Preparing for the Future of HIV/AIDS in Africa A Shared Responsibility (2011) / Chapter Skim
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3 The Burden of HIV/AIDS: Implications for U.S. Interests
3 The Burden of HIV/AIDS: Implications for U.S. Interests
Pages 42-69
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inter ests include moving toward shared responsibility with African partner states, leveraging multilateral assets, and striving for integration and efficiency.
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in 2003, established itself as a global leader in the fight against HIV/AIDS. Through PEPFAR and support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States helped galvanize an extraordinary global response to a single disease and mobilize donor and private-sector resources on an unprecedented scale to respond to the costly but critical task of addressing the HIV/AIDS crisis.
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This model would be one of shared responsibility with African partner states and the broader international community. By looking to African partner states to assume increasing responsibility for leadership, management, and investment of resources in HIV/AIDS, the United States would be promoting a future of self-reliance and self-sustainability.
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An additional 1.9 million individuals in Africa receive treatment through programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund, 2010a) , to which the United States is the largest national contributor.
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U.S. leadership contributed directly to the formation of new international initiatives such as the Global Fund, with the United States providing an early $200 million in seed money, investing considerable attention in the early formation and struc ture of the fund (Summers, 2002)
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. SOURCE: Kaiser Family Foundation, 2010.
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These achievements will ultimately strengthen a long-term, comprehensive approach to HIV/AIDS, but also bring greater focus to the broader disease burden and structural development challenges faced by African countries.
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GBC also manages the private-sector delegation to the Global Fund (GBC, 2010)
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In the early 2000s, pharmaceutical companies were a target of global HIV/AIDS activism, ultimately acquiescing to dramatic price reductions for first-line ARV drugs for the developing world. That experience may better prepare companies for future demands, but may also lead some to disinvest in research and development for products that are perceived as ultimately not serving bottom-line business interests.
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A number of companies have negotiated creative licensing agreements with partner states -- for example, Gilead Science's arrangements with Indian and South African manufacturers to assist them in producing tenofovir while retaining patent rights -- arrangements that offer hope of expanded and more sustainable access to drugs in Africa and the rest of the developing world (Bate, 2010)
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U.S. academic institutions have played a key role in supporting and col laborating with African researchers to make substantial contributions to the gen eration of new knowledge, especially in the areas of clinical and public health research on HIV/AIDS.
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partner institutions and in-country institutions with a view to long-term capacity building and increased South−South collaboration.3 Such programs need to be expanded to more African countries as they help address, and in some instances reverse, the brain drain because of their high in-country retention rates. At another level, strengthening of research capacity needs to extend beyond the training of individual researchers to create academically vibrant and sustain able research institutions in Africa.
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The Gates Foundation has played a vital role in sustaining commitment to HIV/AIDS vaccine and prevention research (AVAC, 2010) and has been the largest private contributor to the Global Fund (Global Fund, 2010c)
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engagement on HIV/AIDS subside, U.S. policy makers will likely seek to take on new global and development challenges, and domestic constituencies and African partners will similarly press for attention and funding for competing health and development priorities.
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investments in HIV/AIDS, as well as greater appreciation of how these investments will shape future outcomes. Moving Toward Shared Responsibility As noted earlier, a central feature of a long-term, sustainable approach is shared responsibility, with African partner governments assuming increasing responsibility for the mustering and management of resources for national HIV/ AIDS strategies.
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support for treatment. Today, the United States supports the provision of ART to some 2.4 million people in need globally, and the Obama administration has promised to extend that commitment to 4 million people by 2014 (Office of the Global AIDS Coordinator, 2009)
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. Many African countries remain highly dependent on external assistance for health resources (Global Fund, 2010d)
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The following are examples of what the United States and other partner governments might include as essential or "nonnegotiable" elements of such a contract relating to African government responsibilities: • sustained political leadership on HIV/AIDS; • ommitment to human rights and an evidence-based national response to c the epidemic; • a strong focus and voice on HIV/AIDS prevention; and • ransparent, efficient, and accountable procedures for the use of both t country-level and donor resources. Those countries deemed as lacking these essential elements would not qualify for elevated levels of financing or a contract model ceding greater control to the African partner government.
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As less restrictive approaches to these types of institutional relation ships have not succeeded in the past, it is the committee's best judgment that binding contracts -- in which the United States would cut back on funding in those countries that lagged in taking the path toward shared responsibility -- are worth trying in the future. Making Prevention a Priority The greatest challenge to U.S.
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They have been a strong asset for U.S. leadership in building international consensus, mobilizing resources and attention, coordinating global efforts, and creating and strengthening international institutions dedicated to global health and the fight against infectious disease.
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For this reason, bilateral programs have been criticized for creating parallel procurement and service delivery systems, for failing to integrate fully with recipient country priorities, and for tending toward short-term strategies that do not necessarily give priority to capacity building or sustainability. The Global Fund model, on the other hand, ensures that funding flows are more clearly aligned with country priorities as determined by a multisectoral Country Coordinating Mechanism; that recipients enjoy greater flexibility in using resources for long-term approaches and system strengthening; and that more responsibility is placed with host countries for planning, management, and institutional capacity to oversee and account for health resources.
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global health spending. Policy makers may face increasing pressure from U.S domestic interests, donor partners, and African partner governments to address more directly health priorities beyond HIV/AIDS and to support multipurpose investments in health system strengthening.4 In a world of finite financial resources, policy makers must confront difficult trade-offs, including that between focusing on lifeprolonging ARV drug purchases and envisioning HIV/AIDS in a broader context of pressing and equally devastating disease challenges.
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development assistance to Africa overall. In many African countries, HIV/AIDS and other health funding is by far the largest component of U.S.
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The Office of the Global AIDS Coordinator should emphasize, develop, and implement a more binding, negotiated con tract approach at the country level. The contract should incentivize shared responsibility whereby additive donor resources are provided to a large extent as matching funds for partner countries' investments of their own domestic resources in health.
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For eign Assistance Act, it should seek to encourage greater flexibility in devel opment funding to ensure that assistance for both health and development meets recipient country priorities. REFERENCES Accordia Global Health Foundation.
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Geneva: Global Fund.
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2002. The Global Fund to fight AIDS, TB, and malaria: Challenges and opportunities.
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Mbabane and Durban: National Emergency Response Council on HIV/AIDS (NERCHA) and Health Economics & HIV/AIDS Research Division (HEARD)
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