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Stakeholders' opinions and expectations of the Global Fund and their potential economic implications.
AIDS. 2008 Jul; 22 Suppl 1:S7-S15.OBJECTIVES: To analyse stakeholder opinions and expectations of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to discuss their potential economic and financial implications. DESIGN: The Global Fund commissioned an independent study, the '360 degrees Stakeholder Survey', to canvas feedback on the organization's reputation and performance with an on-line survey of 909 respondents representing major stakeholders worldwide. We created a proxy for expectations based on categorical responses for specific Global Fund attributes' importance to the stakeholders and current perceived performance. METHODS: Using multivariate regression, we analysed 23 unfulfilled expectations related to: resource mobilization; impact measurement; harmonization and inclusion; effectiveness of the Global Fund partner environment; and portfolio characteristics. The independent variables are personal and regional-level characteristics that affect expectations. RESULTS: The largest unfulfilled expectations relate to: mobilization of private sector resources; efficiency in disbursing funds; and assurance that people affected by the three diseases are reached. Stakeholders involved with the fund through the country coordinating mechanisms, those working in multilateral organizations and persons living with HIV are more likely to have unfulfilled expectations. In contrast, higher levels of involvement with the fund correlate with fulfilled expectations. Stakeholders living in sub-Saharan Africa were less likely to have their expectations met. CONCLUSIONS: Stakeholders' unfulfilled expectations result largely from factors external to them, but also from factors over which they have influence. In particular, attributes related to partnership score poorly even though stakeholders have influence in that area. Joint efforts to address perceived performance gaps may improve future performance and positively influence investment levels and economic viability.
Lancet Infectious Diseases. 2008 Jan; 8(1):14.A report from the International Treatment Preparedness Coalition (ITPC) warns that meeting the "near universal access target" to AIDS drugs access by the 2010 deadline will require an enormous effort by governments, global agencies, and drug companies. According to the report, which looked at AIDS treatment access in 14 countries, "scale-up is working but high prices, patent and registration barriers, and ongoing stock-outs are core issues impeding AIDS drug delivery". "The issues highlighted in this report are real and widespread", said Nathan Ford of Médecins Sans Frontières (MSF; Johannesburg, South Africa). The HIV programmes run by MSF across the developing world are struggling against user fees, high drug costs, lack of human resources, and poor health infrastructure, he told TLID. The ITPC, a group of 1000 treatment activists from more than 125 countries, highlights that the high cost of antiretroviral drugs is a particular barrier in Argentina, China, and Belize. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Sep. 15 p. (UNAIDS Best Practice Collection; UNAIDS/07.25E; JC1362E)A project rolling out in rural Thailand, the Positive Partnerships Program (PPP), has shown that targeted economic assistance can boost self-esteem, ambition and hope-all of which help reinvigorate community bonds and have a beneficial impact in promoting enabling environments for HIV prevention and treatment efforts. This best practice document examines how and why PPP may serve as a flexible and adaptive model in other countries. The project has two distinct yet complementary goals. to enable people living with HIV to lift themselves out of poverty, through the provision of microcredit loans that allow people to set up small businesses in their communities; to reduce HIV-related stigma and discrimination against people living with HIV through business partnerships between one HIV-positive person and one HIV-negative person. The enthusiastic response to PPP from people living with HIV and funders alike serves as a useful reminder of the need to develop comprehensive strategies in response to the AIDS epidemic that reflect a full range of economic, social, legal and political considerations-not just those narrowly based on health. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Jul. 48 p. (UNAIDS Best Practice Collection; UNAIDS/07.22E; JC1260E)Nearly 600 000 people are living with HIV in Thailand. As in every other country, most are poor and many are isolated from their communities. Breaking down the mutually reinforcing barriers of poverty and stigma they face has proved immensely difficult. These barriers are not insurmountable, however. A new project rolling out in rural Thailand, the Positive Partnership Program (PPP), has shown that targeted economic assistance can boost self-esteem, ambition and hope-all of which help reinvigorate community bonds and have a major, positive impact on HIV prevention and treatment efforts. The core of PPP is the provision of microcredit loans to resource-constrained HIV-positive individuals who otherwise have no access to credit in conventional, affordable ways. These loans are intended to support the efforts of people living with HIV to lift themselves out of poverty by setting up small businesses in their communities. Closely linked to this poverty-reduction goal is another vital objective: the reduction of HIV-related stigma and discrimination. As conceptualized by PPP's implementing entity-the Population and Community Development Association (PDA), a Bangkok-based nongovernmental organization-a unique aspect of the PPP project greatly facilitates progress towards achieving these two goals simultaneously: loans are given out not to people living with HIV alone but to partnerships between an HIV-positive and an HIV-negative person. By the end of 2005, a total of 375 partnerships had been formed since the project began in January 2004. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Mar. 4 p. (UNAIDS Policy Brief)Nearly 40 million people in the world are living with HIV. In countries such as Botswana, Swaziland, and Lesotho people living with HIV make up a quarter or more of the population. People living with HIV are entitled to the same human rights as everyone else, including the right to access appropriate services, gender equality, self-determination and participation in decisions affecting their quality of life, and freedom from discrimination. All national governments and leading development institutions have committed to meeting the eight Millennium Development Goals, which include halving extreme poverty, halting and beginning to reverse HIV and providing universal primary education by 2015. GIPA or the Greater Involvement of People Living with HIV is critical to halting and reversing the epidemic; in many countries reversing the epidemic is also critical to reducing poverty. (excerpt)
AIDS is not a business: A study in global corporate responsibility -- securing access to low-cost HIV medications.
Journal of Business Ethics. 2007 Jun; 73(1):65-75.At the end of the 1990s, Brazil was faced with a potentially explosive HIV/AIDS epidemic. Through an innovative and multifaceted campaign, and despite initial resistance from multinational pharmaceutical companies, the government of Brazil was able to negotiate price reductions for HIV medications and develop local production capacity, thereby averting a public health disaster. Using interview data and document analysis, the authors show that the exercise of corporate social responsibility can be viewed in practice as a dynamic negotiation and an interaction between multiple actors. Action undertaken in terms of voluntary CSR alone may be insufficient. This finding highlights the importance of a strong role for national governments and international organizations to pressure companies to perform better. (author's)
Washington, D.C., World Bank, Knowledge and Learning Center, 2005 Nov.  p. (Findings Infobriefs No. 118; Good Practice Infobrief)The Mali Multi-sectoral AIDS Project (MAP) began implementation in late 2004 and is in the preliminary phases of the project cycle. This project has been commended by the World Bank's Board for its innovation and the involvement of the private sector to address HIV/AIDS. Mali is one of the poorest countries in the world due to factors such as its limited resource base, land-locked status and poor infrastructure. According to the 2001 Demographic and Health Survey (DHS) published by the Ministry of Health, Mali's HIV/AIDS prevalence rate is estimated at 1.7% in 2001. The project objective is to support the Government of Malis efforts to control the spread of the HIV/AIDS epidemic and provide sustainable access to treatment and care to those infected with or affected by HIV/AIDS. While Mali currently has a low HIV prevalence rate by Sub-Saharan African standards, it runs a high risk of experiencing an increase in prevalence rates. (excerpt)
Washington, D.C., World Bank, Global HIV / AIDS Program, 2006 Aug. 11 p.AIDS has wide consequences for development, and presents enormous challenges to businesses in the worst hit countries. The epidemic affects workers, managers and markets by increasing costs and reducing productivity. The International Finance Corporation (IFC), the private sector arm of the World Bank Group, works with client companies to mitigate the effects of the epidemic on their operations through its IFC Against AIDS program. The program works with companies in Africa and India, and efforts are underway to raise awareness among clients in China and assess program conditions in Russia. (author's)
SAfAIDS News. 2005 Sep; 11(3):11-12.The AIDS epidemic has become a genuine global emergency with rising numbers of new infections, increasing numbers of deaths and the impact of the epidemic increasingly being felt particularly by the rising numbers of children made orphans or vulnerable by AIDS. The scale of the emergency has resulted in an unprecedented response by African countries, civil society and the international community. Today, there are more resources for HIV prevention, care, support and treatment than ever before. This increase in resources is coupled with an increasing number of actors becoming involved in the AIDS response, often leading to unclear roles and leadership and dispersed authority that may undermine national plans and priorities. Furthermore, resources are often dissipated and scattered, transaction costs have increased, capacities are distracted and weakened while monitoring and evaluation remains fragmented. The result has been that a substantial amount of available resources are not being used effectively and not getting to the people that need them most. (excerpt)
Choices. 2001 Dec; 4.We are facing the most devastating global epidemic in modern history. Over 60 million people have been infected. In the worst affected countries one in four adults are now living with HIV/AIDS, a disproportionate number of younger women and girls. More than 80 percent are in their twenties. The result is a devastating hollowing out of communities, leaving only the very young and the very old and thrusting millions of families deeper into poverty. Meeting this challenge means progress on three fronts: first, preventing new infections and reversing the spread of the epidemic; second, expanding equitable access to new HIV treatments; third, alleviating the disastrous impact of AIDS on human development. Effectively responding to HIV/AIDS requires a wide range of initiatives under strong national political leadership, including sex education in schools, public awareness campaigns, programmes in the workplace, mobilization of religious and community leaders, action to mitigate the impact on poverty and essential social services, support for orphans and tough policy decisions in ministries of finance to ensure optimal allocation of resources to cope with the crisis. (excerpt)
Access to treatment in the private-sector workplace: the provision of antiretroviral therapy by three companies in South Africa.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2005 Jul. 47 p. (UNAIDS Best Practice Collection; UNAIDS/05.11E)The availability of antiretroviral therapy from 1996 onwards has made a huge impact on the lives of those people living with HIV who can afford the drugs. But most of the beneficiaries of the new drugs live in the world's high-income countries. For many of them, AIDS has become a manageable chronic condition rather than a death sentence. Affluent countries have seen a 70% decline in AIDS-related deaths since the introduction of antiretroviral therapy. In countries in which antiretroviral drugs are provided on a large scale (in Brazil, for example), the impact is remarkable. The number of hospital patients with AIDS is greatly reduced, people living with AIDS return to their families and jobs, and AIDS-related morbidity and mortality fall dramatically. However, for the huge majority of people living with HIV in low- and middle-income countries, it is a different story. Neither they nor their countries' health-care services can afford to annually pay the huge amounts of money that the drugs cost, even taking into account recent reductions in drug prices. Cost has not been the only barrier to wide-scale provision of antiretroviral therapy in low- and middle-income countries. Health experts have expressed concerns about providing drugs to large numbers of people in settings where health-care services do not even offer adequate basic care, let alone the support and monitoring needed for antiretroviral therapy. The slow progress in antiretroviral provision has meant that although five to six million people need antiretroviral therapy in low- and middle-income countries, only about 700 000 had access to it by the end of 2004. In sub-Saharan Africa, more than four million people need treatment, but only 310 000 had access by the end of 2004. (excerpt)
In: Global health and governance. HIV / AIDS, edited by Nana K. Poku and Alan Whiteside. Basingstoke, England, Palgrave Macmillan, 2003 Dec. 109-122.Today in much of Africa economic growth has slowed and living standards for the majority have suffered in the face of rising unemployment and mass poverty, resulting in incomes that are presently below the 1970 level. One problem that has been the focus of much attention and contention over the past 20 years is the huge foreign debt owed by African countries to bilateral donors and multilateral institutions. Debt servicing is consuming a disproportionate amount of scarce resources at the expense of the provision of basic services to the poor. In order to receive help in servicing their debts, countries must agree to implement structural economic reforms. This often entails drastic cuts in social expenditures, the privatisation of basic services, and the liberalisation of domestic trade consistent with WTO rules. These policy decisions have had a direct impact on the capacity of African countries to promote, fulfill and protect the right to health of their citizens. This is further compounded by ill-conceived privatisation of basic services such as water and health services, without any regard for the ability of the poor to access these essential services at a cost they can afford. Finally, adherence to WTO trade rules, which often comes as an extension of liberalisation policy, hampers the capacity of African governments to produce or purchase less expensive generic drugs for their citizen without fear of retaliation from the developed countries. (author's)
Close your eyes to the HIV problem today and tomorrow you'll be living in a country of old people and won't have a partner to play chess with.
Connections. 2005 Jan;  p..What is the best way to tackle the HIV/AIDS problem in Russia when the scale of this infection's spread has passed all the bounds? What can be done when the efforts of numerous HIV-service organizations and domestic and international NGOs to implement short-term educational programs and information campaigns are not effective enough to appeal to the common sense of both those who are at risk and those who have the power to stop the virus from spreading further? Do the people of this country have eyes and, if so, what does their future look like when some 80 percent of the estimated 1.5 million HIV-positive Russians are under the age of 30 . . . when only 3,000 out of the 50,000 who are in dire need of treatment have access to it? Will this country still be a strong power if one million young people die from AIDS by 2008, as forecasted by Vadim Pokrovsky, head of the Federal AIDS Center, unless appropriate steps are done by the government to prevent it? (excerpt)
BMJ. British Medical Journal. 2005 Nov 12; 331(7525):1104.By 2010, poor developing countries will continue to suffer from a shortfall in supplies of low cost antiretroviral drugs (ARVs) for patients with HIV/AIDS unless rational measures are taken quickly, a top World Health Organization official has warned. “We’re going to reach a crisis in terms of supply very very soon . . . of [antiretrovirals] throughout the developing world because the scale-up is happening very very quickly,” Dr Jim Yong Kim, WHO’s outgoing director for HIV/AIDS, told the BMJ. The issue now for the public health world, he said, in the aftermath of the recent summit of the G8 (the world’s most industrialised countries) in Scotland, was that a potential eight to 10 million people will need treatment. In July, the leaders of the G8 agreed at the Gleneagles summit “to provide as close as possible to universal treatment for AIDS by 2010.” (excerpt)
Investing in a comprehensive health sector response to HIV / AIDS. Scaling up treatment and accelerating prevention. WHO HIV / AIDS plan, January 2004 - December 2005.
Geneva, Switzerland, WHO, 2004. 72 p.This document discusses the context for the work being undertaken in WHO’s HIV/AIDS programme. It analyses the epidemiological situation and includes the most recent estimates of antiretroviral coverage, the global strategic framework and current challenges to translating this into results at the country level (Section 1 – Background). Section 2 describes the comparative advantages offered by WHO, the functional areas of activity within the HIV/AIDS area of work for 2004–2005 and the specific focus of the programme on scaling up antiretroviral therapy and accelerating HIV prevention. Section 3 describes how WHO is structured and how resources and capacity are being reoriented to support country-level action. Section 4 illustrates how WHO works within the United Nations system and with other partners. Section 5 outlines the resources required in 2004–2005 for WHO to accomplish its stated contribution to HIV/AIDS. Section 6 describes the mechanisms for technical and managerial oversight of the HIV/AIDS programme. The WHO HIV/AIDS Plan is not a detailed work plan. Rather, it provides an overall framework to guide the departments responsible for HIV/AIDS in preparing such work plans at the country, regional and headquarters levels of WHO. These work plans are now being developed and will define the specific tasks and activities required to bring the WHO HIV/AIDS Plan to fruition, together with timelines and resource requirements. Joint planning sessions between headquarters, regional and country offices integrate the work of the three levels to ensure that all priority needs are addressed and that gaps in resources are identified. (excerpt)
Sexual Health Exchange. 2003; (1): p..At the end of 2OO1, an estimated 40 million adults and children were living with HIV/AIDS worldwide, of whom 8.6 million in the Asia-Pacific region - more than any other region besides sub-Saharan Africa. Sixty percent of Asia-Pacific HIV infections were in India alone, translating into almost 4 million people living with HIV/AIDS (PLWHA), the second largest number after South Africa. Although India's adult HIV-prevalence rate is low at about 0.8%, this converts into staggering numbers due to India's enormous population. HIV is spreading among highly vulnerable groups such as sex workers and truck drivers, and beyond, among the general population. (author's)