Sunday, December 4, 2011

Global Fund: It's Not Time to Give Less, It's Time to Take Less

Paul Boateng and Aaron Oxley argue that "Now is not the time to cut funding for HIV and Aids" in the English Guardian's Global Development section, which is prominently sponsored by Bill Gates (and who isn't these days?). The authors argue that cancellation of the Global Fund will reverse gains in combating HIV (TB and malaria). But first, is the Global Fund riding on a publicity wave that taps into gains that can not all be attributed to the Fund itself? And second, does Britain really give a damn about HIV or any other social issues in developing countries?

It is true that new HIV infections have declined over the last decade. But this trend was already well established when the Global Fund got going. The Global Fund and others, such as PEPFAR and the World Bank's MAP, may have hastened the trend, but it's difficult to say by how much. In addition, aids related deaths have dropped, which can be partly (only partly because death rates peaked as a result of epidemic dynamics, often before the big funds were established) attributed to large funds like the Global Fund paying for 6 or 7 million people (depending on your source) to receive life-saving antiretroviral drugs (ART); but at what cost?

The cost of providing 6 or 7 million people with ART, and that's a fraction of the people who need or will need the drugs, is far higher than it should be. These drugs are grossly overpriced under the protectionist policies of the World Trade Organization. The real beneficiaries of big HIV funding have been pharmaceutical companies. If the Global Fund and other big funders really wanted as many people to be treated as possible, they would divert some of their attention to getting genuine competition into the generic HIV drug industry. If ART was more affordable, bug funders could spend some money on effective prevention measures (if and when they get around to finding any).

But the big question is not really about how much donor countries 'put into' HIV, but how much they extract from recipient countries. The article authors point out that 2 billion dollars are needed, from all donor countries, not just from Britain, to meet current requests up to 2014. But just one example of how much is being extracted can be found in an article that appears in the British Medical Journal. The country that benefits most from poaching skilled medical personnel from African countries is Britain, at an estimated 2.7 billion dollars, with the US a distant second, at 850 million.

The value of getting your doctors trained abroad is many times the amount donated to the Global Fund, and that's just from poaching in the health services. Britain is also one of the biggest land grabbers; they receive a large share of the continent's natural resources and leave little behind; they grow many of their luxury crops in countries that they also send food aid to, thereby extracting water, food production potential and cheap labor, not to mention damaging local markets and denying people the right to determining the use of their natural resources and food supply.

I certainly wouldn't advocate reducing spending on HIV, or on development, but I would question how all this money has been spent. Firstly, systematically stigamitizing all Africans as promiscuous, while at the same time calling for a reduction in stigma, is self-contradictory. It's time to look at non-sexual HIV transmission; we know it occurs, we just haven't yet bothered to estimate its relative contribution to the most serious epidemics. Secondly, we will never be able to afford enough drugs at the grotesque prices demanded by pharmaceutical companies; their part in bankrupting the Global Fund needs to be recognized.

So Boateng and Oxley might be better advised to campaign for less to be extracted from African countries, rather than for more token payments to be made to the rather phallic Global Fund. The amount of money extracted from these countries is many times what they have ever received, albeit in the form of highly publicized, magnanimous acts. The few million who benefit from antiretroviral drugs is nothing compared to the hundreds of millions who suffer as a result of what Western countries take, rather than what they fail to give. The authors are right, now is not the time for giving less, it's the time for taking less.

[More about the 'extractive' tendencies of Western countries who make ostentatious payments to well publicized development funds.]


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