Emerging Governance Issues on HIV and AIDS in Asia

[Guest guest]

Dear Colleague,

ActionAid International is an international development organization

working on the core themes of women's rights, education, food

security, human security in conflict and emergencies and issues

related with HIV and AIDS and good governance with a mission to

eradicate poverty and the injustice and inequity that cause it.

We are organizing a regional release of our report " Positive Voices -

Emerging Governance Issues on HIV and AIDS in Asia " in Delhi. This

report is in continuation with our earlier report Time to Act,

released during the International AIDS Conference in 2004 at

Bangkok. We plan to release the report on the World Health Day i.e.

April 7th, 2006 (5:30-8:00 pm).

For this occasion we would like to invite interested e-members of

your AIDS community to be a part of the event. We would like to have

your organization represented at our report launch. The report

launch will be followed by a panel discussion on 'Achieving

Universal Access: How far, How near' and later dinner.

MonAmi

ActionAid Asia.

E-mai: <monami_india@...>

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" Positive Voices " Emerging Governance Issues on HIV and AIDS in Asia

Executive Summary

`Positive Voices' is an ActionAid International report in

continuation to our earlier report `Time to Act'. Its primary thrust

was that AIDS is a political issue. The statement outlined its wider

linkages—as an issue of people's rights, of human and economic

development, dignity and well-being. It advocated intensifying the

HIV and AIDS control efforts by addressing the political will of all

concerned, with the objective of creating conditions that decrease

vulnerability to HIV as well as ensuring access to means of

prevention and treatment.

This report poses issues for shared thinking. How do we best

minimise the suffering caused by the HIV and AIDS epidemic? The

experiences, demands and aspirations of the affected people guide

this effort.

Some Voices of Affected Men, Women and Children

· " We want acceptance, understanding, and the removal

of discrimination and stigma at all levels. Effective policy and

decision making will help make that happen. "

· " We want access to care and treatment for all

opportunistic illnesses for PLWHA. We want free ARV treatment

followed by supplements in nutrition. We deserve adequate care and

support centres and groups for infected individuals, orphaned

children, grandparents, and affected families. "

· " We want access to more information on HIV and AIDS,

and the opportunities to develop our capacities and skills so that

we can help ourselves economically and socially, and live a positive

life with dignity. "

· " We want a voice in policy and decision making so

that we are not forgotten, so that we are considered when programmes

and policies affecting PLWHA are being developed. "

· " We do not always have the opportunity to be

financially independent and secure. We are forced to rely on our

families or husbands, and if they become ill, desert or abuse us, we

must find a way to sustain our children and ourselves. Thus we want

opportunities to develop our education, capacities and skills, and

chances to generate an income. "

· " We want to have lots of friends…. we want to share

our fears and dreams with people around us. We want to study, play

and laugh with other children in our school. We want to be included

in all activities in our school. "

· " When we are sick and can't attend school, we hope

our teacher will not scold us for being absent. When we fall sick,

we want a nice doctor to give us medicines that will make us well

soon. We want health food that will make us strong so we won't keep

falling sick. "

Requirements to Adequately Respond to these Voices

A Paradigm Shift: Thinking Differently

This report is based on the understanding that AIDS control cannot

be carried on in isolation. The positive people's demands make that

very clear. The spread of HIV and the extent of suffering it causes

is influenced by policies affecting all spheres of people's lives;

economic, social, cultural and political. The extent of socio-

economic development and the models adopted to achieve economic

growth are crucial determinants. Colonial and neo-colonial

structures of governance have generated conditions in Asian

countries that make them vulnerable to HIV.

Two conceptual leaps appear necessary within AIDS discourse—

" normalising " the epidemic and reinstating the notion of " social

responsibility " in all relationships; the exclusivist approach will

not do. The low levels of infection rates across Asia offer

tremendous opportunities for concerted actions on several fronts in

order to forestall further advances of the virus. This requires an

approach to AIDS control that addresses HIV and AIDS as a form of

social and human suffering, not as an issue of loss of economic

productivity, of law and order, or of national security.

Generating Humane and Just Governance

The Millenium Development Goals (MDGs) articulate the objectives for

human development that can limit the vulnerability to HIV, dealing

as they do with amelioration of poverty and malnutrition, improving

child health and control of communicable diseases. Achieving the

MDGs by improving the quality of life of people, and not merely

through technological fixes, will make AIDS control efforts more

effective. The right to food, to livelihood with dignity, and to

comprehensive healthcare have to be the cornerstones of governance.

In Asia, the overall proportion of people in the region with

advanced HIV infection receiving ART remains low, mirroring the

global average of around 15 per cent. That means that around one

million Asians with HIV who would currently benefit from

antiretrovirals (ARV) do not have access to the treatment. The

principal reason for extremely limited access to ART is the high

price tag of patented medicines. Also, the limited functional

capacity of health service systems is being weakened further by the

commercialisation of public services and corporatisation of the

private sector. The delivery of ARV can succeed if there

are " functioning public health services that are generally accessed

for curative care " .

The HIV control strategy has to be mainstreamed as part of the wider

strategy for disease control. The general health services

infrastructure in several Asian countries is well developed although

they may be functioning sub-optimally due to resource constraints

and policy shifts.

The TRIPS Agreement was a means to dampen the challenge to the

monopoly of US and European pharmaceutical companies. The importance

of this challenge will be obvious from the fact that Indian

companies today offer a cocktail of anti-retrovirals at US $200 per

year in stark contrast to the $10,000-$12,000 charged by

transnational corporations less than four years back.

Appropriate Knowledge Management is necessary for generating the

right kind of research that will lead to holistic understanding of

issues which can then be used to plan integrated approaches towards

AIDS control.

Financing of HIV and AIDS Control

Consideration of issues in financing of AIDS programmes raises

larger questions about government spending on health service systems

as a whole. A holistic support system has to be evolved, integrating

preventive and promotive measures along with treatment with ARV.

Rational use of ART as a part of comprehensive care of HIV positive

persons and monitoring of ART by civil society is essential.

Current government funding patterns show an encouraging trend:

governments have been increasing their budgets. However, the

challenge for Asian governments is to prioritise and accordingly

increase investment if they are serious about tackling the epidemic.

There are also problems of leakages and non-utilisation of funds.

Private sector financing constitutes a very minor proportion of

total spending across the Asian region. The role of the public

sector will remain critical in terms of prioritising investments

both for and within the health sector, as well as in the signals

that it sends to the private sector.

Out of contracts worth 3.4 billion the GFATM signed between 2002-5,

only 1.6 billion dollars were disbursed. Donors and countries hit

heavily by HIV and AIDS are now asking why funds are sitting lazy in

the World Bank Safe. Except for Cambodia and Laos, per capita health

investment by the Global Fund in Asian countries has been less than

$1 per capita. In Cambodia and Laos it has been between $1-$3.

How Can This Paradigm Shift Be Made Possible?

People Living With HIV and AIDS (PLWHA) themselves demonstrate the

way forward: collectivisation is the most effective tool of the

marginalised.

Asian countries need to come together to think for themselves about

the well-being of their people, especially the most socially

vulnerable. They have to develop their own path of development and

not be forced to accept the terms of the World Trade Organisation

and the TRIPS agreement, and the structural adjustment of their

economies that suits global capital and increases disparities.

The Asian countries also need to come together to evolve their

response to HIV and AIDS as suited to their disease profile, health

services, social and cultural context. They must critically analyse

for themselves and learn both positive and negative lessons from the

experiences of other countries of the region as well as outside.

ActionAid International. Report Release Function

" Positive Voices " Emerging Governance Issues on HIV and AIDS in Asia

7th April 2006, 5:30 PM- 8:00 PM,

Auditorium, Ist Floor, World Wildlife Fund Secretariat, 172 Lodi

Estate, New Delhi 110003

5:30-6:00. Registration

Session I. 6:00-6:45. Report Launch

6:00-6:10. Welcome Note. Mukul Sharma

ActionAid International-Asia

6:10-6:20. Release of the Report

6:20-6:30. Keynote Address. Dr. Mira Shiva

AIDAN. 6:30-6:45

Introduction to the Report. Dr. Ritu Priya

Center for Social Medicine and Community Health, JNU

Session II

6:45-7:45. Panel Discussion on " Achieving Universal Access: How far, How near "

Moderator. Dr. Ritu Priya. Center for Social Medicine and Community Health, JNU

Panelists. 6:50-7:00

Loon Gangte. INP+: Regional Coordinator, South Asia

7:00-7:10 Anjali Gopalan, NAZ Foundation: Director

7:10-7:20 E. Mohamed Rafique

UNAIDS: Resource Person and Moderator, AIDS Community

7:20-7:30. Ramesh Venkataraman Positive Life

7:30-7:40 Christy Abraham ActionAid India: HIV- Theme Leader

7:45-8:15. Open House Discussion

Session III. Dinner

_________

On behalf of

Mukul Sharma

Asia Campaigns and Advocacy Coordinator

ActionAid International Asia

E-88 Saket,

New Delhi

Prof. Babu Mathew

Country Director,

ActionAid India

C-88, South Extension II

New Delhi

Monami Banerjee "

E-mail:<monami_india@...>