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WASHINGTON, Jan 29 2008 (IPS) - Health worker shortages in sub-Saharan Africa and a disproportionate HIV/AIDS burden on women in the region necessitate an increase in funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) prior to a congressional vote next week, human rights groups and advocates say.
First introduced by President George W. Bush in 2003, PEPFAR is now up for reauthorisation by the U.S. Congress. The five-year PEPFAR I initiative committed 15 billion dollars to providing HIV/AIDS treatment to two million people worldwide – or one-third of those in clinical need – by the end of the 2008 fiscal year.
Although President Bush announced this week that he would commit 30 billion dollars and increase treatment coverage for 500,000 people in PEPFAR II, rights groups have derided this new plan as woefully inadequate.
“Under the rhetorical guise of doubling, President Bush is setting us back in the fight against AIDS by proposing to flat fund the flagship programme of his administration,” said Jose de Marco, a board member of the U.S.-based Health GAP (Global Access Project) network.
Since PEPFAR I spending climbed to six billion dollars in its last year, allocating 30 billion for the project over the next five years is the equivalent of a zero increase in funding, Physicians for Human Rights (PHR) pointed out.
“The current level of funding means that less than 25 percent of the people who should be on treatment are on treatment – and in some countries, it’s less than 10 percent,” said Mardge Cohen, a Chicago physician and PHR advisor who founded WE-ACTx, an organisation serving HIV-infected women and children in Rwanda.
In particular, rights groups point to the lessons learned from PEPFAR I as compelling evidence for building the capacity of local health services.
“Getting drugs on the ground is not the only answer. Making treatments available is not the only answer. We need health care workers to deliver the treatments,” said Pat Daoust, director of PHR’s Health Action AIDS Campaign.
According to PHR’s website, in sub-Saharan Africa three percent of the world’s health care workers serve 24 percent of the world’s HIV/AIDS-infected population. It is estimated that an additional one million health workers are needed in the region in order to fully meet the needs of the population.
One successful initiative currently in place utilises mobile health testing services, in which clinics travel by caravan directly to isolated communities, then follow up with home visits by nurses and peer counselors.
Aside from building capacity for local health professionals, rights groups and activists are advocating for a more comprehensive approach that uses health and social services in HIV/AIDS treatment and prevention, which they refer to as “wrap-around programmes”.
One wrap-around programme consists of incorporating testing and treatment into routine primary care visits.
Offering free primary education may also play an important role. Pauline Muchina, who serves in the United Nations’ Global Coalition for Women and AIDS initiative, and is originally from Kenya’s Rift Valley Province, points out that the HIV/AIDS rate dropped in her country when the Kenyan government made primary education free for all children. She now is an advocate for free secondary schooling.
Many rights groups recognise education and economic empowerment for women and girls as a successful HIV/AIDS intervention, and argue that PEPFAR II must incorporate these initiatives in order to confront the epidemic’s disproportionate impact on women in sub-Saharan Africa.
Among youth in the region, 75 percent of those living with HIV/AIDS are young girls, Muchina said. Worldwide, women account for approximately 50 percent of HIV infections, but represent 61 percent of HIV infections in sub-Saharan Africa.
Current prevention approaches rely on the “A-B-C model,” which refers to abstinence, being faithful, and using condoms, yet persistent gender inequality in many sub-Saharan African countries make it difficult for women to demand their partners use condoms.
“These three are all important, but we need to look beyond [ABC],” Muchina said. “We need to look to prevention options that are in women’s hands.”
Activists argue that PEPFAR II should shift its prevention efforts away from abstinence-only programmes to providing prophylactics that are within women’s control, such as antimicrobial foams.
The wide range of approaches proposed by advocates and experts point to the complexity of the HIV/AIDS epidemic in vulnerable regions – a complexity which many hope will be more effectively addressed with increased funding for comprehensive services in PEPFAR II.
“I think we were all pretty naïve. We thought that getting drugs [to vulnerable areas] would address the problem,” Daoust said. “Until we address the overriding issues and make a substantial investment in those issues, we are never going to reach the number of people that we said we would.”
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