Aid Dependence May Hurt Successes in HIV, AIDS

via CAAI

By Marwaan Macan-Markar

BANGKOK, Dec 28 , 2010 (IPS) - Thanks to a healthy cocktail of foreign aid and a pragmatic condom policy, one of South-east Asia’s poorest countries is well on course to meeting an international target aimed at reversing the spread of HIV and AIDS.

But even as Cambodia’s basks in praises for its achievement – completing one of the eight U.N. backed Millennium Development Goals (MDGs) by 2015 – it is facing a steady trickle of troubling questions about a possible reversal of the kingdom’s success.

Cambodia’s continued dependence on foreign donor assistance is not the best prescription for sustaining the country’s "remarkable history in driving down HIV infections", warns a new report, co-authored by Cambodian public health experts, released in December.

"Future success is not guaranteed and the government needs to focus increasingly on wise prevention tactics and assume more of the financing of its AIDS programme," reveals the statement accompanying the Dec. 21 report, ‘The Long-Run Costs and Financing of HIV/AIDS in Cambodia’.

The Cambodian government’s initial response to the report has been conciliatory. "We welcome this in-depth and forward-looking report for our country," says Cambodian Health Minister Mam Bunheng. "Cambodia has a long history of fighting HIV/AIDS head-on, with effective prevention strategies."

The report, which has the backing of the Results for Development Institute (R4D), a Washington DC-based think tank, argues that a gradual increase in a funding role by the Cambodian government would help prevent a worse-case scenario of the virus infecting four times more people in 2031 than has been anticipated.

In a best case scenario, with proper funding, Cambodia could reduce infections to 1,000 people a year in 2031, reveals the report, but warns that if the country’s AIDS efforts "stall and current coverage of key services declines, especially in carefully targeted prevention, the number of infections could climb to 3,800 a year in 2031."

Cash-strapped Cambodia’s recognition as a success story can be seen in its two-decade achievement since HIV/AIDS was first reported in 1991. By 2000, this country, struggling to rise from nearly 20 years of civil war and the impact of the genocidal Khmer Rouge regime, was reporting 15,000 new HIV cases a year.

In 2000, when world leaders announced the eight time-bound development targets, the MDGs, at a U.N. summit in New York, the prevalence rate among adults in Cambodia was close to two percent. Yet by 2009, it had dropped to 0.7 percent.

Besides the call to roll back the spread of HIV in the developing world, the MDGs also targeted countries like Cambodia, where a third of its nearly 15 million population live below the poverty line, to slash the number of the poor, ensure universal primary education and reduce child mortality.

Cambodia’s achievements have been built around a highly publicised 100 percent condom use campaign for sex workers since 1997. Consequently, HIV rates among sex workers have gone from over a 40 percent prevalence rate in 1996 to 14 percent by 2006, according to a national survey.

At the same time, the country has taken strides to provide life-prolonging anti-retroviral drugs (ARVs) for people living with HIV. Currently, 40,000 people with HIV are on the anti-AIDS drug therapy, a number that accounts for over 85 percent of those who need ARVs. A decade ago, only 71 people were on this once costly treatment.

"The issue here is a question of long-term sustainability and predictability," says Tony Lisle, Cambodia country coordinator for the Joint U.N. Programme on AIDS (UNAIDS). "In the medium and short term, the Cambodian government can’t be expected to meet overall costs."

"We need cost-effective, high-impact, low-cost interventions that avert new infections," Lisle said in a telephone interview from Phnom Penh. "Donors need to ensure that as donor resources decline, the government share of resources increases as Cambodia’s GDP (Gross Domestic Product) increases."

According to Lisle, Cambodia will need 500 million U.S. dollars for its HIV/AIDS programme between 2011 and 2015. "The government already has 263 million dollars in the pipeline."

International donors fund close to 90 percent of the country’s HIV programme, whose resources have ballooned from 21 million dollars in 2001 to nearly 52 million dollars by 2008.

Such assistance, including substantial grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria, has been a lifeline in helping Cambodia develop since the 1991 peace accords in the country. In June, international donors pledged 1.1 billion dollars in aid for 2010, up from the 950 million dollars in 2009.

To avoid a second wave of HIV infections, more funds should go toward the populations with the most risky behaviour, ranging from sex workers, men who have sex with men (MSM), and injecting drug users, says Ly Pisey, a member of Social Action for Change, a women’s activist group based in Phnom Penh.

But she cautions against the emphasis international donors put on targeting only a select slice of Cambodian women at risk of HIV and AIDS. "This policy has seen discrimination, since it has just focused on brothel-based sex workers, while sexually transmitted infections and HIV are issues of everyone, including clients and housewives," Ly said in an interview.

Likewise, the Cambodian government’s continued dependence on international aid for a substantial number of its development programmes reveals that Phnom Penh is far from ready to shoulder more funding for HIV programmes, she added. "Without political will, this will never be possible, where Cambodia could walk or run on its own."