Community combats AIDS in the ACP countries

by Achim KRATZ

Silence, discovery, mobilisation and consolidation. These are the four stages of the AIDS control campaign so far, says the World Health Organisation (WHO).

The first of them, which began in the mid-1970s, was the time of the 'silent pandemic' during which HIV took hold in almost every continent, with barely anyone noticing.

In 1981, a description of AIDS signalled the end of this era of silence during which the human immuno-deficiency virus and its methods of transmission had been identified.

In phase three, which began in 1986, the human resources to run the campaign were mobilised first of all in the form of emergency aid and then as medium-term structured aid.

Yet another phase, consolidation, has just begun in which emergency aid is giving way to longer-term activities which are more structured, better thought-out and better coordinated, both nationally and internationally. The Commission's programme is being reorganised to reflect the urgency of operations and there is long-term planning and a drive to ensure that all the national partners in the different sectors concerned take an active part in the national programmes.

This means that specific AIDS control schemes have to be better coordinated and integrated in the EC's development aid programmes, particularly with the health components of the national indicative programmes and the counterpart funds (mainly accruing from the structural adjustment programmes).

Aims

The prime aim, now and in the coming years, is to prevent the sexual, intravenous and perinatal transmission of AIDS.

Prevention is undeniably the most important aspect of international strategy, because it is the only way of limiting the human consequences and social and economic cost of HIV infection. But it is, alas, highly unlikely that any efficient, affordable vaccine will be available by the end of the century, so yet another job in the coming years is to reduce the individual, social and economic impact of the advancing pandemic.

EC priority is on completing and consolidating the ongoing operations and making plans to extend them if this is called for. There are two important criteria for new AIDS control projects. Firstly they must be part of health schemes which the countries are running with EC cooperation and, secondly they must be part of national AIDS control campaigns-which all ACPs now have.

Lominancing

The Commission aims to spend at least ECU 50 million of LomV funds on AIDS, of which at least ECU 30m is to come from the ACP States' national indicative programmes and ECU 20m from the regional funds for all ACPs. This is new, because the ECU 39m of the previous Convention were entirely financed from the regional monies, a decision which the Commission took at the beginning of the AIDS programme, in 1987, for two main reasons.

First of all, it was vital to get over the political and psychological hesitations about the programme in the ACP countries, since some of them even refused to admit that there was any trace of the pandemic on their territories. The addition of regional funds to the national programmes was enough of a financial incentive to overcome this.

Secondly, the AIDS operation was something entirely new, and uniform design and action were vital from the outset to ensure that the right strategy could be developed, on the basis of experience gained.

Once this was achieved, there was no longer any need to go on financing the whole of the AIDS control programmes from the all-ACP regional funds. There were financial reasons for this (i.e. there was a limit on the all-ACP action funds), but the most important thing was that ACP government leaders were now fully aware of the gravity of the situation and financing AIDS campaigns from indicative programmes gave the governments more responsibility for actually running the projects. This is important because the EC drive can never do more than back up the national efforts of the individual States.

Administrative structures

In the emergency phase which began in 1987, these activities were new, the Commission lacked expertise and so the AIDS Task Force was set up outside to identify, define and set up specific AIDS control operations. Given the advance of the pandemic and the fact that the disease is clearly a long-term problem, the Commission of the European Communities' role in the AIDS campaign was stepped up and the Task Force maintained as it stood.

A special AIDS campaign coordination and monitoring unit is now being set up in the Commission to oversee coordination with the Member States and other funders (especially the WHO) and ensure that AIDS-specific activities are consistent with health and development schemes in general. The unit will represent the Commission in international meetings and conferences on the pandemic and establish contact with research institutes, consultants and specialised NGOs.

On 1 January, the AIDS Task Force became a technical assistance group, based in Brussels, to back up the new unit and help the ACP countries define national and/or regional AIDS control policies and prepare and help run specific projects to be submitted for Commission financing. A.K.