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Keep the Promise: HIV and AIDS campaign bulletin no. 2 / 2009

21. September 2009

Do disease-specific programs distort public health priorities?

Much of the world’s burden of disease could be prevented and even cured. However millions of people lack access to appropriate health care. One of the problems are getting drugs, vaccines, and other forms of prevention, care, or treatment to those who need them – on time, reliably, in sufficient quantity, and at reasonable cost. In addition there is a lack of trained staff, weak health information systems or even infrastructure. Delivering adequate health care calls for a functional health system that caters for all these aspects in order to sustain good patient care.

Over the last few years a lot of resources have been poured into programmes such as HIV, malaria and TB and in fact many people have been able to access care. However, in some instances this may have caused a shift of resources within the health sector.

This has caused a rising debate leveled at the amount of aid resources going to HIV and AIDS compared to other health problems, and in particular compared to the need to strengthen health systems in less-developed countries to meet a range of other health problems.

“The belief that global health initiatives such as PEPFAR and the Global Fund are not strengthening health systems is a myth,” said the Global Fund Executive director Dr. Michel Kazatchkine at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention which was held in Cape Town on 19-22 July 2009.

Some health experts have suggested that the vertical funding for disease-specific interventions or programs is not working and is crippling the health systems in developing countries, and are calling donors to explore new ways of channeling funding that can be used to improve service delivery in weak health systems.

Other health experts argue that the momentum on spending for such disease-specific treatment must be maintained. Today, millions of individuals are now receiving HIV treatment thanks to the Global Fund, PEPFAR and other funding institutions, and millions more still needs treatment. But preventing new infections and maintaining patients on lifelong HIV treatment requires a robust health system.

The amounts of money spent on disease-specific initiatives have escalated the debate and are raising questions about the unintended consequences of disease specific funding. The argument reflected in this debate is not a new one. It goes back to the beginning of formulating “primary health for all” as articulated in the 1978 Alma-Ata Declaration. And even at that time, vertical programmes such as GOBI (Growth monitoring, Oral rehydration Breastfeeding and Immunization) to mention just one, were developed.

The HIV epidemic has mobilised huge resources for treatment and prevention on one hand, but also has highlighted the need for a strengthening of overall systems on the other. As the limited empirical evidence suggests, it is overly counterproductive to frame the discussion as disease-specific programs or health systems investment, positioning each as mutually exclusive approaches to global health development.

Many people, including people of faith, recognize that HIV is a long-term problem which will need continuous aid for years to come in some countries, as well as longterm commitments to strengthen health systems. Building integrated health services for broader health outcomes for people living with HIV is crucial in scaling up effective distribution of such life-saving interventions. Therefore, weaker health system can be a key barrier to achieving the internationally agreed Millennium Development Goals (MDGs), and Universal Access to HIV prevention, treatment, care and support. Millions of individuals are now receiving HIV treatment thanks to the Global Fund, PEPFAR, and other institutions; and millions more people still need treatment.

The momentum of AIDS specific funding has to ensure that people can continue to access treatment and care for HIV. In addition new money needs to be found to strengthen health systems overall. The money is there, but it depends on governments and donors to make it a priority.

“What AIDS has shown is that when the world decides to come together around a goal it is possible to achieve [extraordinary things]. Now we are being told it is very difficult to find money for AIDS and health, but money was found to bail out the banks last year and I’m sure that if we have pandemic influenza in the autumn, the money will be found. We need to develop better advocacy arguments for increased funding” said Dr Kazatchkine.

It is critically important to recognize the mutually reinforcing goals of health system strengthening and HIV prevention and treatment initiatives. Therefore, the leadership of organizations and initiatives such as the Global Fund, PEPFAR, the World Bank, the Bill and Melinda Gates Foundation, and many others is needed to continue addressing global health challenges and to emphasize the importance of health system strengthening and a better coordinated, sustainable, and holistic approach to global health. In addition, these same actors should ensure that funding for HIV programming continues and is proportionate to the scale of the epidemic and local needs.

You can read some of the reflection on this topic at: www.e-alliance.ch
fileadmin/user_upload/docs/AmsterdamHealthFinancing.pdf

AIDS and global health at: www.e-alliance.ch/fileadmin/user_upload/docs/
jc1731_aids_and_ global_health_en.pdf

HIV-related Public-Private Partnerships and Health Systems Strengthening at:
www.e-alliance.ch/fileadmin/user_upload/docs/jc1721_ publicprivatepartnerships_
en.pdf

"Universal Access and Human Rights” 2009- 2010 theme for World AIDS Day

The World AIDS Campaign announced the 2009-2010 World AIDS Day theme, “Universal
Access and Human Rights” during its meeting with the UN Secretary General, Mr. Ban Ki-moon, on June 16 at the United Nations Headquarters in New York.

Ecumenical Advocacy Alliance coordinator Linda Hartke was among the members of the Global Steering Committee of the World AIDS Campaign that met with the UN Secretary General to also urge a high level, comprehensive review of the 2001 Declaration of Commitment on HIV/AIDS after 2010.

The 2009-2010 World AIDS Day theme challenges discriminatory laws, policies and practices that stand in the way of access for all to HIV prevention, treatment, care and support. The global theme for World AIDS Day is set by the World AIDS Campaign, a network of civil society groups active in the response to HIV and AIDS, including the Ecumenical Advocacy Alliance (EAA).

You can read the EAA press release on the theme at: www.e-alliance.ch
en/s/news/press-releases/single-view-press-release/article/2009/06/17/humanrights-
focus-of-2009-world-aids-day-key-to-response-say-christian-campaigners/

Posters, postcards and the ecumenical liturgy for World AIDS Day will soon be
mailed and posted on the EAA website at: www.e-alliance.ch/en/s/hivaids/
world-aids-day/

For more resources, visit: www.worldaidscampaign.org

Award offered to recognize home-based care leadership in responding to HIV and AIDS

AIDS has changed the fabric of communities around the world and placed a burden on the lives of many people, especially girls and women, young and old. With health systems failing and people living longer with HIV thanks to access to antiretrovirals (ARVs), mainly poor women are increasingly forced to devote their time, energy, skills and the little resources to care for their family members at home and provide their services to the wider community, often at great expense to themselves. This invisible task-shifting is insufficiently recognized, valued and validated as work.

The Catholic Organization for Relief and Development (Cordaid) and partners of the Caregivers Action Alliance’s (CAA) Organizing Committee (HelpAge International, Huairou Commission, VSO International) as well as the World YWCA, wish to reward and encourage leadership around the strengthening of home based care in responding to HIV and AIDS in the “global South” by awarding €15,000 to an organization and €5,000 to an individual.

Cordaid and partners have sought applications from organizations or individuals committed to supporting home based care as a necessary, effective, and community-based initiative – recognizing home-based care as an insufficiently resourced, under-valued and unrecognized solution for mitigating the effects of HIV and AIDS.

The award recipient will be announced soon.

For more information, see:
www.cordaidpartners.com/rooms/hiv-and-aids-award-2009

Interfaith Conference strengthens faith-based responses to HIV in Asia and the Pacific

160 men and women of faith, from 20 countries, with various roles and responsibilities in religious communities and organizations from Buddhism, Christianity, Hinduism, Islam, and Shinto, met in Bali, Indonesia, 7-9 August, 2009, to strengthen faith-based responses to HIV in Asia and the Pacific. The Interfaith Conference was hosted by the Asian Interfaith Network on AIDS (AINA) in advance of the 9th International Congress on AIDS in Asia and the Pacific. The statement issued at the conclusion of the conference highlighted discussions related to human rights, injustice, and gender-based violence, the devastating impact of the criminalization of drug use, and the start of a regional discussion about HIV and tourism.

At this meeting, the Ecumenical Advocacy Alliance and the World AIDS campaign conducted a joint workshop on HIV and human rights, under the title: Collaboration, advocacy and campaigning on HIV. The workshop highlighted the critical need to promote and protect human rights, particularly in relationship to achieving access for all to HIV prevention, treatment, care and support. Specific examples were given of discrimination against people living with HIV, women, youth and key populations (men who have sex with men, people who use drugs and sex workers), and advocacy efforts to promote human rights.

The interfaith pre-conference was also co-facilitated by the Christian Conference of Asia, World Council of Churches, Ecumenical Advocacy Alliance, UNAIDS, UNICEF, United Evangelical Mission in Asia, and the MICAH Network. Read the statement from the pre-conference under Recent Events at: www.e-alliance.ch/en/s/hivaids/

One-day multi-faith pre-conference to be held at AIDS2010
The next International AIDS Conference (IAC) will be held from 18 to 23 July 2010 in Vienna, Austria (www.aids2010.org). These biennial conferences have been important contributors to the growing visibility and appreciation for the faith-based response to HIV and AIDS, although many challenges remain for all to recognize and appreciate the diversity and depth of that response globally. The EAA has coordinated faith-based activities at the last three conferences.

Since the conclusion of AIDS 2008, the EAA’s HIV and AIDS strategy group has looked at options for activities in Vienna. They have taken into consideration the evaluations of faith-based events, projected costs and attendance in Vienna, and held initial discussions with churches and organizations in Austria. With this information, the strategy group has decided that the EAA should coordinate, with partners from other faiths, a one-day multi-faith pre-conference prior to the main International AIDS Conference in Vienna. This in effect replaces the multi-day ecumenical pre-conference held at previous conferences.

In addition, an interfaith exhibit, prayer room, media team, and daily faith-based
caucuses will also be organized.

The EAA will soon form a Multi-faith Planning Committee for the pre-conference. The committee will develop the theme and program for the event, coordinate fundraising, and insure implementation. The committee should be diverse and include people from different faiths and people living with HIV. The committeewill work by email and conference calls, and members should be committed to providing leadership at the IAC.

On 22 September, the EAA, World Vision Vienna and Caritas Austria will convene a meeting in Vienna to help introduce planning for the IAC, visit possible preconference venues, and identify a local host committee. For more information on faith-based planning for the IAC, please contact Thabo Sephuma at: tsephuma@e-alliance.ch

For more information on how churches and church-related organizations in Vienna could participate in the 22 September meeting, please contact: Ms. Lisa Sterzinger at: Lisa.Sterzinger@worldvision.at

Letters from children call for increased access to testing and treatment
Letters from South Africa, India, United Kingdom, Kenya, United States, Bolivia,
Nigeria, Belgium and Kenya have been arriving at the EAA office demonstrating
action at local schools, churches and communities to help children living with
HIV. The letters, part of the EAA’s year-long action, “Prescription for Life”, aims to
keep governments accountable to commitments made in the Convention on the
Rights of the Child and encourage a proactive response to the need for appropriate
testing and treatment for infants and children living with HIV by pharmaceutical
companies.

A common theme in the letters is to call on pharmaceutical companies to produce
less expensive and more child-friendly ARVs. “I am writing to you to ask you
if you could consider to try and make the drugs smaller,” says one letter. “Your
company can make a difference,” it continues.
Another letter writer addressed Chief Executive Officer of Glaxo-Kline Smith, Mr
Andrew Witty: “I don’t know if you have children Mr. Witty, but, even if you don’t,
it doesn’t take the imagination of an artist to picture the grief stricken faces of
the friends and family of those lost because of a lack of affordable medicines and
testing equipment…”

The EAA is providing a certificate to groups that participate in this initiative to
raise awareness about the affect of HIV on children and to advocate for children
living with HIV to get necessary treatment. In addition, to mark the 20th Anniversary
of the Convention on the Rights of the Child on 20 November 2009, the
EAA is planning an exhibition featuring the letters written through the campaign
at the UN Headquarters in New York.
Learn more about the campaign at: www.e-alliance.ch/en/s/hivaids/accessmeds/
children/resource/

World Health Organization meeting addresses “better medicine” for children
Currently, many medicines are only designed for adults. Over half of the medicines
prescribed for children have either not been developed specifically for children
or have not been proven to be effective and safe for their use. Therefore,
many children lack access to essential treatment, including HIV drugs, because
no suitable pediatric formulation of the necessary medicine exists, is not available
or is too expensive.

The World Health Organization held a partners meeting on Better Medicines for
Children in March 2009 in Geneva, Switzerland. The purpose of the meeting was
to provide an opportunity for interested stakeholders: (1) to be informed about
WHO’s activities in relation to the World Health Assembly Resolution 60.20 and
the project funded by the Bill & Melinda Gates Foundation, and (2) to comment
on other aspects of work that would be relevant to improving the quality of, and
access to medicines for children.

Among the participants of this meeting were EAA members the Evangelical Lutheran
Church in America and Caritas Internationalis, as well as the Ecumenical
Pharmaceutical Network. The EAA was represented by the HIV and AIDS Campaign
Officer, Thabo Sephuma and Patricia Zerega from the ELCA, who convenes
the EAA’s Pharma Working Group.

In the meeting, the EAA and Caritas Internationalis shared their work in the area
of advocacy for comprehensive care of people with HIV and AIDS, in particular
children. The children’s letter writing action was one of the examples shared.
The EAA highlighted the need to recognize the contribution of community health
workers, and to work on strategies to use them as effectively as possible, for instance
through tailored training.

At the meeting, it was very clear that access to medicine is a complex construct
because medicines not only have to be available; they also have to be affordable
and acceptable to patients. The meeting identified four key discussion areas,
which are:
∙∙ research on better medicine for children
∙∙ product development and regulation
∙∙ improving use of medicine in children
∙∙ supply of medicine

Meeting participants agreed and noted that improving essential medicines for
children is a critical global health issue.

You can read the full report of this meeting at: www.e-alliance.ch/fileadmin/
user_upload/docs/PartnersMeetingOnBetterMedicinesForChildren.pdf

UNFPA holds global FBO policy consultation
Approximately 40 representatives of Hindu, Buddhist, Jewish, Christian and
Muslim faith-based organizations, met in New York, USA, for a two day policy
round table for faith-based organizations (FBOs) on a range of issues including
humanitarian relief, migration, maternal health and women’s empowerment.
EAA members and strategic partners were present, including INERELA,
World YWCA, The Lutheran World Federation, World Vision International,
World Council of Churches, World Conference of Religions for Peace, Islamic
Relief, and UNAIDS.

The consultation emerged from a series of forums hosted by the UNFPA over
the course of 2007-2008, with over 300 FBOs from Africa, Asia-Pacific, the
Arab States and Latin America and the Caribbean. These discussions focused
on enhancing partnerships with the UN in general and with UNFPA in particular,
and revolved around issues of youth, reproductive health and migration,
among others.

The main objectives of the August meeting were to:
∙∙ Share updates on developments since the Istanbul launch of Inter- faith Network on Population and Development in October 2008
∙∙ Discuss and prioritize key recommendations for action
∙∙ Identify and agree on key joint activities and modalities of engage- ment 2010-2015
Opening the meeting on August 3, UNFPA’s Executive Director, Thoraya Obaid,
said that engaging with faith-based organisations in development work was a priority
for UNFPA because of the “profound moral authority that religious leaders
have, and we were all aware of the fact that religious organisations are the oldest
social service providers humankind has known.”

The round table included a presentation from the EAA which gave an overview
of the EAA’s collaboration with UNFPA on HIV and AIDS, lessons from the experience
and suggested policy implications to enhance and strengthen the partnership.
The UN Secretary-General made a surprise visit during the reception held for
participants.

You can read the EAA HIV and AIDS Campaign Officer’s presentation during the
meeting at: www.e-alliance.ch/fileadmin/user_upload/docs/UNFPA_FBO_
Meeting_HIV_Presentation_Thabo.pdf

The meeting report will be posted on the EAA website as soon as it is available.

UNAIDS board members go “around the world with HIV”
EAA travel restriction game played at UNAIDS Board meeting
The 24th Meeting of the Programme Coordinating Board of UNAIDS (PCB) met in
June with over 300 participants and observers from member states, international
organizations, civil society and non-governmental organizations. The EAA and
some of its members – The Lutheran World Federation, World YWCA and Catholic
Relief Services – attended this year’s meeting, which had a thematic segment
focused on ‘people on the move’. The session gave an important insight into the
urgent need to provide universal access to HIV prevention, treatment, care and
support services for migrant populations and displaced people.

HIV-related travel restrictions were highlighted, particularly through the use of
the EAA’s “Around the World with HIV” game, which makes travel restrictions personal,
tests and expands knowledge (including correcting misconceptions) about
travel restrictions and addresses stigma and discrimination. The game involves a
fake passport and immigration booth, and participants have to guess whether a
given country (and their own country) have travel restrictions. The passport is
then stamped and a luggage tag is given to each participant that reads: “HIV positive
– it shouldn’t make a difference”.

The game appeared to be a valuable and interesting way to open the issue and
“bring it home”. The session also included testimonies from a person from the
South who migrated and was deported when identified as HIV positive, a representative
of a government which has eliminated travel restrictions, and a positive
UN staff member.

The Board called on UNAIDS to facilitate inclusion of such programmes for
people on the move including migrants and forcibly displaced populations in
national AIDS strategies.

A next meeting of the board will take place in December 2009.
A complete record of the decisions, recommendations and conclusions of the
meeting can be found at: www.e-alliance.ch/fileadmin/user_upload/
docs/24th_UNAIDS_PCB_decisions_recommendations_en.pdf

Learn more about Around the World with HIV game at: www.e-alliance.ch
en/s/hivaids/stigma/travel-game/


High Level Religious Leaders Summit on HIV to be held in March 2010
A Summit of High Level Religious Leaders on the Response to HIV will be held
in The Netherlands 22-23 March 2009. Confirmed participants include HH Sri
Sri Ravi Shankar, Rabbi David Rosen, Sheik Mohamad Gemea, Archbishop Thabo
Makgoba, and Bishop Mark Hanson. UNAIDS Executive Director Michel Sidibé
will also participate. A nominations process for other participants has just concluded,
and the Interfaith Steering Committee planning the Summit will issue
further invitations in mid-September.

The Summit aims to provide:
1. Reflection, conversation and learning among influential religious leaders on
contemporary issues related to the HIV pandemic.
2. Development of greater linkages between high level religious leaders, people
living with HIV, and experts and leaders from other sectors engaged in
the global response to HIV.
3. Exploration of the advantages and opportunities for religious leaders to
speak out and take action on HIV.
4. Increased engagement and visibility of high level religious leaders on key
issues related to the response to HIV after the Summit to achieve Universal
Access.

The Summit is envisioned to have participation of 60-70 invited persons made up
primarily of high level religious leaders of different faiths. It will also include high
level representation from: networks of people living with HIV, governments, intergovernmental
agencies, the academic and scientific community, and civil society.
Efforts will be made to achieve a significant representation of women religious leaders.
Gender issues related to HIV are expected to be part of all discussions.
Religious leaders have a particular responsibility to continue to address in strong,
public and unconditional terms that stigma and discrimination towards people
living with and affected by HIV is unacceptable. Stigma and discrimination will
be the lens through which the religious leaders participating in the Summit will
focus on key elements of the response.

The hope is that the visibility of strong religious leadership in the response to HIV
will not only galvanize the global response at a critical moment in this pandemic,
but create greater awareness and more accurate information and perceptions by
and about faith communities and religious leaders in relation to HIV and AIDS.
The Ecumenical Advocacy Alliance is the international project leader for the Summit
and Cordaid (http://www.cordaid.com) is the local project coordinator. The
Ministry of Foreign Affairs, The Netherlands, is an important contributor and supporter
of the Summit.



 

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