UN special envoy for AIDS in Africa speaks out
Statement by Elizabeth Mataka, United Nations Secretary-General’s Special Envoy for AIDS in Africa on the occasion of Laura Bush, US First Lady’s visit to Zambia, June 28 2007.
We welcome Mrs. Laura Bush, First Lady of the United States of America, to Africa and to Zambia in particular. We are happy that she has found time in her busy schedule to visit Africa and learn of the achievements that have been made through support from the American people through PEPFAR. It is however, imperative that during her visit to Africa, she also learns about the problems we are experiencing and how we think the U.S. support can be more responsive to AIDS in Africa.
PEPFAR set 5 year performance targets in Zambia including support to the prevention of 398,000 HIV infections; provision of ART to 85,000 PLWH and care for 505,000 people affected by AIDS, with 177,000 receiving palliative care and care and support to 328,000 orphans and vulnerable children.
There has been considerable progress in terms of reaching these targets. However, HIV and its related illness’ is increasingly a chronic disease which needs more long term programming rather that project support. It is therefore very disturbing to hear that the U.S. would reduce the target percentage of people living with AIDS who would be supported on treatment with the U.S. Funds. It is equally disturbing that when U.S.
Congress recently attempted to increase U.S. funding for the Global Fund to Fight ADIS, Tuberculosis and Malaria, the White House expressed its opposition to that effort. The Global Fund is saving lives in Zambia, just as PEPFAR is saving lives, therefore, the Global Fund must be given maximum support.
The world pledged to reach universal access to prevention, treatment, care and support; this is therefore not the time for the U.S. to shrink its ambitious treatment scale-up.
Prevention remains a critical component of the response to AIDS. However, prevention strategies need to be programmed in relation to the epidemic in Africa and in accordance with National realities, rather than driven from a formula developed in the U.S. Data collected must determine the most appropriate intervention, for example, there is no evidence to suggest that abstinence programming for young people has produced good results.
What seems to have happened however has been confusion over the messages that are being put out to the communities, for example, the Government in Zambia has been very clear on the ABC message emphasizing all three but with some PEPFAR insists on promoting the abstinence only messages for young people. People are entitled to all available information for informed choices relevant to their particular situation.
An understanding of the drivers of the epidemic in Zambia is currently taking place. It is hoped that this information will guide the development of a national HIV prevention strategy including the strategies and targets which all partners will buy into. Prevention programming also needs to be integrated into existing community based, family oriented care models rather than stand-alone projects which are set-up just for them and have no linkages to the National Prevention Agenda.
Of particular concern is the vulnerability of women and children to infection with HIV. There needs to be a deliberate focus on women and girls within the PEPFAR programming. Although there has been support to institutions working in this area, it has not been affirmative. This means that gender-based budgeting needs to occur within the PEPFAR programme. More support therefore needs to be given to the upstream dialogue on issues that put women and girls at risk – the legal, economic, social and educational issues. Like other partners – UN and bilateral donors supporting the national Gender strategy, implementing this in the PEPFAR programming will go a long way to ensuring that the programming is evidence-informed.
Zambia has developed a Health Sector Human Resource plan, this plan is still yet to materialize into tangible pledges of financial support. It is hoped that US resources will support the plan significantly. Of note, is that the plan is for both public and non-public actors. With an ART programme that provides free services, the numbers of people seeking treatment keep rising. For this year’s COP 2007, PEPFAR has allocated some funds into the national doctor’s retention scheme together with the other bilateral donors, as a trial. It is generally agreed that more could be done in ensuring that a nurses / community health worker retention scheme or similar is supported with many more resources from PEPFAR.
Finally, let me express concern about PEPFAR’s implementation model, PEPFAR should open up to effective local organizations, and work with them instead of favouring external groups that do not increase national capacity to respond to AIDS. PEPFAR needs to invest in strengthening the national capacity to respond to AIDS, I believe this is possible.
Courtesy of safaids media resource desk.