The Global fight against HIV and AIDS.
A statement from HIV Scotland, ImpAcTAIDS, ActionAid, The Stop AIDS Campaign, Waverley Care Trust and The Institute for International Health and Development

The HIV/AIDS pandemic is reversing decades of social and economic development in the world’s poorest countries. Over 20 million people have already died of AIDS and 15 million children have been orphaned.1 Around the world people have participated in campaigns to stop AIDS and to pressurise government leaders to take action. Addressing the issues that create the conditions for the spread of HIV and mitigating the impact of AIDS should therefore be central to the concerns of the G8 leaders when addressing means to reduce poverty. In particular this now needs to focus on reversing the spiral of decline evident in many parts of Africa and other resource poor countries caused by the complex interactions of factors including the burden of debt repayments, unfavourable trading conditions, escalating unemployment and minimal access to HIV medication. Women make up the majority of people infected in Southern Africa and they bear a disproportionate burden of the social and economic impact of the epidemic and therefore development and HIV policies must be gender sensitive.

Why prioritise HIV/AIDS at G8?
This year’s G8 meeting is a critical moment for HIV/AIDS as much as it is for the wider anti-poverty campaign. It is the best opportunity to extend the momentum created by the World Health Organisation’s ‘3 by 5’ initiative 2 towards universal access to HIV treatment and care by 2010. 3 by 5 has established much of the technical groundwork to scale up access to treatment, but it is fundamentally hampered by a lack of resources and political commitment.

The G8 summit is the key political event in 2005 that can scale up the response to HIV and AIDS. The G8 has proven it is capable of bold action – in 2001 in Genoa it launched the Global Fund to Fight AIDS, TB and Malaria (‘the Global Fund’), now providing resources in 128 countries. However there is a huge funding gap between commitments of funding made to the global fund, and the funding requirements to meet the needs of the fund. In addition resources that were promised have not been delivered. Other commitments have been made in the past that have not been kept around debt relief and access to essential medicines.

What can G8 leaders do in 2005?

1. Commit themselves to providing free treatment and care for all by 2010
The 3x5 initiative has enabled much of the ground work to be done for establishing the mechanisms of delivering HIV treatment. There are examples of good practice where community initiatives complement the delivery of medication to ensure the treatment is understood, delivery is equitable and adherence remains high. Where free treatment is available, people with HIV see an immediate improvement in their life, growing more food, having more resources, and able to return their children to school. However it is still the case that in Sub Saharan Africa, the area of the world with the most affected populations, only 1% of people who need treatment can access it. Progress on this issue has been too little and too slow.

While 2010 is too late for those people who require HIV treatment now, withou such a target even less might be achieved in some areas. We would like to see 2010 as the latest date for universal access to free treatment. This commitment must be backed up by adequate resources to enable it to be carried out. Commitments without adequate resources will not achieve their aims.

2. Honour existing promises for providing HIV treatment
The Global fund was announced at the G8 in 2001. There is currently a large funding gap in the financial resources that were promised to the Global Fund as well as the funding required to meet need by 2007.

At this moment, the Global Fund requires US$700m to make up a shortfall in its delayed Round 5 in October and has shortfalls of US$2.9bn and US$3.3bn for 2006 and 2007 respectively.3 If the G8 summit does not identify an increase in aid levels, the Global Fund Replenishment Conference in September will be the first visible casualty. In addition the application and reporting processes for the Global Fund need to be simplified.

It has now been acknowledged that WHO will not achieve its target of treating 3 million people by the end of 2005, and part of the reason for this is a lack of funding. Filling the immediate funding gap can ensure that the targets set can be met during 2006.

3. Cancel debt
Repayments of debts taken out by prior regimes are draining poor countries of resources. More is being paid on debt repayments than on developing health systems which could enable a better response to HIV. This is the case even in countries that are eligible for debt relief. The Commission for Africa criticises the current ‘HIPC’ debt relief package that only writes off that part of a country's debt that it could never afford to pay. The Commission concludes that, “it is time for the developed world to own up to the fact that where debt could never be repaid, debt ‘relief’ merely relieves the creditor of a balance sheet fantasy… Even after various rounds of debt reduction, sub-Saharan Africa still pays out more on debt service than it spends on health”.4 It also argues that policy conditionality undermines institutions of accountability in African countries. International financial agreements on debt relief centre on trade liberalisation and privatisation which has been demonstrated to be damaging to social and health structures and resulted in situations where poor people affected by HIV may not have access to basic services such as clean water because of inability to pay.

A transparent agreement to provide 100 percent debt cancellation for all sub-Saharan African countries that need it, should be agreed without the use of policy conditionality associated with external assistance and no associated reduction in aid. Resources generated by debt cancellation must be equitably distributed and meet the needs of the most marginalised including women.

4. Trade Justice and access to essential medicines
In 2001 the TRIPS Doha Declaration made at the WTO meeting promised to address the problems caused by tightened agreements around patenting of medication through WTO membership. These problems have meant that it is progressively harder for poor countries to access cheaper generic versions of HIV medication.

The August 2003 solution to allow continued import of generics must be reviewed and incorporated permanently into the TRIPS agreement. The recent legislation in India, introduced to enable India to comply with their WTO membership, will have a dramatic effect on the global supply of HIV medication. The G8 must propose ways to ensure that poor countries continue to have access to generic HIV medication rather than expensive patented versions.

5. Adopt the recommendations of the Commission for Africa report
The Commission for Africa report proposes full debt cancellation, an end to forced economic liberalisation and massively increased investments in HIV Treatment. Economic liberalisation and unequal trading agreements are resulting in spiralling unemployment, under resourced health systems, reduced access to education, less access to essential public services such as water and electricity and other conditions which contribute to creating conditions in which HIV flourishes. The G8 should support efforts to ensure the full and equitable participation of women in economic development. HIV prevention must go beyond individual behaviour change to working to change the economic conditions that have fuelled this epidemic in poor countries. The G8 leaders should adopt the recommendations of the Commission for Africa in order to commence a change of attitude towards the economic relationships between rich and poor countries.

1 UNAIDS. 2004 Report on the global AIDS epidemic, June 2004
2 World Health Organisation. 3 million by 2005, 2003, WHO policy to bring political and technical leadership to the task of scaling up access to HIV treatment in developing countries.
3 Addressing HIV/AIDS Tuberculosis and Malaria: The Resource Needs of the Global Fund 2005-2007, Global Fund, May 2005.
4 The CFA cited in ACTSA 2005 There can be no excuse www.actsa.org

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