Nomandla
Yako and her son Thamsanqa, by Gideon Mendel, from his recent 'Treatment Access'
poster series produced in collaboration with South Africa's Treatment Access Campaign.
Nomandla lives in the Khayelitsha squatter community near Cape. She discovered
she had HIV in 1999 when Thamsanqa was very ill. "My child has now been on antiretroviral
drugs for a few weeks," she says. "I want to make sure he can live as long a life
as possible. I blame myself for transmitting the disease to him although it was
not my sin. But at the same time I blame government for not providing a proper
mother to child prevention programme for our people."
A selection of Gideon's work can be viewed at www.abrokenlandscape.com
Gus Cairns asks the question
Is this the future? It is 2010. There are 75 million people living with HIV in the world, with only half a million on treatment. A vaccine is still five years away. 45 million have died of Aids. In Botswana, the average life expectancy is 26. After lengthy ditherings, the G7 - the richest countries in the world - have finally committed themselves to a $30 billion global HIV treatment plan. Every rural centre in the worst-affected countries has its spanking-new clinic, stocked with cheap drugs strong-armed out of the companies. But it's too late. All the adults have died of Aids. There is no one to staff the clinics. Whole villages are empty of anyone but feral children.
The decision to opt for this future - or a better scenario where at least three million people have managed to get HIV drugs, enough to make all the difference - is likely to be made over the next three months. And one country may have the pivotal role, the historic destiny of deciding. The UK.
 Simon Wright |
 Noerine Kaleeba |
 Gro Harlem Brundtland |
 Richard Feacham |
Drawing the Short straw
This is where The Global Fund for Aids, TB and Malaria (TGF) is now. It has granted
$1.4 billion, in two rounds of giving, to 150 programmes in 92 countries.
It has never got near to what UN Secretary-General Kofi Annan among others wanted it to be: a $10 billion Aids war chest, the minimum sum needed to, in the words of Bill Clinton, "stop Aids on a dime."
On 3 June, at the G7 summit this year, bids for round three are due, with grant decisions to be issued in October. So far the round has $250m pledged to finance it. If TGF is to maintain its level of funding it needs at least $1.6 billion.
This expenditure is dwarfed by the profits of the drug companies and by the $14 billion (plus $1billion for TGF) George Bush says he wants to spend on turning back Aids with US-controlled blitzkriegs in 14 handpicked countries.
Even Britain's Department for International Development, DFID, has spent more on global health - $2.4 billion since it started.
The Fund itself, in tight-lipped italics, says: "Approval of round three proposals in early October will rely on confirmed pledges of resources which must then be received soon after the proposal approval to sign Grant Agreements and begin disbursement."
In other words, if you bastards don't give us $1.6bn NOW, we'll have to shut up shop.
So what will happen on 3 June? Some countries will give more, undoubtedly. Italy has announced a tax-deductible donation scheme so people can give to TGF. France is supposedly keen to 'Fund The Fund' to improve its standing after the Iraq war.
But one country appears to have no intention of giving TGF any more, or not until too late. The UK, and in particular its Department for International Development (DFID).
In parliamentary answers former DFID minister Clare Short has said TGF "is not being led as well as it might be" and that its "performance to date has been mixed". She was "holding back from commitments...rather than simply giving more money, I am in dialogue with the Fund about doing a better job." A formal review of TGF's structure and performance won't report until November.
Simon Wright is HIV Campaign Director for ActionAid UK and former secretary to the All-Party Parliamentary Committee on Aids (APPG-Aids). He says: "DFID were never very keen on the Fund, they just couldn't resist the political pressure to set it up." Parliamentary insiders say freely Clare Short wanted to kill the Fund.
Why? In a statement to PN, the former Minister herself said this: "The primary role of the Fund is to provide drugs and commodities for...Aids, TB and Malaria. [DFID] has pledged $200 million over five years to the Fund...In addition we [are] committed to supporting the development of health systems in poorer countries. Strengthening these systems is vital if drugs are to be safely and sustainably supplied to the poor. The Fund's performance to this end has been mixed, and our future support will depend on its effectiveness."
DFID insiders cite situations where a big injection of TGF money has caused problems by 'bumping into' carefully-planned pre-existing Aids programmes, hijacking human and technical resources committed elsewhere.
One Aids sector watchdog says: "Agencies like DFID want to keep hold of the purse strings. If you donate to TGF you let go of the strings. Gordon Brown doesn't want TGF funding Aids programmes that use off-brand generic drugs, for example."
The editor of one of the main HIV websites comments: "DFID is concerned the Fund has no mechanism to measure effectiveness. Money won't go missing, but there's no quality control overseeing, for instance, the best combinations of Aids drugs to buy, or forging cast-iron guarantees about future supply."
In the opinion of Neil Gerrard MP, Chair of the APPG-Aids, "Gordon Brown took his cues from Clare in this field. I really don't understand DFID's attitude. The whole point about the Fund is that it has the mechanism to get the money right into the heart of affected communities; targeted work, the kind that governments can't deliver."
The Global Fund - why The Global Fund for Aids, TB and Malaria was meant to be the biggest player on the world HIV scene.
It was set up to be something new. It was designed as a fast-track way of getting money to where it could work best. It would not just target the most-affected countries, but the ones where HIV may always remain confined to despised minorities.
TGF Director Richard Feachem insists he's proud of what TGF has achieved in its first 15 months. It's the job of the precise, evangelistic health academic to spin the straw of bad publicity into the gold of Aids money, but he makes a convincing case that TGF represents 'added value' when it comes to turning dollars into drugs into deaths prevented.
"We're an entirely new financial mechanism. Other mechanisms were not turning round these epidemics.
"We've been pledged $3.4bn and got one billion in the bank. We are on track to be what we're meant to be. I forecast we'll be up to a 'cruising altitude' of $7-8 billion a year expenditure by 2008. In 15 months we've come from nothing to $1.5 granted."
But there's only a billion in the bank, remember?
TGF's other saving grace is that it was designed as a true, bottom-up 'multilateral'. This distinguishes it from 'bilaterals', government agencies like DFID and, in the States, USAID.
In bilateral schemes the donor has all the say in how the money's spent. A classic example is George Bush's $14bn for HIV. The US Congress recently passed this, but with a specification that $5 billion must be spent on 'no sex, not safer sex' abstinence-only projects.
At least with TGF, the local countries co-ordinating agencies are supposed to be genuinely representative not just of local politicians but of all parties that have a stake in HIV - government, non-governmental organisations (NGOs), HIV peer support groups, religious organisations.
Feachem is contemptuous of the superfunders' constant demands for more 'accountability' before more money. "We have ways to measure the effectiveness of what we're doing right now.
"In any case," he adds, icily, "if the house is burning down a discussion about 'harmoniousness of methodologies' doesn't quite cut it. You have to put out the fire before returning to long-term agendas."
The Global Fund - why not
Feachem insists the remaining money pledged for the two rounds by donor countries
(and other bodies like the Gates Foundation, the EU and so on) will be paid. But
he already knocked $1.6 billion off the projected budget last October when it
became clear there wouldn't be enough money for a third round in 2002.
Harvard economist Jeffrey Sachs, one of the devisers of the Fund, says TGF should shut up shop. In POZ magazine in January he suggested the Fund should go bankrupt in order to shame the countries who starved it. Feachem says this would be immoral, like pulling all the troops out of Iraq with the war half-finished.
But hasn't the US Congress just authorised $1bn for TGF? No. It authorised 'up to' $1bn as long as that is not more than one-third of total contributions to TGF in 2003-4.
DFID's role here is pivotal, because the UK has so far been the second-largest donor to the Fund, and because of its relationship with the USA. It could start the ball rolling to get the $2billion to match the US billion.
Hopes were riding high that the G7 summit on 3 June will be where the rich countries follow the US lead. But no one is now expecting this to happen, Simon Wright warns: "Everyone is now predicting that if there is any significant HIV input into the G7 summit it will involve the leaders trying to thrash out an agreement with the Pharmacos to set across-the-board lower prices for developing countries.
"The TGF funding is now meant to be discussed at a Donors' Conference on July 16-19 in Paris, immediately after the international Aids Conference there. But the top leaders won't be there. It's a real signal that Funding The Fund has slipped off their radar."
Dr WHO is worried
Gro Harlem Brundtland, soon to retire as Director-General of the WHO, provides
the long view. The ex-Norway PM has seen global health programmes rise and fall.
There has been, she says, a real and lasting change in the money going into Aids
in the last two years.
"But now we see the Fund is running out of resources. In the back of my mind I always felt the big targets talked about were difficult. Major shifts in the sums spent on global aid are very rare.
"The Fund is in a catch-22. The politicians are saying 'prove it works', but its too soon. It's not the first time. The Global Access to Vaccines Initiative (GAVI) ran into the same problem...We can only hope the Fund survives.
"DFID is a good example of an agency that has been stung before, trying to work with different agencies in different parts of the world working to very different guidelines."
Sometimes, in other words, there is no alternative to the Long Haul - 'horizontal' programmes that slowly build infrastructure and capability. Suddenly inserting millions 'vertically' into a poor country to blitzkrieg Aids may distort a culture hardly less than the disease.
"On the other hand," she adds, "we must never lose focus on learning from how developing countries deal with their own situation. We mustn't take for granted that we're on the donor side and all that counts is how much we give."
The south/south divide
In the end, what may lie deep behind the Global Fund's problems is the sheer pain
of making the transition from a total global health divide to approximate equality.
Noerine Kaleeba, Global Mobilisation Worker at UNAIDS, driving force behind Uganda's
successful HIV programme, mother of African Aids if there is one, has an anecdote:
"When I invited Bono to visit Uganda he got to know 20 people with HIV and said, 'Well, I must keep these people alive anyhow.' Only nine actually needed antiretrovirals. But two of those wouldn't take them. When he asked why they said, 'Because we couldn't stand the guilt'.
"The global movement has reduced prices so that some people in the south can get antiretrovirals (ARVs). I have a brother on ARVs, and his wife, who is ill, is not. Oddly, Aids treatments can act as a breaker of solidarity.
"What we have to do is care for the whole family."
 Clare Short |
Funding the Fund
Maybe the Fund has been too polite, too ensnared in the politics of international
development, to be the HIV Vanguard it was meant to be. Maybe it should be Aids
Aid.
Last November, Richard Feachem said mobilising the general public's goodwill might be the only way forward. Maybe it's time for the distinguished professor to stand on stages with rock stars and shout: "Give us the F***in' Money!"
 Bono and US Treasury Secretary Paul O'Neill speak with pupils from a school in Kampala, Uganda) |
So Bono's organisation Debt Aids Trade Africa has joined up with ActionAid, the National Aids Trust, Action for Southern Africa, the TB Alliance, UKC and others, to set up a UK branch of the Fund the Fund campaigns that are already springing up in places like France.
Simon Wright says: "There have been so many Aids initiatives. Every time we think 'this is the one where the big money comes'. The Global Fund mustn't be allowed to fail like the others."
ActionAid is running an email campaign calling on Government ministers to increase funding to The Global Fund. Tell your MP: 'Put our money where your mouth is - Fund the Fight against AIDS'. Go to www.actionaid.org to email your MP. There is a Worldwide Day of Action in support of the Fund on 30 May.
