[Ip-health] "A false threat of epidemics"

[Julian Harris]

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[ Picked text/plain from multipart/alternative ]
Hey all,

Thought this might be of some interest to the list:

http://www.bdafrica.com/index.php?option=3Dcom_content&task=3Dview&id=3D914=
8&Itemid=3D5821

It's time to dismantle UNAIDS (Business Daily, Kenya)
*
August 4, 2008: *As the biennial international Aids industry conference
gathers 25,000 delegates in Mexico, a wind of change is blowing. UNAids, th=
e
UN's Aids advocacy body, stands accused of exaggerating the threat of Aids,
wasting  billions on "preventing" epidemics that were never going to happen
and undermining basic healthcare in Africa by diverting ever-larger funds t=
o
HIV/Aids.

The impending change of leadership of UNAids provides an opportunity for
fresh thinking. That is why I am a candidate for the position. My platform
is to dismantle the organisation constructively, to help ensure that HIV
spending is balanced with that on other equally pressing diseases through
stronger primary health care.

No one is denying that HIV/Aids is a serious problem: it has hit some
sub-Saharan African countries hard, particularly South Africa. Globally,
however, its impact is less severe. The annual two million deaths from HIV
is about the same as the number of under-fives who die in India from easily
preventable diseases like pneumonia.

But while HIV causes only 3.7 per cent of global mortality, it receives 25
per cent of all health aid plus a big chunk of domestic expenditure. At its
worst, in sub-Saharan Africa, HIV/Aids constitutes less than 20 per cent of
the disease burden, an average that is skewed upwards by South Africa's hig=
h
prevalence.

Yet globally HIV/Aids receives 40 per cent of health aid =97 $4.6bn in 2006=
,
and rising. HIV/Aids aid now often exceeds total domestic health budgets.

For years, activists have justified this disproportionate spending by
claiming that HIV/Aids is exceptional: a disease of poverty, a developmenta=
l
catastrophe and an emergency demanding wide-ranging UN intervention.

These claims have now been demolished. New data from Africa show that
prevalence is highest among the middle classes and more educated. Although
HIV can tip households into poverty and constrain national development, so
can all serious diseases and accidents.

Prevalence in Africa has peaked and rates in Asia are far lower than
projected by UNAids. The UNAids claim that HIV is a "potential threat to th=
e
survival and well-being of people worldwide" is sensationalist.

As the World Health Organisation's head of HIV stated last month, "it is
unlikely there will be a heterosexual epidemic" outside sub-Saharan Africa.

The success of UNAids advocacy is constraining improvement in basic health
services in the poorest countries. Excessive HIV funding has created
two-tier health systems, a kind of medical apartheid in which HIV patients
receive treatment free, while non-HIV patients pay for sub-standard
services.

HIV funding also by-passes countries' institutions, creating parallel
financing, employment and systems, thus entrenching bad management and
creating duplication and waste.

The USA in particular is at fault: its HIV programme PEPFAR has flooded 15
countries with HIV-dedicated resources, attracting staff and skills away
from other needs. And the Global Fund to Fight Aids, TB and Malaria is not
far behind.

Although UNAids has now reduced world HIV estimates from 39.5 million to
33.2 million, it is still calling for huge increases in annual spending,
from $9 billion today to $42 billion by 2010 and $54 billion by 2015.

Flooding the world's poorest countries with foreign currency on this scale
would cause inflation and push up interest rates =97 a de facto tax on the
poor. As an advocacy body, it is hardly surprising that UNAids wants more
money but its demands look increasingly absurd.

*Industry grows
*
While the Aids industry grows fatter, primary healthcare in the poorest
countries is in crisis. As Mozambique's health minister Paulo Ivo Garrido
wrote last year: "The reality in many countries is that funds are not neede=
d
specifically for Aids, tuberculosis or malaria. Funds are firstly and mostl=
y
needed to strengthen national health systems so that a range of diseases an=
d
health conditions can be managed effectively."

Time is up for UNAids. Why do we have a UN agency for HIV and not for
pneumonia or diabetes, each of which kills more people? UNAids should be
dismantled rapidly, because its single-issue campaigning is distorting
global health spending and betraying the world's poor. Its useful monitorin=
g
function can be transferred to the World Health Organisation.

This will be resisted strongly. The worldwide HIV industry has become a
monster with too many vested interests and reputations at stake, too many
single-issue NGOs and too many rock stars with Aids support as a fashion
accessory.

In Mozambique, there are 100 times more NGOs devoted to HIV/Aids than to
maternal and child health. With UNAids dismantled, international donors can
concentrate on strengthening health systems by providing sustained and
predictable funding. This will be good for all poor people, not just those
with HIV/Aids.


*England is chairman of the Health Systems Workshop, an independent
think-tank promoting health systems reform.*