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Friday, Jan 9, 2009
Discussion of issues like prostitution has been difficult at this U.N. meeting. The mention of homosexuality and sex workers even created a battle between Northern European and Islamic nations, over the wording in the U.N. platform of which groups are "vulnerable" to HIV/AIDS.
The term "vulnerability" is causing so much heartache in that building right now. It's quite astonishing. I flash back to my life in the field and I think about the people I see dying and I think: If they only knew the time and the heartache caused by one word in a very beautiful document, they would be distraught.
The people I deal with on a daily basis are asking for clean water, for food, for pain relief, for simple skin preparations for itchy skins. They seem very far removed from these large declarations and large meetings in U.N. buildings.
But the meeting itself is good in that it's bringing together lots of different people to talk about this very serious pandemic. In the last 20 years, 58 million people have been infected, many of whom have already died. We are at a crucial time where something must be done -- there's a small window of opportunity for us all to do something substantial. As such, it's disappointing to see that all we can come up with is a $1 billion to $2 billion fund.
Why is it so difficult for the United Nations to raise funds for such a high-profile cause? Do corporations and governments fear that their contributions won't be well spent?
Many of us here have had previous experience with these large funds. What happens? Yet again another bureaucracy must be formed to administer the funds. A quantity of the money will be taken for administrative purposes. There are already people talking about this money being spent on drugs and commodities and other people arguing that we need it for prevention.
People are very wary of these large U.N. hierarchies and the so-called panel of experts who will determine how the money is going to be spent and whether the programs are technically good.
Would the money be better spent if it were given directly to local programs and nongovernmental organizations rather than a new bureaucracy?
Our experience is that if you get this money down to the community level, the communities themselves should be directing where the money is spent. It should be community led and community focused.
The NGOs are one means by which the money can get down. Over the last few years, following the Jubilee 2000 debt relief movement, there's been a lot of interaction between local governments and civil societies for debt relief and poverty reduction strategies. I'm not saying the systems are perfect. We're saying use the channels that have already been set up -- donate the money bilaterally, some to international governments, some to NGOs, some to civil society. Don't set up another hierarchy, another bureaucracy. These are the problems we see with the fund.
What sorts of community-focused groups would you like to see funded with this money?
In the Congo, we work with women who are HIV-positive through Fondation Femme-Plus. They're a very practical organization -- they're all HIV positive and concerned about who will look after their children when they die, who will look after them when they are sick.
A lot of them have faced stigma and have been ostracized from the community. They're a self-help group, and they are incredible, they're so strong and courageous. Though they don't set themselves up as a medical agency, they will take people who are sick to the medical services that are available locally. They will make sure that they are paid, they ensure that the women's children get to school. They also pay the consultation and fees for drugs and for the education of their children. For families without food, they will make sure they have food packets. Life is very difficult for them. Those are the groups we should be supporting.
My personal experience in Africa is that the best work is being done in communities. But the hospitals are now so oversubscribed, and 80 to 90 percent of their occupancy is due to HIV/AIDS, so there's no room in the hospitals, even if you wanted to provide the anti-retrovirals. The state health systems are crumbling under the strain, and other systems need to be formed.
Throughout Africa, Christians have done a huge amount of health work. In the Congo, 80 percent of the work is being done by the Catholic Church. In Malawi, 50 percent is done by the Anglican Church. Because their state health systems are failing, the churches are having to take up a huge amount of the load. They're struggling -- they need more resources and people. That's a serious issue for us. A large number of our partner staff have died of the disease, lots of health workers are dying of the disease or getting burnout because it's exhausting work dealing with people who are so ill and dying all the time. These are very serious issues that have got to be considered in the next few years.
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