Dear Colleagues,
Patrick Friel wrote the following message on World AIDS Day....
and some of the points he makes about the failed efforts to ad-
dress the health crisis apply across the board to almost all as-
pects of relief and development.
The plight of poor people in developing countries should not
be... but the welfare driven development paradigm on the one
hand... and unseemly greed on the other... is a potent mix that
ends up with crisis and no obvious exit strategy.
I cannot pretend to have the "silver bullet" answer, but I know
one thing that is glaringly missing from the relief and develop-
ment arena, including the health sector, and that is "management
information"... and without it a failed paradigm never needs to
change. But with good management information, then there can be
accountability and after that big organizations might be pre-
pared to let themselves operate in a transparent mode. I have
been hoping (for 20 years) that the big organizations in devel-
opment would address transparency and accountability for them-
selves by encouraging management information, but rather than
progress there has been backsliding. However, I am increasingly
encouraged that if the big organizations won't do it for them-
selves, then maybe, we should do it for them.
And thank you again, Patrick Friel, for the following.
Sincerely
Peter Burgess
mailto:Profitinafrica@aol.com
>>>>>>>>>>>>>>>>>>>>>>>>>
In a message dated 12/3/2004 12:01:35 PM Eastern Standard Time,
stigma-aids@eforums.healthdev.org writes:
> Subj:[stigma-aids] World AIDS Day
> Date:12/3/2004 12:01:35 PM Eastern Standard Time
> From:stigma-aids@eforums.healthdev.org
> To:Profitinafrica@aol.com
>
> World AIDS Day follow up material - Women, AIDS and Structural
> Factors
> ****************
>
> [Mod note: this posting, distributed on World AIDS Day, discusses
some
> of the key issues around gender and HIV.]
>
> Women, AIDS and Structural Factors (or why AIDS Prevention is
Failing the
> World's Women and Girls)
>
> Today is World AIDS Day. Hundreds of thousands of public and private
> employees around the world who deal with its prevention, treatment
and care will
> join the millions of other people affected by AIDS to commemorate
our long
> struggle against the greatest epidemic the world has ever seen.
Regrettably,
> while the global response to AIDS has gotten bigger and more complex
in the past
> 20 years, while AIDS workers now access combined budgets that reach
into the
> multi-billion dollar range, the fight against AIDS is failing. If we
look at
> the numbers of its victims-20 million have died, 15 million orphans
and
> upwards of 40 million people infected with HIV, the virus that
causes AIDS, we
> cannot avoid the conclusion that our efforts against AIDS are
stalled.
>
> What's wrong with what we've been doing? For decades AIDS program
planners
> have been developing prevention "interventions" to modify the
behaviors that
> put people at risk. Typically, these limited scope and duration
efforts
> focus on prostitutes and their clients, homosexual men and
intravenous drug
> users, each with its own label and built-in potential for stigma and
> discrimination. Promotions of abstinence, being faithful or using
condoms (ABC) are now
> common in many programs. But, we are learning that behavior change
strategies
> don't work for everyone, especially the millions of women who have
no risk
> factor other than being married. Studies in communities across
Africa and
> Asia reveal that as many as three out of four HIV positive
monogamous women are
> infected by their husbands.
>
> Twenty years ago AIDS mainly affected men. Today, fully half the
people in
> the world living with HIV are women and girls and, in some areas, as
many as
> 60 per cent or more. This shocking news becomes more understandable
when
> viewed alongside a body of thought that highlights the underlying
structural
> factors that increase one's vulnerability to HIV/AIDS. In short, the
main
> factors that make women, especially young women and girls, more
vulnerable to AIDS
> are widespread gender inequality, i.e., their low social status,
combined
> with the effects of severe poverty. These powerful structural
factors explain
> why AIDS prevention interventions that focus on behavior and risk
alone will,
> in the long run, fail. Designing prevention interventions without
> aggressively addressing the structural factors of inequality and
poverty is
> essentially akin to applying band-aids to a hemorrhage.
>
> The development community needs to do more than acknowledge this and
carry
> on business as usual. We need to adopt strategies that confront
these
> structural factors with a renewed commitment to grassroots
development. The AIDS
> community and the donors that support its work must shift from
short-term
> donor-driven interventions to long-term country-led, community-based
efforts.
>
> Wealthy countries can do much more. Consider the facts: only a few
well-off
> governments live up to their commitment to provide aid at 0.7% of
domestic
> GNP; "structural adjustment" payments from poor countries to the
World Bank
> and the IMF are actually five-times greater than the President's $15
billion
> AIDS' grant over the same period; and, the sum of wealthy country
subsidies to
> their agri-businesses is six times greater than their combined aid
budgets,
> i.e., $300 billion vs. $50 billion. To radically break with old
ineffective
> strategies, well-off governments must increase their contributions
to the
> Global Fund to Fight AIDS, TB and Malaria, a leader in sponsoring
multisectoral,
> country-led efforts. They must revamp World Bank and IMF policies
and
> forgive the huge debts that burden developing countries. And, they
must finally
> put an end to the unfair and unseemly subsidies they give to their
> agri-businesses that undermine the ability of farmers in poor
countries to compete in
> global markets.
>
> Our limited approaches to AIDS prevention are not working. Five
million
> people will likely become infected with HIV in the next twelve
months and 3
> million others will die. This latter figure doesn't register very
well but is
> the equivalent of twenty 747's crashing every day into a mountain in
the Andes.
> Unless we address the underlying causes of AIDS, we can look ahead
to an
> expansion of the pandemic over the next 20 years, especially in
"second wave
> countries" like China, India and Russia. Some epidemiologists
forecast more
> than 100 million people infected by 2010, mostly through sexual
transmission
> and nearly all in poor countries. To escape that fate, all countries
must
> support measures that help women achieve an equal place in society
and we must
> seriously underwrite social and economic progress. Strong support
for
> community-driven structural interventions is desperately needed now
to turn back this
> epidemic which threatens the health and stability of women and girls
in many
> poor countries and by extension the whole world.
>
> WRITER: Patrick Friel, PhD is formerly with the World Health
Organization's
> Global Programme on AIDS and the United Nations Population Fund. He
is
> retired and lives in New York City.
>
> ---------
> Speak your world!
>
> A posting from Stigma-AIDS
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