Fall out from Bangkok 2004?
Posted on July 27th, 2004
After all the hype Bangkok came and went. More delegates than ever, bigger than ever! Was it worth it? Reading between the lines from editorials and peoples comments, it seems it was not. Even though many have tried to put a positive spin on the whole proceedings, I can sense a feeling of frustration that not enough came out of it.
Speaking of which; one of the purposes of the AIDS Conference was to raise awareness and profile of AIDS. To make sure that funders, policy makers and so forth to make sure money and resources are directed to where they needed most. Someone should have told the people at the Global fund. They just turned down Zimbabwe’s application for Funds:
Zimbabwe has one of the world’s highest HIV infection rates, with nearly 25 percent of adults infected.
“Yes, the politics of a nation plays a role when we determine the country’s application,” Feachem said. “It does not help the people of Zimbabwe to pass money through channels which are not well worked out.” was quoted as saying.
With attitudes like this, what hope is there that we’ll be able to tackle the AIDS epidemic effectively? How can we prevent the spread of HIV if resources are withheld from the people that really need them? The money is not meant for the government, it is not an endorsement of the governments policy, it is meant to for people with AIDS.
Is this fall out for criticism received at the Bangkok conference? Somebody should give the people at the Global Fund a good talking to. (I did say I liked the concept of the Global Fund didn’t I…)
A Rogue in our Midst
Posted on July 23rd, 2004
As African countries struggle with HIV/AIDS, and others are seeking ways to resolve age old conclusions, there’s another that is doing it’s best to add to trouble in the region, a rogue in our midst. I’m talking about Sudan. The world has now been made aware of the terrible conditions in Darfur through high profile visits by UN Sec Gen. Kofi Annan and the US Secretary of State, Colin Powell. The Sudanese government has been implicated as being involved in the ethnic cleansing there.
But that’s not all the Sudan government have been involved in; the Ugandan government has for almost a decade and a half accused Sudan of harbouring the Lords Resistance Army (LRA), which has been waging one of the most grotesque, horrific campaigns, of kidnap, mutilations, and enforced slavery on the children of Northern Uganda. It has been all but forgotten by the international community.
Hopefully the new focus of the world on Sudan will also bring the plight of the suffering in the Northern Uganda, and bring pressure on Sudan to stop giving safe haven to the LRA.
I didn’t go to Bangkok 2004
Posted on July 19th, 2004
I didn’t go to Bangkok 2004, but 15-20,000 delegates did. At a cost of $20 million dollars – enough to treat 142,875 people. Currently 400,000 people are on treatment.
They went to talk about increasing the number of people on antiretrovirals. They might as well stayed at home, and donated the money.
By the time they next meet again, another 10,000,000 will have AIDS. I probably won’t be there either. People with AIDS cant afford it, neither can I
*$1,000 per delegate to attend (excluding travel, meals, accomodation)
*$140 – price of cheapest generic FDC
Throwing Stones: The GFATM A Way Forward
Posted on July 17th, 2004
While I’m chucking rocks at the Global Fund, I’ll throw in a couple of bouquets as well. If there’s one thing I’ll say for the GAFTM, at least they’ve had the guts to not only do a self evaluation, but to release it at a time when it is most relevant. Well done for that!
Evaluation and Monitoring – words more often heard than acted on. Everyone say we need more of this, because how else can an organization know if it’s performing, hitting targets, or most importantly what works. And this is of course the real problem; more money than ever is being spent on HIV/AIDS, but there’s virtually no evaluation. This is why after more than 20 years of AIDS, the debate of condoms vs abstinence could still dominate IAS 2004. Actually both methods work, but because no one bothered making assessments from the beginning, we are till not sure what works best where, even when we know they work. This is an unacceptable state of affairs.
So hats of to the GFATM – I did say I was a fan of sorts. I just wish they’d be more focused.
Throwing stones? The Global Fund.
Posted on July 15th, 2004
I strangely find myself in the company of none other than Randall Tobias, for the subject of this blog is the Global Fund. And there are some points of agreement. I hear gasps of horror! Say it ain’t so…. It is so, but not for the reasons you think. First a comment on the reasons that Randall Tobias gave for not supporting the Global Fund, “…although the Global Fund is “a very promising vehicle and a critically important part” of the fight against AIDS, it is “a young venture and still maturing…
Alright I must confess I’m no great fan of the Global Fund, but that is absurd reasoning, after all if I’m not mistaken PEPFAR itself isn’t exactly a venerable entity with a long track record of success; it has no success at all. Methinks it may be more to do with a control rather than anything else, in a bilateral relationship, the US can dictate it’s own terms, in a multilateral relationship such as within the Global Fund, they would be forced to listen to view’s other than the own, and take the position of the majority.
Anyway to my reasons; surprisingly it is this very fact of multilateralism. As attractive as it is, I was opposed to the idea of the global fund because when it was conceived, AIDS was mainly an African problem. My feeling was that it would divert people’s attention, and also diffuse their efforts; instead of focusing on the particular regions that required immediate help and in an effort to prove how “global” it is, they would be tempted to start casting around for other global candidates. The fact that money was awarded to Mongolia (less than 100 cases of AIDS), and Chile (20,000 with AIDS, $38,151,562)got more money as Tanzania (1,500,000 with AIDS, $20,980,796) didn’t exactly convince me.
Now we have the first evaluation of the Global Fund, their own evaluation I hasten to add. According to the report 1 in 5 programmes, 20 percent are failing. One can look at it this and say that 4 out of 5 are succeeding, and then we would get into the debate of acceptable success rates, but in the case of HIV, should failure be an option?
Ok, Ok, it is easy to criticize. That’s why I made the title throwing stones; but remember, this is from the first round, when they (the GFATM) were under fire for not giving money to the countries that really needed it…heavens’ knows what the next evaluation will show?
I have no problem with the concept of the Global Fund; I would have liked it to be more regional. If 70% of AIDS patients are in Africa, that’s where 70% of the money should go. If you are going to report failure, let the failure take place in the areas where real the problems are; at least it shows that you have the right focus, and perhaps you’ll learn from your mistakes. I still think not enough money is going to Africa. But in the meantime, even less funding is being given to the fund as I feared would happen; and because by not focusing on the right areas, time was lost so that what is left is a radpidly shrinking pie, what with the increase in numbers of AIDS cases from Asia.
As it is, I think we have run out of time, and we can no longer afford to try new unproven interventions. If the global fund has proven good at one thing (supposedly), it is being able to disburse funds quickly; not always to the right people, but that can be fixed. If we can build on this, strengthen other areas, such as monitoring and accountability of programs, and even build in implementation facilitation capabilities perhaps there may be some hope for the future.
Posted on July 15th, 2004
So some truths about ARV’s are coming out from IAC 2004 (Bangkok). At a Plenary session Dr Jim Yong Kim of WHO was reported as being humble and honest saying “We’ve failed to do enough in the precious years since Barcelona…..3 x 5 is our best chance.” I should hope so! Being humble was the least he could do; but I think he should be more apologetic, because to be put it mildly, the WHO has truly dropped the ball on this one. And I’m a fan (sort of) of the WHO, or at least their principles. Maybe it was basking in the unaccustomed glow of success at tackling SARS that went to their heads, who knows…. The debate for 3×5 was started in 2001; it should have ended in 2001. Why wasn’t the energy that was used in tackling SARS carried to the AIDS epidemic? The tally for SARS, 800 or so lives, the tally for AIDS at least 6 million and counting since the debate started…And why was there a debate in the first place? It was clear that a treatment action plan would have to be undertaken. Why in fact did it take so long for the WHO to take up the mantle for treatment, which is their mandate and leave the job to others? True the task is daunting, but that doesn’t mean one should flinch from it; but this is what they did. There has been too much talk already. Apologies are not what is required, humble posturing is not what is needed, enough debate its time to just get on with the job.
Bangkok View from Afar
Posted on July 14th, 2004
You may have been surprised not to have seen a missive from me about the proceedings in Bangkok, given me recent references to the Conference. Frankly so am I. After all ‘tis the season for AIDS, as if there is an other, time for any self respecting health commentator to get their writing shoes on so to speak. But it had seemed like a spectator sport so far, a bit like watching a football cup final, the world cup, perhaps that is not quite living up to it’s billing:
Near miss – “Efforts to fight HIV/AIDS are falling short, and world leaders should be more active in the fight against the disease, U.N. Secretary-General Kofi Annan said…
Another shot but wide of the target – “Global Fund projects not meeting targets…”
A corner, a chance, miss – “AIDS Drugs target will not be met…”
Poor pass – “’Brain Drain’ of African Health Workers Slowing Fight Against AIDS, Physicians for Human Rights Report Says…”
Ball out of the park – “Number Of AIDS Orphans Worldwide To Explode, Report Says…”
This is a match is going to end goalless, so one might as well have stayed at home…the crowd is beginning to boo and throw things… (these are headlines from the stories coming out of Thailand
AIDS in the land of confusion
Posted on July 6th, 2004
I was going to title this Lies, Statistics, AIDS and Damned Lies… but I thought that’s a bit too harsh. So I sat back to take a moment and re-think what I was going to sat about the contradictory stories I’ve been seeing about AIDS figures. It seems I’ve been preempted by UNAIDS who have just released a new AIDS report. I haven’t read it yet, but judging from the headlines, the news is not good. Perhaps I’ll revisit this after reading the report. The words may have literally been taken out of my mouth. So what was I going to say about the figures; just that on the one hand, some scientists believe that the AIDS data is wrong and things are much worse than they really are. While others are saying, the figures are not wrong, we’re just measuring (and interpreting?) them in a new way. Hmm…Confused? What is a body to think? More on this…..
Through a glass darkly – the prism of AIDS
Posted on July 3rd, 2004
Through a glass darkly – the prism of AIDS
Extracts ” For over two decades years the HIV/AIDS epidemic has stubbornly refused to yield to the best efforts of thousands of researchers, scientists, doctors and other health personnel. In that time the victories have been few and far between, a mere handful to date. Despite the best efforts science has had to offer, only a small percentage of people are on treatment, the drugs though cheap are still toxic, must be taken carefully and only keep the virus at bay. We are no nearer to creating a vaccine; a cure appears to be wishful thinking.”
Read the complete article at