Talking Points by Asia Russell, by Ma5vn8


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                         Talking Points by Asia Russell,
                Director of International Advocacy, Health GAP
            UN High Level Comprehensive Review Meeting on HIV/AIDS
      June 11, 2008, Panel 5: Resources and Universal Access-Opportunities and

My name is Asia Russell, I am a member of Health GAP, an AIDS advocacy and policy
organization in the US that fights for global access to HIV treatment, care, and prevention; I also
serve on the board of the directors of the Global Fund to Fight AIDS, Tuberculosis and Malaria,
representing NGOs from the developed world. Before I begin I want to make sure that I note
that I am a stand in for Mr. Vladimir Zhovtyak of Eastern European and Central Asian Union of
People Living with HIV/AIDS in the Ukraine. He was unable to present at this meeting because
he is part of his country’s delegation.

I am here today to address the issue of funding universal access to AIDS treatment care and
prevention by 2010, from the perspective of civil society.

7 years ago, when the UN deliberated over the global AIDS crisis at a special session of the
general assembly, the cost of ensuring access to life saving treatment and prevention was too
often used by countries to excuse their own decisions not to increase AIDS spending—just
seven years ago, it was considered by many country governments unwise to agree to invest
billions in the response to AIDS in the developing world.

Since that time, a powerful global civil society movement of people with HIV and their allies has
forced governments to retreat from that position, and as a result to significantly scale up AIDS
spending. Although we have made moderate progress, for example in the area of HIV treatment,
which just 7 years ago was considered by many developed and developing countries, as well as
many UN agencies, ‘inappropriate’ or ‘unsustainable’ for millions in low income and middle
income countries. Now there are 3 million people on ARV treatment, in defiance of that failed
position, and the world has committed to reaching the estimated 10 million people in urgent
need of treatment by 2010—which is only two years away.

What now are the major financing roadblocks preventing us from achieving universal access?
Current UNAIDS estimates project that globally, the cost of reaching universal access by 2010
to prevention, treatment and care is $40 billion per year; today developing and developed
countries together spend approximately $10 billion per year—this is a figure that includes the out
of pocket expenditures for services by HIV-positive people in low- and middle-income countries
who in any reasonable costing model cannot actually afford to pay. The funding gaps are hugged,
and they are caused by developed and developing countries’ refusal to allocate predictable
financing consistent with their fair share of the global AIDS funding burden.

We are extremely concerned that several G8 donor countries are breaking their commitments to
fund efforts to reach universal access, and are not yet shouldering their share of the burden of
the AIDS response, for example countries such as Japan, the world’s second biggest economy,
but only the 6th largest contributor to the Global Fund. Likewise the UK has just announced a
long term funding commitment of about $12 billion, but with no clear spending target for AIDS
and no clear way for civil society to monitor and trace those investments, and to ensure real
Talking Points from Asia Russell, Health GAP
Panel 5 Resources and Universal Access-Opportunities and Limitations
June 11, 2008
results for people in developing countries.
In four weeks at the G8 Summit in Toyako Japan, the announcements of the G8 could indicate
the major donors of the world are falling behind in their own AIDS funding commitments.

However the G8 hardly has the monopoly on breaking funding promises; in the developing
world, governments are also largely refusing to prioritize recurrent AIDS funding at appropriate
levels. In 2001 African heads of state gathered in Abuja committed to spending at least 15% of
domestic spending on health budgets, but perhaps only one country, Botswana has since reached
that target. In other regions, for example Eastern Europe and Central Asia, there are critical
concerns over insufficient funding levels, as well as lack of transparency regarding expenditures
of money, for example in procurement of medicines that are more expensive than WHO
prequalified generic equivalents or in insufficient involvement of people living with HIV in
planning and implementing the national response. In some countries, despite concentrated
epidemics among men who have sex with men and other sexual minorities, sex workers and
injecting drug users, country plans do not prioritize interventions in those populations, nor do
they include those populations in the planning process. In some countries, policies that restrict
the response to vulnerable groups such as sex workers, for example the prostitution loyalty oath
that the U.S. government requires funding recipients to sign, are clearly blunting the impact of
the global AIDS response, and resulting in AIDS funding that already committed, being poorly
spent at country level. Or the decisions by some governments, for example Cambodia, to arrest
and detain sex workers rather than ensure programming that protects and promotes their human
rights--there are many examples, each indicating that we have much more work to do together
when we consider the urgent need for increased funding for programs that work, not programs
the undermine the rights and fundamental entitlements of HIV positive people and those at
greatest risk of infection. Civil society has proven itself to be a critically important partner in
program implementation, but we are still excluded from program implementation efforts. To
reach universal access, this must change.

We face another tremendous roadblock: in order to scale up rapidly to reach universal access, the
severe shortage of health workers, doctors and nurses and community health workers who
provide care and treatment and prevention services, primarily in sub Saharan Africa, must be
integrated into the response to HIV.

It is unacceptable that a nurse in a rural clinic in Kenya is paid the same in one month as it costs
to eat dinner for two here in Manhattan—although she is doing the work of a nurse, doctor,
counselor, outreach worker, emergency surgeon, and palliative care provider. Donors must end
their refusals to invest in recurrent costs such as increased salaries and other incentives for health
workers; donors must invest in professional training to increase the supply of health workers,
and they must end their own recruitment and other practices which contribute to the
hemorrhaging of health workers from the developing to the developed world.

While the price tags associated with AIDS spending might seem staggering compared with other
recent health investments, the cost of not making these investments far outweighs the cost of
countries paying their fair share, now.

Likewise, we must challenge the macroeconomic policies of the IMF, too often supported and
upheld by Ministries of Finance, which dictate that countries hold back from scaling up crucial
investments in health and education, despite an urgent need for increased investment in these
areas to reach universal access and the MDGs. Recently reports from the IMF’s own evaluations

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Talking Points from Asia Russell, Health GAP
Panel 5 Resources and Universal Access-Opportunities and Limitations
June 11, 2008
have shown that 70% of the increases in donor aid to sub Saharan Africa between 1999-2005
were not spent as aid but instead were spent on paying down domestic debt or was redirected
into increasing international currency reserves in central banks. These overly restrictive
macroeconomic policies mean countries cannot implement emergency health worker retention
and production plans; as a result HIV positive people in those countries facing the most acute
health workers shortages are suffering and dying unnecessarily. The G8 summit in four weeks
has a tremendous opportunity to address the shortage of health workers, and should map out
concrete efforts to reach the target of at least 4.1 doctors, nurses, midwives and community
health workers per 1,000 people, as well as a doubling of health workers in Africa to 1.5 million,
by 2015.

AIDS is still an exceptional crisis, I wish that were not the case, but it is as true today as when
the first cases were reported 25 years ago. We need to address the reality: the global movement
for AIDS treatment and prevention access for all recognizes that there is a simultaneous need to
guarantee secure financing for AIDS as well as increased financing for primary care. It is not a
question of ‘either/or.’ We are not spending too much on AIDS. We are spending too little, and
we are spending shockingly too little on primary health care programs as well.

The AIDS response has exposed health systems that have been weakened to point of collapse by
decades of underinvestment, neglect, and structural adjustment policies of the IMF and World

We are actively building bridges to health advocates in other movements, without denying the
reality: AIDS is as exceptional a disease as when the first cases were identified 25 years ago, and
thus requires adequate, predictable, and long-term funding rather than the current unacceptable
reality of escalating funding gaps. We reject the false choices that are being posed by some,
pitting funding for AIDS against horizontal funding for health systems, funding that all too
often comes without clear and traceable funding targets and benchmarks, and with no
meaningful involvement of civil society as watchdogs or as implementing partners.

The unmet spending needs for AIDS, as well as primary health care are huge, and given the
current reality of massive increases in the cost of food and fuel, these spending needs will only

We are fighting for universal access, but we are also fighting for global health justice, these
essential health needs are interrelated and collective, not competitive—we call on governments
and policymakers to stop once and for all pitting so called ‘vertical’ disease specific AIDS
programs against general health spending—at the mid point of the MDGs, and with only two
years until the goal of universal access, we must stand together.

The Universal Access target will not be reached unless:

    • Governments implement transparent and accountable plans and take full responsibly to
meet the presentation, treatment, care and support needs of their citizens
    • Civil society holds government accountable for their response on the one hand and is fully
supported to implement high quality programming
    • Governments in rich countries meet the funding gap by funding the massive shortfall to
ensure that the universal access target is met by 2010

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