Committee Reports > List of Committees > Joint > 2003 > Committee on European Affairs > Report No. 01 - Report of the Advisory Group to the JC on EU Affairs

Annex 3

HIV/AIDS

General Statement of the Problem

There is now a growing understanding that the promotion of good health is central to poverty reduction and economic development; good health contributes to economic growth while poor health drives people further into poverty. The extent that poor health is linked to poverty has been brought very sharply into focus as a result of the global HIV/AIDS pandemic.

Over the last 20 years, HIV has generated an AIDS epidemic that has spread to every part of the world. Statistics released by UNAIDS in July 2002 indicate that there are now over 40 million adults and children living with HIV/AIDS worldwide. Over 90 percent of these live in developing countries. Though Africa had been hardest hit by this global epidemic or pandemic, it is becoming very clear that the disease is spreading rapidly in parts of Asia, Eastern Europe and the Caribbean.

While HIV/AIDS remains a very significant public health concern in industrialized countries, the existence of high levels of HIV infection is now clearly related to poverty and disadvantage. The rates are highest among poor people- whether they live in the developed world or in developing countries. In these situations, AIDS is contribution to suffering and disadvantage. In poorer countries it is precipitating premature death and halting social and economic development.

Impact of HIV/AIDS

Sub-Saharan Africa remains by far the worst affected, but mostly poorly resourced region in the world. HIV/AIDS is now the leading cause of death in this region. In Africa, 2,200,000 people died of AIDS in 2001-there are another 28 million people living with HIV on that continent. The vast majority of them are in the prime of their lives as workers and parents. Those most at risk are in the 15-40 age group.

Largely because of HIV/AIDS, life expectancy in the most severely affected countries in Sub-Saharan Africa has been reduced by almost a third, from about 63 years to 43 years, reversing gains made over the century. If effective action is not taken, UNAIDS estimates that 4 out of every 10 adolescents will be infected with HIV in countries such as Ethiopia and Cote d’Ivoire ant the rate raises to 6 out of 10 in counties such as Zambia and South Africa. Of the worlds 14 million children orphaned by AIDS, over 12 million are living in Africa.

Although the current pandemic is largely concentrated in Africa the epidemic is growing fastest in Asia, the states of the former Soviet Union and in Eastern Europe. In these situations HIV/AIDS threatens to derail economic prospects and weaken social and political systems.

While HIV/AIDS has devastating effects on individuals, families and communities, it has a profound effect on the social and economic development of countries most affected by the epidemic. In these situations this epidemic will prove to be the biggest single obstacle to reduce poverty and to attain the development goals agreed by the international community at the United Nations Millennium Summit.

Response of the International Community

There is now a recognition that the global community has completely underestimated the extent and the implications of the HIV/AIDS pandemic. Time and again reports of the numbers of people infected with HIV virus have surpassed earlier projections. In most situations where the disease is now firmly established, the response has been too little and too late.

Over the last three years however, there has been a growing recognition of the extent of the problem worldwide. Since 2000, there have been three debates on HIV/AIDS at the UN Security Council. The AIDS catastrophe has been a key subject of many recent meetings of the G8, African Leaders and OECD Donor Agencies.

In June 2001, a UN General Assembly Special Session on HIV/AIDS was convened in New York the first ever such meeting devoted to a health issue. The Special Session was a historic landmark, highlighting the fact that the HIV/AIDS pandemic was of a severity warranting unprecedented international commitment and response.

At the meeting, Heads of State and Representatives of Governments issued a Declaration of Commitment on HIV/AIDS. This Declaration deals with the extent of the problem the responsibility of the international community to respond to it, and the actions that need to be taken to halt the progression on HIV/AIDS-particularly in poorer countries.

In short-the Declaration presented, for the first time in history, a framework for an international response to a disease that threatens the livelihoods and security of individuals, communities and nations. It established, for the first time ever, time-bound targets tow which governments and the United Nations may be held accountable.

An important objective in mobilizing the international community is to generate adequate financial resources to arrest the spread of HIV/AIDS. It is estimated that a minimum of $7 to $10 billion is required a year to respond to HIV/AIDS in developing countries. This is over ten times the amount currently being spent (by developing country governments and OECD donors).

The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) was developed at the instigation of the UN Secretary General following the UN Special Session. To date the Global Fund has received pledges of over US$2.1 billion in support of HIV/AIDS, Tuberculosis and Malaria programmes in developing countries.

The Policy Approach currently adopted by the EU

The EU and its Member States together constitute the largest contributors to Health, Aids and Population (HAP) programmes in developing countries. The EU has made a substantial and increasing level of investment in Health, AIDS and Population activities over the last decade. EU commitments to health, AIDS and population (HAP) totalled Euro 4.2 billion over the period 1990-1999 of which Euro 700 million was committed in 1998 alone. An approximate total of Euro 2.6 billion went to African States.

In 1993 the Commission presented two communications to the European Parliament and the Council on cooperation policy with developing countries in the field of health and HIV/AIDS. These communications set out the broad focus of EU policy support for health in the latter years of the decade. Priority areas supported have included support for policy and institutional reform of health ministries, financial assistance for the strengthening and improvement of basic health services, technical and financial support for human resource development, support for civil society organisation, support for the prevention and control of HIV/AIDS and sexually transmitted diseases and support for family planning and reproductive health programmes.

A new ACP-EU Agreement was signed in June 2000. In relation to EU support for Health, AIDS and Population (HAP) programmes under this new framework, a more holistic and comprehensive approach, situated within a wider human and social development approach, was proposed. There is a commitment to prioritise Health, AIDS, and Population (HAP) interventions over the period 2002-2006. There is a commitment also to increase the volume of funds allocated to HAP activities and to ensure there are synergies between HAP and other programmes supported by the EU.

On 20 September 2000 the Commission adopted a new policy framework presented in the Communication on “Accelerated Action targeted at major communicable diseases within the context of poverty reduction”. The stated aim of the new EC policy aims was to respond to what is now generally acknowledged as a global emergency: the death of five million people per year from three major communicable diseases HIV/AIDS, Malaria and Tuberculosis.

This policy framework identifies three objectives for targeted action:

•Optimal impact from existing interventions, services and commodities targeted at the major communicable diseases affecting the poorest populations;

•Increased affordability of key pharmaceuticals;

•Increased investment in research and development of global public goods.

The EU convened a high level Round Table meeting in September 2000 to which all major financiers of health and HIV/AIDS programmes were invited. Following this a Programme for Action for HIV/AIDS, malaria and tuberculosis was approved by the EU in February 2001. This provides the policy framework for a coherent EC response to these three diseases for the period 2002-2006.

In this context the European Commission has been closely involved in the development of the Global Fund to fight Aids, Tuberculosis and Malaria (GFATM). To date €120 million has been pledged by the Commission to the GFATM (60 million from the Community Budget and 60 million from the 6^th and 7^th EDF). This contribution represents around 6% of total pledges and has secured the EU a seat on the Board of the GFATM. It is their intention to continue to contribute to the GFATM throughout the implementation period of the EC programme for Action on Communicable Diseases (2002-2006).

In an attempt to bring greater coherence to its support for health and HIV/AIDS, the Commission developed a policy framework on health and poverty in 2002. The objective of this framework was for the EU to present a broad analysis of the international and development context for supporting health and development activities, and to situate the EU response within this framework.

This is the first single community policy framework to guide future EC investment in health, AIDS and population within the context of overall community assistance to reduce poverty in developing countries. The European Council Resolution on Health and Poverty Reduction in Developing Countries was approved earlier this year.

Problematic Areas with these Policies

It is worth noting at the outset that the EU is an important international stakeholder in the international fight against HIV/AIDS. The Commission has revised its policy framework to improve the coherence of its response. It plans to allocate increasing volumes of financial resources to HIV/AIDS programmes. It has played an important role in strengthening coordination between Member States in their response to HIV/AIDS (through facilitating meetings of HIV and Health Experts from each Member State). It is playing an important role in efforts to reduce the price of pharmaceuticals and of stimulating investment in research and development for drugs that primarily affect the poor in developing countries. It played an important role in negotiating the UN Declaration on HIV/AIDS and was instrumental in the establishment (and support of) the Global Fund for Aids, TB and Malaria. Attempts have been made also to improve the internal (institutional) structures of the Commission with a view to improving the effectiveness of their support to HIV/AIDS and the health sector.

Some Prevailing Problems/Challenges Remain. These include the following:

•Sub-optimal internal communication/co-operation between different Directorates within the Commission

•A disconnect between EU development policies (which prioritise health and HIV/AIDS) and their translation into support for EU country strategies and programmes of support at country level

(in this context, much of the EU support at country level is given as programme aid or budget support and is not necessarily directed at health or HIV/AIDS activities)

•A substantial disconnect between what is committed by the EU for HIV/AIDS programmes in developing countries and what is actually disbursed

(in this context, in the period from 1995 to 2000, only 17% of EDF funds committed for health programmes in the ACP region, were disbursed)

•Grossly inadequate levels of financial and technical resources available to the Commission and to Delegations at country level to ensure EU funds for HIV/AIDS activities are effectively programmed and implemented at country level

•Poor ongoing communication between the Commission (in Brussels) and Delegations (in developing countries). Very little support for Delegations at regional level. This often translates into a disconnect between technical personnel advocating greater health/HIV/AIDS expenditure in the Commission and those engaged in planning/implementing programmes at country level

•An essential focus of EU Development policy in the area of HIV/AIDS on the needs of the least developed countries to the neglect of other countries/regions highly affected by the epidemic

•In view of the highly dynamic nature of the HIV/AIDS pandemic and the international response, there is a need for a regular review of the appropriateness of current policy frameworks (for example, in the area of access to anti-retro-viral treatment in low income countries).

Options to Consider for Redressing Current Constraints

In view of the growth of the HIV/AIDS pandemic and its clear (negative) effect on the attainment of the Millennium Development Goals and regional/national security, advocate an accelerated, more co-ordinated and coherent response by the Commission and by Member States to the global HIV/AIDS pandemic.

With a view to improving the efficiency and effectiveness of resources allocated by the EC for HIV/AIDS programmes, advocate further reform of EC structures to facilitate greater communication between Directorates, the contracting of additional technical capacity, improved linkages between the Commission and Delegations and improved budget management.

In view of the enormous growth of the epidemic in Eastern Europe, the lack of political will to address it, the threat this presents to economic and social development in this region (and to the European Community in general), and the lack of a definitive response in the EU to date, advocate that the EU should revise its current policy framework, contribute funding and catalyse political interest in responding effectively to HIV/AIDS among accession states, as a matter of urgency.