5. Policy Coordination and Resources

The 1993 World Bank Report stated: “Because good health increases the economic productivity of individuals and the economic growth rate of countries, investing in health is one means of accelerating development. More important, good health is a goal in itself.” Heavy as the additional costs of effective programmes to combat AIDS may be, they would be far outweighed by the economic and social costs of not confronting this epidemic.

It was pointed out that support by the international community for AIDS prevention is not a donation, but rather, in view of the global spread of the HIV virus and the implications for political and economic stability, an act of enlightened self-interest. It is clear that the epidemic can be successfully confronted only if there is high-level political will in the international community as well as in the countries most severely affected. Government planners and policy makers need to plan more effectively for the socioeconomic and development impacts of the AIDS epidemic, particularly on key occupations, large cities, selected rural areas, tourism potential, etc. For their part, external partners can be most helpful by cooperating closely with developing country governments and assisting in designing coordinated national AIDS control strategies.

A study by the WHO Global Programme on AIDS has estimated that an investment of US$ 2.5 billion annually could prevent almost one half of projected new HIV infections in developing countries by the year 2000. This represents an investment of as little as US$ 0.60 per person per annum in these countries. This figure includes education, counseling, diagnosis, provision of condoms and promotion of their use, and treatment of STDs.

From information submitted by representatives of aid agencies from Canada, the European Community, Germany and the United Kingdom, as well as from the United Nations Development Programme, the United Nations Population Fund, the World Bank, and Family Health International, it is difficult to be sanguine about prospects for significantly increased international financial support to combat HIV/AIDS. International assistance generally is in a phase of debate and reorganization, and economic and fiscal problems in the traditional donor countries combine with a perceptible disenchantment with the effectiveness of past resource flows.

Although there is often strong rhetorical commitment to population programmes and AIDS control, the amounts devoted to these sectors currently account for only a very small portion of total international assistance.

When financing is scarce, optimal use must be made of existing resources. This could be achieved, for example, by integrated programmes involving family planning, women’s and children’s health, and HIV/AIDS prevention. The efficiency and effectiveness of ongoing population and family planning programmes with an AIDS prevention component can be increased. Suggestions to this end included achieving economies of scale through larger projects. Programmes could be designed to provide for at least partial cost-recovery. Efforts should also be mounted to encourage more participation of the private sector and the leveraging of private funding, for instance by removing taxes on condoms and on drugs to treat STDs. It is also important to involve local communities in mobilizing resources to a greater extent. Finally, governments may need to be persuaded that the time has come when borrowing money for AIDS prevention is a worthwhile investment, in long-term socioeconomic development.

The problem of supply and distribution of condoms, and the related issue of education and motivation for their use, is a classic example of the need for creative approaches and coordination at national and international levels. UNFPA has launched a global initiative to assess contraceptive needs, possibilities for local production, and management and logistical problems. An important objective of this programme, which also involves other international agencies, is to develop long-term estimates of condom demand and supply and to design appropriate strategies for expanding distribution and use. Some participants raised the possibility of creating an international fund dedicated to increasing the supply and use of condoms.