K St. Gore, in The American Prospect for July-August
1999 (http://epn.org/prospect/45/45judis.html).

GORE STUMPING DISRUPTED FOR SECOND TIME
AIDS Activists confront VP on African drug policy Thursday
June 17, 1999 , Manchester NH

AIDS activists took over Vice President Al Gore's second
campaign stop this morning in Manchester, New Hampshire. The
activists were protesting Gore's instrumental role in
preventing AIDS medications from reaching people in developing
countries, including South Africa and Thailand.

Five protesters, organized by the local chapter of AIDS Drugs
for Africa, disrupted Gore's campaign speech with noisemakers,
chants and banners reading "GORE'S GREED KILLS: AFRICA NEEDS
AIDS DRUGS." They were seated directly behind Gore in the
audience of 300 in the Hesser College Gym.

"After our protest, Gore said AIDS drugs for Africa are very
important. Yet, he is personally standing in the way of cheap,
life-saving treatment for Africans with HIV", said Moshe
Mizrahi, a protester. "I guess Gore does have strong family
values after all; he has family ties to the pharmaceutical
lobby and he's killing people on their behalf."

Gore's domestic policy advisor, David Beier, is the former
head lobbyist for Genetech, a major U.S. pharmaceutical
company. Tony Podesta, top Gore advisor and brother of
Clinton's chief of staff, is currently the contracted lobbyist
for PhARMA (Pharmaceutical Manufacturer's Association) and
most other U.S. drug interests. Tom Downey, close Gore
associate and former congressman, lobbies for Merck
pharmaceuticals. Gore fundraiser Peter Knight is a former
Schering-Plough lobbyist.

Gore has vehemently opposed the practice of "compulsory
licensing", which allows local companies to produce cheap,
generic AIDS drugs. He has threatened sanctions against the
South African government unless President Thabo Mbeki calls a
halt to generic drug production. Compulsory licensing is legal
under current international trade agreements, and provides
royalties to patent owners. AIDS medications would be
available at 10% of their American price.

Currently, 22.5 million Africans are HIV-positive, including
up to 26% of young adults, and totaling 67% of the world's
HIV+ population. Virtually all are poor and unable to afford
treatment at American prices. Most AIDS deaths in developing
countries result from lack of access to drugs for treatable
infections. Average income in South Africa is $2,600/year, and
name-brand AIDS drugs cost around $12,000/year.

Pharmaceutical companies based in the U.S., long under attack
for price-gouging at the expense of human lives, have claimed
that the high cost of treatment reflects their production
expenses. These companies stand to lose credibility as generic
drug licensing exposes the true low cost of AIDS drug
production; which may prevent them from continuing to
drastically overcharge in first-world markets.

"Gore's abuse of power is a campaign issue," said Anna
Janssen, a local AIDS activist. "He's taken a position, for
the sake of earning points with lobbyists, that absolutely
guarantees millions of deaths. Now he wants us to place our
fate in his hands as President. Personally, I don't dare."

Local chapters of AIDS Drugs For Africa have vowed to confront
Gore at every campaign stop.

Contacts : John Riley Email: [log in to unmask]

************************************************************
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