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(30/11/09) Reinforcing the response to AIDS in the World

Started in 1988, World AIDS Day (1st December) serves as a timely reminder that the problem of AIDS has not gone away – indeed, in spite of the important progress made in preventing new HIV infections and lowering the annual number of AIDS-related deaths, it is expected that the impact of the continued rise in the number of people living with HIV in sub-Saharan Africa will remain a serious challenge to the continent’s development efforts in decades to come. Already a major contributor to the response to AIDS, the European Union – the Member States and the Commission- is committed to further reinforcing its actions in this area, working in close partnership with its partner countries and the communities most affected.

The theme for this year’s World AIDS Day (1 December 2009) is ‘Universal access and human rights’ – two concepts which are central to the EU’s approach, as confirmed by EU Ministers for development at the General Affairs and External Relations Council (GAERC) on 17 November 2009. In its review of the European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007-2011), the Council concluded that “strong and sustained commitment is required to support partner countries in scaling up towards universal access to HIV prevention, treatment, care and support by 2010, and in reaching the 2015 targets related to HIV/AIDS, malaria and tuberculosis expressed in the Millennium Development Goals (MDGs).” It further noted the need for actions to be underpinned by the “European common values of country ownership, gender equality and human rights.”

Africa at the forefront of AIDS epidemic

According to latest UNAIDS report 2009, there are now 33.4 million people living with HIV worldwide, including 2.1 million children. Of these, 22.4 million are living in sub-Saharan Africa, which remains the region most heavily affected by HIV. In 2008, sub-Saharan Africa accounted for 67% of HIV infections worldwide (22.4 million), 68% of new HIV infections among adults and 91% of new HIV infections among children. The region also accounted for 72% of the world’s AIDS-related deaths in 2008. The epidemic continues to have an enormous impact on households, communities, businesses, public services and national economies in the region.
Women and children continue to suffer disproportionately from this epidemic, not only from the illness itself but also from its indirect consequences. In 2008, it is estimated that some 14.1 million children in sub-Saharan Africa have lost one or both parents to AIDS.  There are still significant gaps in the provision of care and support for these children. The prevention of mother to child transmission (PMTCT) needs to be significantly improved and the position of women in general has been highlighted as an area of concern.
There is increasing recognition, however, that there are often large variations in HIV prevalence and epidemiological patterns within regions, and indeed countries, and that there is therefore a need both to tailor prevention strategies more closely to local needs, and to further decentralize AIDS responses. This is the approach followed by the Joint Africa-EU Strategy (JAES), which focuses essentially on capacity building, enhanced coordination and improved policy dialogue. The ultimate aim is to provide better aid, by placing country ownership, and alignment to country priorities and processes at the centre of the global response to the AIDS epidemic.

European Union – a key partner in the fight against AIDS

Photo source: EC/Carolina Martin Tirand

The Europe Union has been, and continues to be, a leading actor in the global response to AIDS.  As the world’s largest donor, the the EU Member states and the Commission have collectively provided the majority of the significant increase in recent years in international financing earmarked for the fight against HIV/AIDS, malaria and tuberculosis. Collective EU contributions to the Global Fund have almost quadrupled, from a total of US$403 million in 2003 to US$1 546 million in 2008, representing around 55% of total contributions in the years 2004-2008. As a founding member of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the European Commission has to date pledged a total of €1,072.5 million covering the period 2002-2010. The Commission and other EU donors are making funds available to strengthen health systems and confront AIDS through a variety of financing instruments. In the case of the Commission, for the period 2007-2011 covered by the Programme for Action19, programmed ODA financing earmarked for health is estimated to total €3.043 billion, a slight decrease from the total of €3.151 billion programmed for the preceding five years 2002-200620. This financing includes support for research and technological development, where more than €200 million have already been allocated in the 7th Research Framework Programme (2007-2013) specifically for research on AIDS, malaria and tuberculosis.

General budget support has increased sharply from a total of €1.425 billion in the period 2002-2006 to €2.571 billion for the period 2007-2011. General budget support can be particularly beneficial for health systems and other social sectors, as it provides longer-term and predictable financing, which strengthens country ownership and allows countries to cover recurrent costs such as salaries of health workers and teachers, buildings and infrastructures. The new MDG contract introduced by the Commission expands the financing cycle from three to six years, and parts of the disbursements are based on progress in MDG-related indicators.

In addition, the European Programme for Action to confront HIV/AIDS, malaria and tuberculosis through external action, launched in 2007, calls for a reinforcement of political dialogue on key issues related to country leadership and governance (balanced and comprehensive strategies for prevention, treatment and care; rights of children and women; sexual and reproductive health and rights; orphans and vulnerable children; needs of other vulnerable groups; stigma and discrimination; and greater involvement of people living with HIV). A first review of this Programme for Action was published by the European Commission in May this year. This sets out a number of priority actions for the future, defined through broad stakeholder consultations. This Review was examined by EU Ministers responsible for Development at the Council Meeting of 17 November 2009.

The way forward

The conclusions of the Council stress the need for a broader participation of all stakeholders in efforts to confront this disease, including NGOs and other non-State actors, as well as greater involvement of the people directly affected by HIV/AIDS (GIPA). Approaches should likewise ensure the full participation of partner countries in order to promote stronger country ownership and should better address capacity constraints through capacity building at all levels. In this context, within the Africa-EU MDG Partnership, the EU is working closely with African governments to enable them to fulfill their commitment to allocate 15% of state budgets to health, in line with the 2001 Abuja Declaration. The overall objective is to strengthen health systems at all levels.
The Council called for particular attention to the following priority actions:

• Promotion of full adherence to human rights and rights-based approaches to addressing HIV/AIDS, including information campaigns against stigmatisation and discrimination of people living with HIV/AIDS.
• Ensuring greater involvement of the people and communities directly affected, bearing in mind that such an involvement often requires support for capacity building of local civil society organizations.
• Increasing access to HIV prevention, addressing the local drivers of the epidemic and the specific needs of women, young people and key populations at risk.
• Strengthen actions to address gender inequality and the feminisation of the HIV/AIDS epidemic, in particular through the strengthening of female rights, including and sexual and reproductive health and rights (SRHRs) .
• Further integrating HIV prevention and services into other health interventions and services
• Continuing support for prevention, diagnostics and treatment, in particular through the provision of safe, accessible and affordable medicines.
• Enabling effective and sustainable country responses through long term and predictable investments in research and development of new tools and interventions.

EU Action Teams

One idea put forward by the review, and approved by the EU Ministers, is the establishment of specific task forces or ‘EU Action Teams’ in priority areas such as access to drugs, comprehensive care and support, prevention, and human rights. The role of these 'EU action teams' would be to consider and plan how to take forward, implement and develop further the recommended actions and approaches. Each team would be led by one of the Member States or the Commission, and would include other interested Member States, civil society organisations, public-private partnerships, UN and other international organisations.  This idea will be explored further.

The Council also invited the Commission to initiate a broad consultative process with Member States and other stakeholders for the preparation of a geographically comprehensive European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action for 2012 and beyond based on an assessment of lessons learnt from EU action.

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