Who Will Save the Children of Africa?
By Kingsley Chiedu Moghalu, Esq. - October 30, 2003

WASHINGTON, DC - The HIV/AIDS pandemic is continuing its relentless onward march - a catastrophe that United States Secretary of State Colin has described as greater than terrorism and conventional weapons of mass destruction, one that the United Nations and its Secretary-General Kofi Annan has described as the greatest threat to the wellbeing of future generations.

'The HIV/AIDS Epidemic and the Future of Africa's Children'

42 million people live with HIV/AIDS worldwide, 29 million of them in Africa, most of them women and children. For them, this a death sentence because they have no access to the

medicines that can treat the disease.

They have no medicines because they are too poor to afford life-saving drugs. Everyday in Africa, 7,000 people die of AIDS.

By the end of this decade, if we do not do what we should do, if we do not shake off our apathy and fight this war harder than any other, with real interventions and resources rather than words, close to 100 million people worldwide will be infected by the epidemic.

In Asia and Eastern Europe, the epidemic is also on the rise. They too are at risk. But in Africa, the enemy is already inside the gates, and the impact of the epidemic is destroying whole societies.

One of the most terrible aspects of the epidemic - and the least acknowledged - is that HIV/AIDS has created 14 million orphans, 12 million of them in Africa. In the words of Nelson Mandela AIDS is "a threat that puts in the balance the future of nations. AIDS kills those on whom the society relies to grow the crops, work in the mines and factories, run the schools and hospitals and govern countries. It creates poverty when parents and breadwinners die and children leave school earlier to support the remaining children".

These are people we know, our relatives and friends; they are not statistics.

Speaking of statistics, it is projected that by the end of this decade there will be 25 million children and young people orphaned by AIDS. In countries like Kenya and Zimbabwe, close to a million children are already AIDS orphans in each country.

Children orphaned by AIDS are often consigned to a life without hope, beginning with the emotional trauma of their parents dying of AIDS before their very eyes.

A future of dysfunctional societies is being created today. Consider:

• Children orphaned by AIDS are more vulnerable than other orphans to high-risk lifestyles that result in HIV infections, perpetuating a vicious cycle of transmission of HIV/AIDS
• Children orphaned by AIDS are more likely to drift into crime.
• Such children often become the victims of exploitative child labor.
• AIDS orphans are prone to become child soldiers. Warlords and terrorists will conscript these children - a trend with important future strategic implications. We have already seen too many television pictures of hordes of children, many of them orphaned by AIDS, as child soldiers in the wars that have wracked the African continent in recent years - in Liberia, Sierra Leone, Democratic Republic of Congo, and other theatres of conflict.
• As children lose their parents to the AIDS epidemic and drop out of school - or are unable to get into school - a critical mass of citizens without knowledge and skills grows up. This will create massive unemployment.
• The rise of AIDS orphans is breaking the generational transmission of knowledge that enables societies survive, and will mire affected countries in poverty. The result will be the economic collapse of several societies.

Signs of Hope

The world is finally waking up to the impact of the AIDS crisis.

Several countries have formulated national strategies to combat AIDS, but for lack of resources, the fight against the epidemic has not been scaled up to match its true dimensions.

At a summit of African leaders on HIV/AIDS in Abuja, Nigeria in April 2001, Kofi Annan issued a call to global action through the establishment of a "war chest" to fight AIDS and other diseases of poverty.

The Global Fund to Fight AIDS, Tuberculosis and Malaria was established in January 2002 with its headquarters in Geneva. The Global Fund was created to finance a dramatic turnaround in the global scale fight against the three diseases that kill six million people each year. It is an innovative partnership of governments, civil society (including communities of persons living with these diseases) and the private sector.

The Fund finances concrete programs for prevention, treatment and care of the three diseases in highly affected poor and lower-middle income developing countries. These programs are developed and proposed by the affected countries and communities themselves, ensuring local ownership of these interventions. Proposals are reviewed by the Fund in periodic funding rounds according to rigorous standards of feasibility and potential to save lives.

In three rounds of proposals and funding decisions, the Global Fund has committed US $2.1 billion to 200 programs in 121 countries for a two-year initial period, renewable for another three years based on performance. Money is being disbursed to the frontlines through light but accountable mechanisms, and lives are already being saved as persons living with AIDS in an increasing number of countries are treated with medicines purchased with resources from the Global Fund and prevention and voluntary counseling and testing programs are set up.

60% of all grants have gone to African countries, with more than $1 billion committed to programs in 40 countries in the continent. 20 % of funding has gone to Asia, 11% to Latin America and the Caribbean, and 9% to Eastern Europe.

60% of funds support anti-AIDS programs, 23% for malaria, and 17% for tuberculosis.

In Swaziland, which has one of the world's highest HIV/AIDS epidemics (one-third of all adults are HIV-positive, and prevalence among pregnant women has risen from 4% in 1992 to 39% in 2002), the Global Fund is supporting that country's national response against HIV/AIDS with a grant of $30 million.

These resources will train 95% of doctors and midwives in prevention of mother-to-child-transmission (PMTCT), provide aids orphans with food, rehabilitate the institutions in which they live and offer educational opportunities through scholarships.

In Zambia, the Global Fund is providing $68 million over two years to expand a comprehensive response involving prevention, mitigation and treatment of HIV/AIDS.

In Kenya, the Global has committed $55 million over two years to programs to fight AIDS, including a communication and behavior change campaign targeting 8 million youths in four provinces and funding for the Kenya Network of Women Living with AIDS.

In Nigeria, the Global Fund has committed $28 million to support the expansion of the existing national HIV/AIDS treatment program, including prevention of mother-to-child-to-child transmission, as well as advocacy campaigns by non-governmental organizations.

The Global Fund has committed $6 million to support national efforts to fight HIV/AIDS in Senegal.

In just over 18 months of existence the Global Fund has altered the landscape of possibilities in the fight against AIDS, TB and malaria.

As Secretary of State Colin Powell said at the United Nations High-Level Meeting on HIV/AIDS in New York on 22 September, "only two years ago, the Global Fund was just an idea. Today, it is a reality. The Fund is already helping deliver lifesaving treatments, and to prevent new infections".

There are many who believe the developing countries have no capacity to absorb large-scale resources. But the work of the Global Fund proves that there is a far higher level of absorption capacity than is generally believed by some donors. That is because Global Fund financing utilizes the capacities of all sectors in recipient countries, not just that of governments. While 50% of all recipients so far have been government agencies, 40% are from civil society, including NGOs, faith-based organizations, people living with the diseases, and academic institutions.

The Global Fund is a financing mechanism, not an implementing entity. We work very closely with -- and would not be effective without - our technical partners in the United Nations system, especially the Joint United Nations Program on AIDS (UNAIDS), the World Health Organization (WHO) and the World Bank. UNAIDS and WHO provide essential technical assistance to various countries in the submission of funding proposals to the Global Fund and the implementation of successful ones.

The Fund is also supported by bilateral partners including the United States Government. U.S. Secretary of Health Tommy Thompson is Chair of the Board of the Global Fund and has made enormous contributions to the Fund's governance and resource mobilization efforts.

But we are not yet there - not by a long shot. To continue to finance lifesaving programs in poor countries, and expand these programs to a scale at which they can actually begin to turn the powerful tide of infections and death, the Global Fund needs far more resources than the $4.7 billion that have been pledged to it through 2008.

UNAIDS has projected that the world needs to spend $10 billion annually by 2005 in the global fight against AIDS, rising to $15 billion annually by 2007. Half of these resources are expected to be channeled through the Global Fund, the other half through direct bilateral assistance from donor countries and domestic resources of affected countries.

To finance future rounds of proposals in 2004 and re-finance existing programs beyond the initial two-year commitment, the Global Fund needs $3 billion in 2004.

Precious momentum will be lost if new rounds of proposals are not financed as a result of inadequate resources.

Recommendations to Reverse the Impact of HIV/AIDS on the Future of Africa's Children

• Far more - and effective - national strategies are needed to halt the exploding phenomenon of AIDS orphans. Far too few African countries have as yet formulated a coherent policy to save the future of their at-risk children - let alone implement one.
• Stop the problem at its source. This can only be achieved by providing life-extending treatment to adults and children with AIDS. Of the 5-6 million people who need it, just 50,000 Africans today have access to medicines, though those numbers will multiply dramatically over the next five years as a result of treatment programs financed by the Global Fund and bilateral initiatives such as President Bush's Emergency AIDS Plan and the William Jefferson Clinton Presidential Foundation, as well as those by the Bill and Melinda Gates Foundation,
• The World Health Organization has declared the absence of treatment a global emergency, and has set a goal of getting 3 million people on treatment by 2005. For that goal to be met, the Global Fund will need to receive - and have the resources to finance - ambitious, credible proposals for treatment programs in 2004. Synergies with bilateral initiatives will be critical to closing the treatment gap in Africa.
• National political leadership makes a difference, especially in prevention of transmission of HIV. Uganda is a well-known example of success. More African leaders are taking political leadership of the fight against AIDS in their countries, but much more needs to be done to translate political engagement into effective national policies. With effective programs, backed up with resources, 29 million of the projected 45 million new infections by the end of the decade can be averted.

Conclusion: Don't Forget Malaria

Let me conclude with a word on malaria.

Malaria kills more than one million children each year, more than 90% of these in Africa alone. Yet the world is losing sight of the impact of this scourge partly as a result of the increased attention to the AIDS crisis.

In addition to programs against AIDS, the Global Fund is financing with equal vigor the fight against malaria in African countries including Tanzania, Senegal, Swaziland, Kenya, Zambia and Mozambique, and is set to achieve unprecedented outcomes.

Global Fund-financed programs in Africa will purchase and make available over 60 million insecticide-treated bed nets to prevent malaria transmission. Too many African families are too poor to afford this effective and long-lasting intervention at the average cost of $5 a net. The Global Fund is also financing the availability of medicines for resistant malaria in the continent.

Longer term, the Gates Foundation is funding research into a malaria vaccine.

Investing financially and politically today in the fight against AIDS, TB and malaria is an investment in our global future.



Kingsley Chiedu Moghalu, Esq. is Head of Resource Mobilization and Global Partnerships at The Global Fund to Fight AIDS, Tuberculosis and Malaria

	AIDS in the DRC "In the Democratic Republic of the Congo it might be several years until the full impact of HIV/AIDS is revealed. A telltale sign of the impending crisis, however, is that patients suffering from AIDS-related diseases occupy up to 50 percent of hospital beds in the country." William Swing Special Representative of the UN Secretary-General in the DRC

	AIDS Orphans With 12.1 Million AIDS Orphans, Sub-Saharan Africa has more than 91% of the world's AIDS Orphans. If current trends continue, it is estimated that by the year 2010 there will be approxi-mately 25 million AIDS Orphans in Sub-Saharan Africa.

	Children with AIDS 1.4 million children (under the age of 15) worldwide were living with HIV/AIDS as of the end of the year 2000—1.1 million of those children were innocent African children! 500,000 children worldwide died from HIV/AIDS during the year 2000—440,000 of those children were African children.