The health of our global workforce is severely threatened by the spread of HIV, and the UN is urging nations to fill the ‘funding gap’ that exists in addressing HIV/AIDS. In 2005, $8.3 billion was available, with an additional $3.3 billion needed; this number grew to $8.9 billion available in 2006 with $6 billion additionally needed. However the emphasis solely on massive financing in misleading. My study joins the body of research and voices of grassroots workers on the HIV/AIDS issue that argue massive funding alone will not achieve global goals to end AIDS.
“Good” policies are important, but better data is urgently needed. Referring back to Table 1, it is troublesome that in 22 cases of aid giving, or over 12% of AIDS-aid recipients, UNAIDS possessed no information about the HIV rate in the recipient nation. There is a troublesome lack of accurate, sufficient data on development, and a lack of transparency and logic in presentation of the numbers that do ‘exist’. Unfortunately funding decisions continue to be made in the midst of insufficient information. There were many variables that I felt would have given a clearer picture as to when aid works and who receives aid, but because of problems like self-reported behavior and politicization of the pandemic, this information does not exist. Better surveillance methodologies for calculating true HIV rates must be created and implemented.
It would be helpful to gather data on broadly exactly what kinds of programs are funded. As noted by Human Rights Watch, “Groups know the more they talk about abstinence, the more they’ll get US funding. And they fear that if they talk about condoms they’ll lose funding – or, worse, get kicked out of the country.” From my experience in Ghana and Tanzania, I met many local leaders of NGOs who wasted much of their time that could have been used to provide services on burdensome grant writing and reporting tasks. In one instance, a leader had to find ways to hide in the budget her distribution of condoms to youth at risk and in need, because her PEPFAR grant did not permit promotion of condom use to young people.
My study is broad and preliminary, and I look forward to specifying further research on populations and regions receiving aid. To really understand effective financing methods, better data on programs and populations are necessary. For example, if pregnant women have significant HIV declines, it would imply prevention efforts are working. If newborns have significant HIV declines, it would imply treatment efforts are working. This population specific data does not exist in a standardized data set and UNAIDS individual country surveillance reports are often missing and abundance of intended measurements.
My study also grossly overlooks the intricacies of funding AIDS initiatives to what programs should money go to best serve the population? While Easterly (2006) argues that treatment efforts are ultimately a less cost effective and perhaps wasteful use of funds, one must also consider the social limitations and complications of effective prevention messaging and consequent behavior change. I cite my own experiences with youth in Ghana and Tanzania, where youth explained the blatant correlation in their vision between increased use of condoms (a product introduced to the continent only after AIDS began to ravage) and increased HIV rates. While at the root of this misunderstanding is an ignorance of the science of contraceptives, which can be ameliorated with an education program, there is a justifiably strong element of trust involved in something as personal as sexual health. Prevention education is complicated and may require more attention and funds - certainly more than the $14 a year for a box of condoms (Easterly, 2006) – than we presently anticipate. Also AIDS treatment is not only saving the life of one person, but consequently, the lives of those dependent on the person. In this specific disease that overwhelmingly kills parents and members of the labor force, treating and sustaining the lives of those most affected mean less AIDS orphans, the next major challenge on the AIDS frontier, and a stronger labor force and revived national economy.
This study therefore suggests that giving money for HIV/AIDS as a disease-specific initiative may be an effective way to decrease the burden of the pandemic. As briefly mentioned in the paper, and implied in the choice of independent variables, AIDS is a syndrome closely entwined with other diseases and health conditions, most of which can be effectively addressed for far less money than AIDS, for example, diarrhea, measles, or malaria. However this study does not abandon the need for AIDS specific intervention, because unlike the most cheaply treated diseases, which also need funds, AIDS comes with uniquely complicated social stigma that creates enormous barriers to access, even when resources and services do exist. For example, someone may choose not to get tested if they suspect they are positive, and therefore not seek treatment, because walking into an AIDS clinic implies to the community that they have been promiscuous or sinful in some way. There is therefore a need to pay closer attention and perhaps spend more money on testing different interventions and initiatives that will break down social stigma – a very real process far more complicated than handing out pills or giving vaccines.
Although data on pledged AIDS-Aid was extractable, the process involved extensive manual gathering of dispersed information. Limited information is publicly available on how the money is actually spent, so this study was restricted to the assumption that money given was money spent, which may not always be the case.
As noted above, It is difficult to measure the opposing influences on HIV prevalence of prevention efforts that reduce new infections and treatment scale-up that reduces deaths among people with HIV. HIV data itself is also suspect, as in 2007 all estimates were revised by the UN based on updated and implemented surveillance methodologies. Data are often missing, as oftentimes countries like Angola, Liberia, or Sudan, have limited HIV prevalence data because of country conflict, yet they are sadly countries with most at-risk and possibly most infected populations.
Laurie Garret of the Center for Global Development, notes that “What in reality has happened is we have had to use [certain] markers for HIV in society because we didn’t have people on the ground with the skill set, nor the political support from governments to do the kinds of door-to-door surveys, household surveys and so on that could have revealed more meaningful figures for what was actually going on with HIV/AIDS.” The UN itself recommends that more emphasis is required to strengthen systems to collect and analyze data and to improve the quality of such data to strategically guide programming.” My research has led me to enthusiastically concur on both points.
I conclude that although the significance of my results do not give strong proof that policies interacted with aid will bring AIDS relief, my findings support and now join the work of scholars who have proved that aid alone is ineffective if not detrimental to development, and “good” policies show promise for aid efficacy. Significant results argue that whether or not a country receives aid does make a difference in decreasing HIV, however a selection bias does exist and is fueled by conditions other than need. Surely, AIDS is an urgent issue and the international community must support effective prevention, treatment, and care programs. The World Bank, Global Fund, and PEPFAR programs are indeed changing people’s lives by providing necessary services and attention to HIV infected and affected communities. However the international community must also simultaneously push the UN and its organizations to put their well-researched and developed methodologies into action to engage national governments in information seeking and national surveillance, and prioritize possession of accurate and up to date information.
Monday, April 28, 2008
References
Akunyili, Dora, 2006. “The fight against counterfeit drugs in Nigeria.” Global Corruption Report 2006. (5): 97.
Alesina, Alberto and David Dollar. 2000. “Who Gives Foreign Aid to Whom and Why?” Journal of Economic Growth. 5(1): 33–63.
Bearce, David and Daniel Tirone. 2007. “Foreign Aid Growth, and the Strategic Goals of Donor Governments.” Paper presented at the annual meeting of the American Political Science Association.
Bernstein, Michael and Myra Sessions. 2007. “A Trickle or a Flood: Commitments and Disbursement for HIV/AIDS from the Global Fund, PEPFAR, and the World Bank's Multi-Country AIDS Program (MAP)” Washington, DC: Center for Global Development.
Boone, Peter. 1994. “The Impact of Foreign Aid on Savings and Growth” Mimeo, London School of Economics.
Boone, Peter. 1996. “Politics and the Effectiveness of Foreign Aid” European Economic Review 40, 289-329.
Bourguignon, Francois and Mark Sundberg, 2007. "Aid Can Work" Finance and Development, 44(1).
Bueno de Mesquita, Bruce and George W. Downs. 2005. “Development and Democracy” Foreign Affairs. 84(5): 77–86
Bueno de Mesquita, Bruce, Alastair Smith, Randolph M. Siverson & James D. Morrow. 2003. "The Logic of Political Survival." Cambridge, MA: The M.I.T. Press.
Bueno de Mesquita, Bruce, and Hilton Root. 2002. “The Political Roots of Poverty.” National Interest 68 (Summer): 27-35.
Burnside, Craig & David Dollar. 2000. “Aid, Policies, and Growth.” The American Economic Review pp. 847–864.
Center for Global Development: The HIV/AIDS Monitor.
Chenery, Hollis and Alan Strout. 1966. "Foreign Assistance and Economic Development”, American Economic Review, 56(4): 679-733.
Cohen, Susan A. 2008. “U.S. Global AIDS Policy and Sexually Active Youth: A High-Risk Strategy.” The Guttmacher Report on Public Policy: 8(3).
Collins J, and B. Rau. 2000. "AIDS in the context of development. UNRISD Programme on Social Policy and Development." No. 4; UNRISD/UNAIDS.
Easterly, William, Ross Levine and David Roodman. 2004. “Aid, Policies, and Growth: Comment.” American Economic Review. 94(3): 774-780
Easterly, William. 2005. “ How to Assess the Needs for Aid? The Answer: Don’t Ask” Paper prepared for the Third AFD/EUDN Conference.
Easterly, William. 2002. “The Cartel of Good Intentions: The Problem of Bureaucracy in Foreign Aid.” Journal of Policy Reform. 5 (4): 223-50
Easterly, William. 2006. "The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good." New York, NY: Penguin Press.
Farmer, Paul, Margaret Connors, and Jane Simmons. 1996. Women, Poverty and AIDS: Sex, Drugs and Structural Violence. Monroe, ME: Common Courage Press.
Feachem, Richard. 2005. "The Age of AIDS: Interview with Richard Feachem" PBS
Filmer, Deon and Pritchett, Lant. 1999. “The impact of public spending on health: does money matter?” The World Bank Social Science and Medicine 49: 1309-1323.
Garcia-Calleja, J.M. , E Gouws, and P D Ghys. 2006. "National population based HIV prevalence surveys in sub-Saharan Africa: results and implications for HIV and AIDS estimates." Sexual Transmission Information; 82(3): iii64 - iii70.
Halperin, Daniel. “Putting a Plague in Perspective” January 1, 2008. New York Times
Hillbrunner, Chris. 2007. Working Groups Discussion Paper for Workshop on Integration of Water, Sanitation and Hygiene into HIV/AIDS Home-Based Care Strategies. Malawi
Kaisernetwork. 2006. "Inquiry Into Alleged Mismanagement of Ugandan Global Fund Grants Has Revealed 'Pile of Filth,' Commission Head Says."
Kates, Jennifer and Eric Leif. 2006. “International Assistance for HIV/AIDS in the Developing World: Taking Stock of the G8, Other Donor Governments, and the European Commission.” Henry J. Kaiser Foundation.
Kaufmann, Daniel, Aart Kraay and Massimo Mastruzzi. 2006. "Governance Matters V: Governance Indicators for 1996-2005". World Bank Policy Research.
Knack, Stephen 2001. “Aid Dependence and the Quality of Governance: A Cross-Country Analysis.” Washington DC: World Bank, 2001
Kurtz, Marcus and Andrew Schrank. 2005. “Growth and Governance: Models, Measures, and Mechanisms” Journal of Politics Vol. 69:2.
Lieberman, Evan S. 2007 "Ethnic Politics, Risk, and Policy-Making: A Cross-National Statistical Analysis of Government Responses to HIV/AIDS."
Malawi Network of People Living with HIV/AIDS (MANET+) 2003. "Voices for equality and dignity. Qualitative research on stigma and discrimination issues as they affect PLWHA in Malawi."
Mann, Jonathan, Daniel Tarantola, and Thomas Netter. “A Global Report: AIDS in the World.” Harvard University Press: Cambridge, 1992.
Milner, Helen V. 2005. “Globalization, Development, and International Institutions: Normative and Positive Perspectives.” Perspectives on Politics 3(3): 833-854.
Oster, Emily. 2005. "Sexually Transmitted Infections, Sexual Behavior, and the HIV/AIDS Epidemic." The Quarterly Journal of Economics, MIT Press, 120(2): 467-515.
PEFAR Watch. 2006.
Plusnews 2008. "Chad: Shaky Start to AIDS Fight" 26 March 2008. United Nations Office for the Coordination of Humanitarian Affairs - Integrated Regional Information Networks.
President's Emergency Plan for AIDS Relief 2008.
Radelet, Steven. 2003, "Will the Millennium Challenge Account Be Different?" The Washington Quarterly 26(2): 171-187
Report on the Global HIV/AIDS Epidemic 2002
RESULTS Educational Fund, Network Public Health Programs and the Open Society Institute. 2004. "The Challenge for the President’s AIDS Initiative."
Rodrik, Daniel. 1999. “Where Did All the Growth Go? External Shocks, Social Conflict, and Growth Collapses.” Journal of Economic Growth 4:385–412.
Sandler, Todd and Raechelle Mascarenhas. 2006. "Do Donors Cooperatively Fund Foreign Aid?" Review of International Organizations, No. 4.
Shiffman, J “Has donor prioritization of HIV/AIDS displaced aid for other health issues?” Health Policy and Planning, 2008 - Oxford University Press
Smith, Alastair. 2005. “Why International Organizations Will Continue to Fail Their Development Goals.” Perspective on Politics 3(3): 565-567.
Smith, Alastair. 2006. “Pernicious Foreign Aid?: A Political Economy of Political Institutions and the Effect of Foreign Aid.” Unpublished Paper.
Stillwaggon Eileen. 2002. "HIV/AIDS in Africa: fertile terrain. J Dev Studies." 38:1–22.
Tanui , Kipkoech and Nixon Ng’ang’a. 2006. “Corruption in Kenya’s National Aids Control Council.” Global Corruption Report 2006, Ch 6: 12.
Taylor, Liz and Clare Dickenson, 2006. “The link between Corruption and HIV/Aids.” Global Corruption Report 2006. 6:104
The Global Fund.
The UNAIDS Report. 21 July 1999.
The World Bank Multi-Country HIV/AIDS Program.
The World Bank Multi-Country HIV/AIDS Program. 2008.
Timberg, Craig “In Zimbabwe, Fewer Affairs And Less HIV” Washington Post Foreign Service. July 13, 2007.
Timberg, Craig. “ ‘Best Kept Secret’ for HIV-Free Africa” Washington Post Foreign Service Sunday, December 16, 2007
UNAIDS 2004 Report on the Global AIDS Epidemic
UNAIDS 2005 "Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries"
UNAIDS 2006 Report on the Global AIDS Epidemic
UNAIDS 2007 AIDS Epidemic Update; 19 Nov 2007.
UNAIDS Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: 2004
Vreeland, James.2004. “The International and Domestic Politics of IMF Programs.” Paper presented at the conference Reinventing Bretton Woods Committee and World Economic Forum, Amsterdam, November 2004.
World Health Organization. 2006."Pursue High-Quality DOTS Expansion Enhancement."
Alesina, Alberto and David Dollar. 2000. “Who Gives Foreign Aid to Whom and Why?” Journal of Economic Growth. 5(1): 33–63.
Bearce, David and Daniel Tirone. 2007. “Foreign Aid Growth, and the Strategic Goals of Donor Governments.” Paper presented at the annual meeting of the American Political Science Association.
Bernstein, Michael and Myra Sessions. 2007. “A Trickle or a Flood: Commitments and Disbursement for HIV/AIDS from the Global Fund, PEPFAR, and the World Bank's Multi-Country AIDS Program (MAP)” Washington, DC: Center for Global Development.
Boone, Peter. 1994. “The Impact of Foreign Aid on Savings and Growth” Mimeo, London School of Economics.
Boone, Peter. 1996. “Politics and the Effectiveness of Foreign Aid” European Economic Review 40, 289-329.
Bourguignon, Francois and Mark Sundberg, 2007. "Aid Can Work" Finance and Development, 44(1).
Bueno de Mesquita, Bruce and George W. Downs. 2005. “Development and Democracy” Foreign Affairs. 84(5): 77–86
Bueno de Mesquita, Bruce, Alastair Smith, Randolph M. Siverson & James D. Morrow. 2003. "The Logic of Political Survival." Cambridge, MA: The M.I.T. Press.
Bueno de Mesquita, Bruce, and Hilton Root. 2002. “The Political Roots of Poverty.” National Interest 68 (Summer): 27-35.
Burnside, Craig & David Dollar. 2000. “Aid, Policies, and Growth.” The American Economic Review pp. 847–864.
Center for Global Development: The HIV/AIDS Monitor.
Chenery, Hollis and Alan Strout. 1966. "Foreign Assistance and Economic Development”, American Economic Review, 56(4): 679-733.
Cohen, Susan A. 2008. “U.S. Global AIDS Policy and Sexually Active Youth: A High-Risk Strategy.” The Guttmacher Report on Public Policy: 8(3).
Collins J, and B. Rau. 2000. "AIDS in the context of development. UNRISD Programme on Social Policy and Development." No. 4; UNRISD/UNAIDS.
Easterly, William, Ross Levine and David Roodman. 2004. “Aid, Policies, and Growth: Comment.” American Economic Review. 94(3): 774-780
Easterly, William. 2005. “ How to Assess the Needs for Aid? The Answer: Don’t Ask” Paper prepared for the Third AFD/EUDN Conference.
Easterly, William. 2002. “The Cartel of Good Intentions: The Problem of Bureaucracy in Foreign Aid.” Journal of Policy Reform. 5 (4): 223-50
Easterly, William. 2006. "The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good." New York, NY: Penguin Press.
Farmer, Paul, Margaret Connors, and Jane Simmons. 1996. Women, Poverty and AIDS: Sex, Drugs and Structural Violence. Monroe, ME: Common Courage Press.
Feachem, Richard. 2005. "The Age of AIDS: Interview with Richard Feachem" PBS
Filmer, Deon and Pritchett, Lant. 1999. “The impact of public spending on health: does money matter?” The World Bank Social Science and Medicine 49: 1309-1323.
Garcia-Calleja, J.M. , E Gouws, and P D Ghys. 2006. "National population based HIV prevalence surveys in sub-Saharan Africa: results and implications for HIV and AIDS estimates." Sexual Transmission Information; 82(3): iii64 - iii70.
Halperin, Daniel. “Putting a Plague in Perspective” January 1, 2008. New York Times
Hillbrunner, Chris. 2007. Working Groups Discussion Paper for Workshop on Integration of Water, Sanitation and Hygiene into HIV/AIDS Home-Based Care Strategies. Malawi
Kaisernetwork. 2006. "Inquiry Into Alleged Mismanagement of Ugandan Global Fund Grants Has Revealed 'Pile of Filth,' Commission Head Says."
Kates, Jennifer and Eric Leif. 2006. “International Assistance for HIV/AIDS in the Developing World: Taking Stock of the G8, Other Donor Governments, and the European Commission.” Henry J. Kaiser Foundation.
Kaufmann, Daniel, Aart Kraay and Massimo Mastruzzi. 2006. "Governance Matters V: Governance Indicators for 1996-2005". World Bank Policy Research.
Knack, Stephen 2001. “Aid Dependence and the Quality of Governance: A Cross-Country Analysis.” Washington DC: World Bank, 2001
Kurtz, Marcus and Andrew Schrank. 2005. “Growth and Governance: Models, Measures, and Mechanisms” Journal of Politics Vol. 69:2.
Lieberman, Evan S. 2007 "Ethnic Politics, Risk, and Policy-Making: A Cross-National Statistical Analysis of Government Responses to HIV/AIDS."
Malawi Network of People Living with HIV/AIDS (MANET+) 2003. "Voices for equality and dignity. Qualitative research on stigma and discrimination issues as they affect PLWHA in Malawi."
Mann, Jonathan, Daniel Tarantola, and Thomas Netter. “A Global Report: AIDS in the World.” Harvard University Press: Cambridge, 1992.
Milner, Helen V. 2005. “Globalization, Development, and International Institutions: Normative and Positive Perspectives.” Perspectives on Politics 3(3): 833-854.
Oster, Emily. 2005. "Sexually Transmitted Infections, Sexual Behavior, and the HIV/AIDS Epidemic." The Quarterly Journal of Economics, MIT Press, 120(2): 467-515.
PEFAR Watch. 2006.
Plusnews 2008. "Chad: Shaky Start to AIDS Fight" 26 March 2008. United Nations Office for the Coordination of Humanitarian Affairs - Integrated Regional Information Networks.
President's Emergency Plan for AIDS Relief 2008.
Radelet, Steven. 2003, "Will the Millennium Challenge Account Be Different?" The Washington Quarterly 26(2): 171-187
Report on the Global HIV/AIDS Epidemic 2002
RESULTS Educational Fund, Network Public Health Programs and the Open Society Institute. 2004. "The Challenge for the President’s AIDS Initiative."
Rodrik, Daniel. 1999. “Where Did All the Growth Go? External Shocks, Social Conflict, and Growth Collapses.” Journal of Economic Growth 4:385–412.
Sandler, Todd and Raechelle Mascarenhas. 2006. "Do Donors Cooperatively Fund Foreign Aid?" Review of International Organizations, No. 4.
Shiffman, J “Has donor prioritization of HIV/AIDS displaced aid for other health issues?” Health Policy and Planning, 2008 - Oxford University Press
Smith, Alastair. 2005. “Why International Organizations Will Continue to Fail Their Development Goals.” Perspective on Politics 3(3): 565-567.
Smith, Alastair. 2006. “Pernicious Foreign Aid?: A Political Economy of Political Institutions and the Effect of Foreign Aid.” Unpublished Paper.
Stillwaggon Eileen. 2002. "HIV/AIDS in Africa: fertile terrain. J Dev Studies." 38:1–22.
Tanui , Kipkoech and Nixon Ng’ang’a. 2006. “Corruption in Kenya’s National Aids Control Council.” Global Corruption Report 2006, Ch 6: 12.
Taylor, Liz and Clare Dickenson, 2006. “The link between Corruption and HIV/Aids.” Global Corruption Report 2006. 6:104
The Global Fund.
The UNAIDS Report. 21 July 1999.
The World Bank Multi-Country HIV/AIDS Program.
The World Bank Multi-Country HIV/AIDS Program. 2008.
Timberg, Craig “In Zimbabwe, Fewer Affairs And Less HIV” Washington Post Foreign Service. July 13, 2007.
Timberg, Craig. “ ‘Best Kept Secret’ for HIV-Free Africa” Washington Post Foreign Service Sunday, December 16, 2007
UNAIDS 2004 Report on the Global AIDS Epidemic
UNAIDS 2005 "Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries"
UNAIDS 2006 Report on the Global AIDS Epidemic
UNAIDS 2007 AIDS Epidemic Update; 19 Nov 2007.
UNAIDS Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections: 2004
Vreeland, James.2004. “The International and Domestic Politics of IMF Programs.” Paper presented at the conference Reinventing Bretton Woods Committee and World Economic Forum, Amsterdam, November 2004.
World Health Organization. 2006."Pursue High-Quality DOTS Expansion Enhancement."
Saturday, February 23, 2008
Hope is not (yet) in the Headlines
After an overview of what has been accomplished empirically in the past weeks, I would like to address a few pointed questions offered graciously by a dear advisor of mine. (And in his tenacious spirit I encourage you also to read and challenge the entries as well!)
My analysis of country-year data on HIV rates, changes in HIV, and country financial, policy and institutional indicators has revealed clear results: despite our best efforts, there is NO correlation between countries who receive large amounts (or ANY amount) of AIDS-specific foreign aid and the change in their national HIV rate. Quite bluntly, if we measure our efforts to end AIDS by dollars poured into AIDS relief projects, our efforts (whether or not they are our best is undeterminable) to relieve the pandemic have failed.
However you don’t need to be a professional statistician or researcher to realize that results revealing “no correlation” are not nearly as interesting or significant as results revealing a positive or negative relationship. As expected, there are negative relationships between HIV rates and GDP, GDP per capita, and polity ratings (higher means more democratic), and positive relationships between HIV rates and unemployment and ethnic fractionalization (see Lieberman’s interesting paper, “Ethnic Politics, Risk…”).
When we look into the factors that make the HIV change up or down, variables that appear more powerful than AIDS-aid are variables like national public health expenditures, number of children immunized, and success in treating tuberculosis. Suggesting that instead of throwing money at AIDS, perhaps it’s more effective to throw money at improving financial systems, health institutions, and health resources.
When AIDS-aid is brought back into the picture, indeed, it does appear to be more significant in countries who spend more on health, who immunize high percentages or children, who have a lot of success with treating TB. Countries who already have the financial commitment and infrastructure capability of addressing AIDS effectively.
Though far more remains to be said about how we can give aid more effectively, I will pause for this week on the presentation of results, in order to address a few thoughtful questions regarding the last entry on the selectorate theory. Confronting the challenge of the ‘dreaded administrator’, the national leader/s who act not on behalf of an ambiguous ‘national interest’ but purely out of desire to maintain political survival, I am asked ‘why not just influence the selectorate?’ - the people who make a Presidential or Congressional candidacy viable. The question points us in a great direction, but the plague of caring first about ones only survival persists at every level. Which means, for America and comparable givers, that unless the citizenry – you and I – forcefully and passionately, on a large scale, begin to pressure our local leaders to take responsible action on issues of AIDS or poverty in general, they will not. And if they do not, higher-level administrators will not, right up to those with the power to make significant change in good time. Unless they believe they will be voted out immediately if they don’t support a certain cause, they will not individually bring up the cause as something to support. Quite frankly, because sick, starving Africans do not threaten our own personal survival, I do not forsee anytime soon this revolution taking place.
And with our voting cycle, this can all be manipulated by time as well. Why is President Bush so vigorously supporting Africa in his outgoing months? He’s a lame duck – he has no opportunity for reelection, and his power now is to at the least leave Americans with a positive image of the GOP, the “compassionate conservatism” he used to launch his election bid so strongly, and then proceeded to neglect for most of his 8 years.
[And not sure I have to address it, but what this means for a small selectorate country is that we have to befriend and win over the AK-47 toting cronies. When your fear of being ousted increases, so does your willingness to do violent and inhumane things to others to keep your power. I, and many westerners who are born into security and stability, would rather not step into that risky cycle, if at all possible, which is disappointing, because it means the large portion of the population who has been disenfranchised and unrepresented remains stuck in the cycle indefinitely.]
An alternate suggestion was made, also in a great direction, that instead of relying on the bureaucracy of public politics, we focus on and invest in pragmatically compassionate philanthropists, the Gates and the Soros’ of the work. Amen! Agreed! As a global community I believe we should definitely focus on and promote such wise and careful investors. Though they retain full control and do not need to listen to the masses, they do, and their sensitivity to others’ interests goes for both donors and recipients. But while their plans are reasonable their power scope is limited.
At the end of the day in foreign aid, it is a nearly impossible task to bypass the recipient government. No matter the corruption level of the leader or lack of rule of law and accountability, national leaders still control the natural resources and provision of basic public services. If an NGO or charitable/philanthropic foundation wants to provide public services to a suffering, disenfranchised community, they can do all they can, but if the government shuts off electricity, or worse, water, then they cannot do their work. They are still at the mercy of government.
Our Reynolds Program in Social Entrepreneurship recently hosted a lecture by the brilliant Jacqueline Novogratz of The Acumen Fund, an organization that uses philanthropic and charitable funds to invest in a variety of local businesses and institutions in South Asia and East Africa to building sustainable local routes out of poverty. She explained our present predicament in several ways, such as her disappointment at local registrars whose corruption significantly slowed down her real estate endeavors. Acumen can work, but they are forced to work at the pace of the government. Capital becomes, as she euphemistically terms it, "patient capital."
Ms. Novogratz also made a point that a Gates or Soros representative might also make, that "there are reasons why we don't work in Sudan or Chad or such places,” conceding that because of political instabilities, some people will simply never be served. At the end of the day, America and rich countries’ nuclear weapons, exponentially strong military, and history of brutality make us a force to fear, and deter countries from crossing our path. I think this sounds ridiculous, but it is true. Aid-recipient governments will cooperate and negotiate with the US more readily than with any NGO or charity or philanthropy, because they know they can renege on any promise to a charity, as the charity cannot send in troops or bomb the nation if they 'misbehave'.
It's the same logic that explains the failure of the United Nations to have ever solved any genocide, civil war, or act of massive violence. There is no enforcement mechanism, no threat, no counter-force to effectively punish perpetrators. My heart sank to the floor this summer as I took a few hours in Arusha, Tanzania, to sit in on hearings of the Rwandan Genocide trials. Endless trivial questions were asked, perpetrators taking their sweet time to answer, knowing that the longer they were in 'custody', the longer they would enjoy staying in nice hotels, eating full meals everyday, and being part of this official UN cadre. Perpetrators blatantly lied, were told they were lying, apologized, and perpetuated this foolish cycle, and after three ALL that had been determined was that the man in question had been wearing a red, not a white, sash on the day of a church attack.
Seriously. That's it. Millions still suffering from the aftermath, while the UN hosts a trial that is wasting time and resources and doing nothing. No one takes them seriously because they don't put forth any realistic threat.
Also, although large-scale philanthropic endeavors are effective and are reaching many, they are possibly not as effective as small NGOs who will only reach small communities. Large amounts of money are simply impossible to hide from recipient country leaders; where as small efforts and investments from foreign funds can be done more easily under the radar. Therefore, large amounts of aid are more likely to be stolen from or misused, as it is difficult to not involve the recipient government in large transactions. A few cases of such corruption:
1. Red Cross missing millions
2. Post-Tsunami funds not getting to victims – Red Cross, Save the Children, Oxfam
3. Red Cross financing of development can't begin due to corruption
Now the HOPE is that Gates, Soros, Acumen and their peers continue to be satisfied with piecemeal their progression, small projects that can go under national radar. As of now, little, if any, accusations have been made on corruption in the ranks of these philanthropists, and I think this is largely due not only to character (I think almost all aid efforts - including UN trials - have good intentions) but rather to the system of distribution they have devised. Even on small scales, as Ms. Novogratz noted, there will be unavoidable issues that slow down work. But at the end of the day, donors need to work WITH and not AGAINST governments, no matter their record on corruption, violence, and abuses. Acumen's "patient capital" maintains hope in that capital to make change, but acknowledges the reality of the challenges before them.
Even in my minor work in Tanzania, my hands were tied on making progress unless I involved the local Health Ministry, which took ages, but with persistence, happened and allowed out HIV testing program to flourish. The local NGO with which I was working soared from unrecognized peer-health-educators to local superstars based largely on a sheet of paper declaring their worthiness by the Regional Health Minister. They did not do very much to change their composition, energy, or work, but the mere recognition of a local government agency boosted their ability to serve exponentially.
Personally, my faith and my funds are invested in the next generation of leaders, as I am privileged to know many brilliant and strong youth determined to change the reputation of their current leadership - both in poor communities and in rich nations. Especially notable are the youth who have a fraction of that I/we have been given to work with (in terms of basic resources, access to health services, education opportunities, many not even having the basic love of a parent figure), yet are succeeding to make change locally in impressive and creative ways. I believe investing in young people so that they can be great leaders– a broad goal, but considering the daunting needs of that poverty inflicts generally, a specific focus and end-goal - is globally our best bet for progress out of poverty and into a more just, meaningful and humane world.
But unfortunately this hope is not in the headlines. We do not see or realize how much people, without any voice, want to make change and are making change. We also don't hear that our own efforts, proud as we may be of them, are not working as intended. We have an issue admitting our own failures, and an issue in acknowledging others' success. Very obvious globally, but probably something we're each individually guilty of at one time or another.
So whoever you are, Bill Gates or Reynolds Scholar or a 'no name', start making headlines with your positive change. Look harder at what is being done and why it is not working, and then direct your efforts at what will work. Recognize and promote those whose efforts ARE working, even if on a small scale.
Please always feel free to use this blog as a place to post such headlines, and as always, comments, criticisms, and questions are always most welcome.
My analysis of country-year data on HIV rates, changes in HIV, and country financial, policy and institutional indicators has revealed clear results: despite our best efforts, there is NO correlation between countries who receive large amounts (or ANY amount) of AIDS-specific foreign aid and the change in their national HIV rate. Quite bluntly, if we measure our efforts to end AIDS by dollars poured into AIDS relief projects, our efforts (whether or not they are our best is undeterminable) to relieve the pandemic have failed.
However you don’t need to be a professional statistician or researcher to realize that results revealing “no correlation” are not nearly as interesting or significant as results revealing a positive or negative relationship. As expected, there are negative relationships between HIV rates and GDP, GDP per capita, and polity ratings (higher means more democratic), and positive relationships between HIV rates and unemployment and ethnic fractionalization (see Lieberman’s interesting paper, “Ethnic Politics, Risk…”).
When we look into the factors that make the HIV change up or down, variables that appear more powerful than AIDS-aid are variables like national public health expenditures, number of children immunized, and success in treating tuberculosis. Suggesting that instead of throwing money at AIDS, perhaps it’s more effective to throw money at improving financial systems, health institutions, and health resources.
When AIDS-aid is brought back into the picture, indeed, it does appear to be more significant in countries who spend more on health, who immunize high percentages or children, who have a lot of success with treating TB. Countries who already have the financial commitment and infrastructure capability of addressing AIDS effectively.
Though far more remains to be said about how we can give aid more effectively, I will pause for this week on the presentation of results, in order to address a few thoughtful questions regarding the last entry on the selectorate theory. Confronting the challenge of the ‘dreaded administrator’, the national leader/s who act not on behalf of an ambiguous ‘national interest’ but purely out of desire to maintain political survival, I am asked ‘why not just influence the selectorate?’ - the people who make a Presidential or Congressional candidacy viable. The question points us in a great direction, but the plague of caring first about ones only survival persists at every level. Which means, for America and comparable givers, that unless the citizenry – you and I – forcefully and passionately, on a large scale, begin to pressure our local leaders to take responsible action on issues of AIDS or poverty in general, they will not. And if they do not, higher-level administrators will not, right up to those with the power to make significant change in good time. Unless they believe they will be voted out immediately if they don’t support a certain cause, they will not individually bring up the cause as something to support. Quite frankly, because sick, starving Africans do not threaten our own personal survival, I do not forsee anytime soon this revolution taking place.
And with our voting cycle, this can all be manipulated by time as well. Why is President Bush so vigorously supporting Africa in his outgoing months? He’s a lame duck – he has no opportunity for reelection, and his power now is to at the least leave Americans with a positive image of the GOP, the “compassionate conservatism” he used to launch his election bid so strongly, and then proceeded to neglect for most of his 8 years.
[And not sure I have to address it, but what this means for a small selectorate country is that we have to befriend and win over the AK-47 toting cronies. When your fear of being ousted increases, so does your willingness to do violent and inhumane things to others to keep your power. I, and many westerners who are born into security and stability, would rather not step into that risky cycle, if at all possible, which is disappointing, because it means the large portion of the population who has been disenfranchised and unrepresented remains stuck in the cycle indefinitely.]
An alternate suggestion was made, also in a great direction, that instead of relying on the bureaucracy of public politics, we focus on and invest in pragmatically compassionate philanthropists, the Gates and the Soros’ of the work. Amen! Agreed! As a global community I believe we should definitely focus on and promote such wise and careful investors. Though they retain full control and do not need to listen to the masses, they do, and their sensitivity to others’ interests goes for both donors and recipients. But while their plans are reasonable their power scope is limited.
At the end of the day in foreign aid, it is a nearly impossible task to bypass the recipient government. No matter the corruption level of the leader or lack of rule of law and accountability, national leaders still control the natural resources and provision of basic public services. If an NGO or charitable/philanthropic foundation wants to provide public services to a suffering, disenfranchised community, they can do all they can, but if the government shuts off electricity, or worse, water, then they cannot do their work. They are still at the mercy of government.
Our Reynolds Program in Social Entrepreneurship recently hosted a lecture by the brilliant Jacqueline Novogratz of The Acumen Fund, an organization that uses philanthropic and charitable funds to invest in a variety of local businesses and institutions in South Asia and East Africa to building sustainable local routes out of poverty. She explained our present predicament in several ways, such as her disappointment at local registrars whose corruption significantly slowed down her real estate endeavors. Acumen can work, but they are forced to work at the pace of the government. Capital becomes, as she euphemistically terms it, "patient capital."
Ms. Novogratz also made a point that a Gates or Soros representative might also make, that "there are reasons why we don't work in Sudan or Chad or such places,” conceding that because of political instabilities, some people will simply never be served. At the end of the day, America and rich countries’ nuclear weapons, exponentially strong military, and history of brutality make us a force to fear, and deter countries from crossing our path. I think this sounds ridiculous, but it is true. Aid-recipient governments will cooperate and negotiate with the US more readily than with any NGO or charity or philanthropy, because they know they can renege on any promise to a charity, as the charity cannot send in troops or bomb the nation if they 'misbehave'.
It's the same logic that explains the failure of the United Nations to have ever solved any genocide, civil war, or act of massive violence. There is no enforcement mechanism, no threat, no counter-force to effectively punish perpetrators. My heart sank to the floor this summer as I took a few hours in Arusha, Tanzania, to sit in on hearings of the Rwandan Genocide trials. Endless trivial questions were asked, perpetrators taking their sweet time to answer, knowing that the longer they were in 'custody', the longer they would enjoy staying in nice hotels, eating full meals everyday, and being part of this official UN cadre. Perpetrators blatantly lied, were told they were lying, apologized, and perpetuated this foolish cycle, and after three ALL that had been determined was that the man in question had been wearing a red, not a white, sash on the day of a church attack.
Seriously. That's it. Millions still suffering from the aftermath, while the UN hosts a trial that is wasting time and resources and doing nothing. No one takes them seriously because they don't put forth any realistic threat.
Also, although large-scale philanthropic endeavors are effective and are reaching many, they are possibly not as effective as small NGOs who will only reach small communities. Large amounts of money are simply impossible to hide from recipient country leaders; where as small efforts and investments from foreign funds can be done more easily under the radar. Therefore, large amounts of aid are more likely to be stolen from or misused, as it is difficult to not involve the recipient government in large transactions. A few cases of such corruption:
1. Red Cross missing millions
2. Post-Tsunami funds not getting to victims – Red Cross, Save the Children, Oxfam
3. Red Cross financing of development can't begin due to corruption
Now the HOPE is that Gates, Soros, Acumen and their peers continue to be satisfied with piecemeal their progression, small projects that can go under national radar. As of now, little, if any, accusations have been made on corruption in the ranks of these philanthropists, and I think this is largely due not only to character (I think almost all aid efforts - including UN trials - have good intentions) but rather to the system of distribution they have devised. Even on small scales, as Ms. Novogratz noted, there will be unavoidable issues that slow down work. But at the end of the day, donors need to work WITH and not AGAINST governments, no matter their record on corruption, violence, and abuses. Acumen's "patient capital" maintains hope in that capital to make change, but acknowledges the reality of the challenges before them.
Even in my minor work in Tanzania, my hands were tied on making progress unless I involved the local Health Ministry, which took ages, but with persistence, happened and allowed out HIV testing program to flourish. The local NGO with which I was working soared from unrecognized peer-health-educators to local superstars based largely on a sheet of paper declaring their worthiness by the Regional Health Minister. They did not do very much to change their composition, energy, or work, but the mere recognition of a local government agency boosted their ability to serve exponentially.
Personally, my faith and my funds are invested in the next generation of leaders, as I am privileged to know many brilliant and strong youth determined to change the reputation of their current leadership - both in poor communities and in rich nations. Especially notable are the youth who have a fraction of that I/we have been given to work with (in terms of basic resources, access to health services, education opportunities, many not even having the basic love of a parent figure), yet are succeeding to make change locally in impressive and creative ways. I believe investing in young people so that they can be great leaders– a broad goal, but considering the daunting needs of that poverty inflicts generally, a specific focus and end-goal - is globally our best bet for progress out of poverty and into a more just, meaningful and humane world.
But unfortunately this hope is not in the headlines. We do not see or realize how much people, without any voice, want to make change and are making change. We also don't hear that our own efforts, proud as we may be of them, are not working as intended. We have an issue admitting our own failures, and an issue in acknowledging others' success. Very obvious globally, but probably something we're each individually guilty of at one time or another.
So whoever you are, Bill Gates or Reynolds Scholar or a 'no name', start making headlines with your positive change. Look harder at what is being done and why it is not working, and then direct your efforts at what will work. Recognize and promote those whose efforts ARE working, even if on a small scale.
Please always feel free to use this blog as a place to post such headlines, and as always, comments, criticisms, and questions are always most welcome.
Tuesday, January 29, 2008
What About it?
NYU classes began full swing last week. Already immersed in Keep a Child Alive duties and thesis research, the formalization of readings and reports blends smoothly into my normal bustling schedule. My final International Relations elective is a course called "Solving Foreign Crises," taught by a favorite professor in the department, one who I reference often and whose research conclusions have consistently resounded with truth in my experiences working abroad, the man known as "BdM".
After a brief review of the selectorate theory, the cornerstone of his teachings, each student addressed our group of 15 by sharing an international policy crisis in which we are personally interested. Nuclear proliferation! Israel-Palestine! UN peacekeeping of civil wars! As my turn to speak approached, I fumbled around mentally with my topic of HIV/AIDS for a moment, realizing that in the face of the stated immediate violence and security threats, the relative 'aloofness' of AIDS might be a sub-par topic.
But of course I firmly stated, "HIV/AIDS", and of course, BdM stared me down,
"What about it?"
It is not that I did not anticipate that exact follow up phrase, but his tone hit me hard nonetheless. Despite rampant political rhetoric of caring about the world's disenfranchised, when the time comes to allocate budgets and take action, this seems to be an all too common catchphrase of policymakers. Hunger, sanitation, AIDS...what about it? How does it affect me? I won't be bombed if I don't pay attention to this issue, I'm not risking any national security or international stability. If the stakeholders, the people with the power, are not threatened, the issue is of secondary concern.
I know clearly and can defend easily that HIV/AIDS is an enormous policy issue as a public health emergency and threat to economic stability worldwide. But at our mock-Cabinet session, reviewing key policy issues, my topic was clearly out of place among the other high-ranking concerns. Not to say the high-rankers are not important! But policymakers, naturally, take far more seriously the issues that could tangibly effect their security in the short run. HIV has neither effect, as its spread is silent and difficult to track and see, and the problems emerge over the long run.
I have simple data to share with you, data that took far too long for me to gather! I have yet to come upon a website where HIV rates are posted coherently, consistently, and accurately for years before 1999, for every nation in the world. UNAIDS boasts meticulous methodologies and measurement protocol, but the actual consistent numbers are missing, or at least not publicized. It is frustrating to think that a majority of HIV/AIDS relief is all talk, and politicians make promises becaues they know those who most fiercely want to hold them accountable for keeping their promises are powerless or dying.
The countries in which HIV prevalence rates were highest in 2005 may not surprise you, although I hope you will visualize the immense implication of these estimates. These are national averages, and hidden within this number are the fact that some areas within the country suffer rates of 70%+, but are evened out by less infected areas.
2005
Swaziland 33.40
Botswana 24.10
Lesotho 23.20
Zimbabwe 20.10
Namibia 19.60
South Africa 18.80
Zambia 17.00
Mozambique 16.10
Malawi 14.10
Central African Republic 10.70
Nevertheless, imagine if we rephrased this to say 33% of the population is attacked by terrorists every year? Perhaps it is just the term "HIV" that feels harmless, while "terrorist" sounds frightening. We spend billions defining and measuring and controlling "fundamentalist Islam" which, like AIDS, is not tangible, can manifest itself through violence, and spreads silently but quickly and destructively. But AIDS is not given such attention nor considered such a threat. There is a facade of having control over the disease.
Consider now the rates of change -- where are we making progress, and where are there increases in transmission? Although Swaziland suffers the biggest burden, their present rate is 14% less than their 2003 estimate. The largest increases of 2003-2005 may surprise you:
Gambia 100%
Iran 100%
Ireland 100%
Lithuania 100%
Sweden 100%
United Kingdom 100%
Uzbekistan 100%
Papua New Guinea 200%
Moldova 450%
Although these stats reflect smaller prevalence rates doubling, the rapid increase is cause for concern. What is it about HIV/AIDS that makes it a foreign policy issue worthy of the time we also need to spend on national security, intelligence and defense?
HIV/AIDS will never kill the rich and powerful, but nuclear bombs and anthrax and assassinations could. Leaders will always find a way to escape drought, famine, and disease, so they do not need to invest as much time or serious energy in these issues. It is difficult to say what it is about AIDS that makes it an issue, because although it can attack anyone, those with resources can get treatment and care and never acknowledge they are infected, and never discuss the issue.
Ironically, HIV holds potential comparable to nuclear proliferation and transnational terrorism to destroy a population if the issue is left unchecked...but the risk is not immediate with HIV. An estimated 100,000 died at Hiroshima. Every death is a tragedy. Every of the nearly 3,000 American lives on 9/11 is a tragedy.
So why do we not take as seriously or as urgently the 28 million that AIDS has tragically killed?
Because we don't: Our collective response is somewhat laughable when put in such a context ( 'our' being both us as a rich nation and as a member of the G8 and the UN) Although it involves people who are no doubt committed to the cause, our actions seem to suggest otherwise. Instead of facing this issue head-on, we are creating what many of my African friends have called the "Fat AIDS" pandemic. Their logic reveals how much we do not realize the blatant failures of our nation to actually do good and act on promises and intentions. "There is skinny AIDS and there is fat AIDS," I have been told by several doctors and community workers. "We are dying here from skinny AIDS which makes us thin and weak, and the men in suits and ties fly around to meetings and conferences about AIDS saying all sorts of good things, and they get they paid to do this. They get fatter the more AIDS remains an issue."
Phrased well also by an African delegate interviewed by Michael Maren in his expose on foreign aid, "The Road to Hell", we read, "The more desperate our conditions are portrayed in the U.S media, the more money you American organizations seem to raise for your own overhead and projects." The skinny get skinnier, the fat get fatter.
So, AIDS...what about it?
Though it's a tough pill to swallow, we must acknowledge first that AIDS does not pose a significant threat to our world's most powerful.
But the problem is devastating and quite real.
HIV/AIDS is an issue, and we can decide whether to prioritize it or not. This does NOT translate to giving it more money, but rather, more thoughtful and strategic attention. We have the numbers on HIV -- like a fanatic ideologue, it is a loaded weapon. Someone with something invisible in them that they could spread to someone else without even realizing they are spreading it...but if it gets to enough people, we see complete collapse of that community, loss of stability, economic losses and unchecked spread.
Perhaps it is crude to parallel a disease like HIV with the complexities and immensely intricate concerns embedded in fundamentalist Islam...but in that case I demand, why haven't we fixed AIDS yet? If it's so simple, why is it still on the rise in so many places?
Sometimes it seems we spend so much time reactively averting destruction that we have no time to pro-actively prevent it. AIDS is at the root of all our broad, prioritized issues. Paying attention to health-care infrastructure, building roads, hiring doctors,and stabilizing daily life will do far more than the "aid" we give now, too often merely fostering secret deals and relationships with the main people in power who may not be in power the next day. We won't get rid of skinny AIDS until we wipe out fat AIDS, but getting rid of fat AIDS is unfortunately not a priority of the fat cats who allocate the budgets and carry out the plans.
Being a responsible global citizen and caring about each other are not sufficient motivators to stop this cycle. Thanks to BdM I am reminded that if bringing HIV under control is a true priority and worthy goal, it must appeal to the incentives of those in power, or those that elect and ensure the political survival of those in power.
On that conclusive note...Happy Super Tuesday! Get out there and vote and make sure your candidate does support goals that you feel are worthy of our time and funds.
It is ultimately we as the citizens of rich, democratic nations, that will have the opportunity to respond to "what about it?" Speak up!
After a brief review of the selectorate theory, the cornerstone of his teachings, each student addressed our group of 15 by sharing an international policy crisis in which we are personally interested. Nuclear proliferation! Israel-Palestine! UN peacekeeping of civil wars! As my turn to speak approached, I fumbled around mentally with my topic of HIV/AIDS for a moment, realizing that in the face of the stated immediate violence and security threats, the relative 'aloofness' of AIDS might be a sub-par topic.
But of course I firmly stated, "HIV/AIDS", and of course, BdM stared me down,
"What about it?"
It is not that I did not anticipate that exact follow up phrase, but his tone hit me hard nonetheless. Despite rampant political rhetoric of caring about the world's disenfranchised, when the time comes to allocate budgets and take action, this seems to be an all too common catchphrase of policymakers. Hunger, sanitation, AIDS...what about it? How does it affect me? I won't be bombed if I don't pay attention to this issue, I'm not risking any national security or international stability. If the stakeholders, the people with the power, are not threatened, the issue is of secondary concern.
I know clearly and can defend easily that HIV/AIDS is an enormous policy issue as a public health emergency and threat to economic stability worldwide. But at our mock-Cabinet session, reviewing key policy issues, my topic was clearly out of place among the other high-ranking concerns. Not to say the high-rankers are not important! But policymakers, naturally, take far more seriously the issues that could tangibly effect their security in the short run. HIV has neither effect, as its spread is silent and difficult to track and see, and the problems emerge over the long run.
I have simple data to share with you, data that took far too long for me to gather! I have yet to come upon a website where HIV rates are posted coherently, consistently, and accurately for years before 1999, for every nation in the world. UNAIDS boasts meticulous methodologies and measurement protocol, but the actual consistent numbers are missing, or at least not publicized. It is frustrating to think that a majority of HIV/AIDS relief is all talk, and politicians make promises becaues they know those who most fiercely want to hold them accountable for keeping their promises are powerless or dying.
The countries in which HIV prevalence rates were highest in 2005 may not surprise you, although I hope you will visualize the immense implication of these estimates. These are national averages, and hidden within this number are the fact that some areas within the country suffer rates of 70%+, but are evened out by less infected areas.
2005
Swaziland 33.40
Botswana 24.10
Lesotho 23.20
Zimbabwe 20.10
Namibia 19.60
South Africa 18.80
Zambia 17.00
Mozambique 16.10
Malawi 14.10
Central African Republic 10.70
Nevertheless, imagine if we rephrased this to say 33% of the population is attacked by terrorists every year? Perhaps it is just the term "HIV" that feels harmless, while "terrorist" sounds frightening. We spend billions defining and measuring and controlling "fundamentalist Islam" which, like AIDS, is not tangible, can manifest itself through violence, and spreads silently but quickly and destructively. But AIDS is not given such attention nor considered such a threat. There is a facade of having control over the disease.
Consider now the rates of change -- where are we making progress, and where are there increases in transmission? Although Swaziland suffers the biggest burden, their present rate is 14% less than their 2003 estimate. The largest increases of 2003-2005 may surprise you:
Gambia 100%
Iran 100%
Ireland 100%
Lithuania 100%
Sweden 100%
United Kingdom 100%
Uzbekistan 100%
Papua New Guinea 200%
Moldova 450%
Although these stats reflect smaller prevalence rates doubling, the rapid increase is cause for concern. What is it about HIV/AIDS that makes it a foreign policy issue worthy of the time we also need to spend on national security, intelligence and defense?
HIV/AIDS will never kill the rich and powerful, but nuclear bombs and anthrax and assassinations could. Leaders will always find a way to escape drought, famine, and disease, so they do not need to invest as much time or serious energy in these issues. It is difficult to say what it is about AIDS that makes it an issue, because although it can attack anyone, those with resources can get treatment and care and never acknowledge they are infected, and never discuss the issue.
Ironically, HIV holds potential comparable to nuclear proliferation and transnational terrorism to destroy a population if the issue is left unchecked...but the risk is not immediate with HIV. An estimated 100,000 died at Hiroshima. Every death is a tragedy. Every of the nearly 3,000 American lives on 9/11 is a tragedy.
So why do we not take as seriously or as urgently the 28 million that AIDS has tragically killed?
Because we don't: Our collective response is somewhat laughable when put in such a context ( 'our' being both us as a rich nation and as a member of the G8 and the UN) Although it involves people who are no doubt committed to the cause, our actions seem to suggest otherwise. Instead of facing this issue head-on, we are creating what many of my African friends have called the "Fat AIDS" pandemic. Their logic reveals how much we do not realize the blatant failures of our nation to actually do good and act on promises and intentions. "There is skinny AIDS and there is fat AIDS," I have been told by several doctors and community workers. "We are dying here from skinny AIDS which makes us thin and weak, and the men in suits and ties fly around to meetings and conferences about AIDS saying all sorts of good things, and they get they paid to do this. They get fatter the more AIDS remains an issue."
Phrased well also by an African delegate interviewed by Michael Maren in his expose on foreign aid, "The Road to Hell", we read, "The more desperate our conditions are portrayed in the U.S media, the more money you American organizations seem to raise for your own overhead and projects." The skinny get skinnier, the fat get fatter.
So, AIDS...what about it?
Though it's a tough pill to swallow, we must acknowledge first that AIDS does not pose a significant threat to our world's most powerful.
But the problem is devastating and quite real.
HIV/AIDS is an issue, and we can decide whether to prioritize it or not. This does NOT translate to giving it more money, but rather, more thoughtful and strategic attention. We have the numbers on HIV -- like a fanatic ideologue, it is a loaded weapon. Someone with something invisible in them that they could spread to someone else without even realizing they are spreading it...but if it gets to enough people, we see complete collapse of that community, loss of stability, economic losses and unchecked spread.
Perhaps it is crude to parallel a disease like HIV with the complexities and immensely intricate concerns embedded in fundamentalist Islam...but in that case I demand, why haven't we fixed AIDS yet? If it's so simple, why is it still on the rise in so many places?
Sometimes it seems we spend so much time reactively averting destruction that we have no time to pro-actively prevent it. AIDS is at the root of all our broad, prioritized issues. Paying attention to health-care infrastructure, building roads, hiring doctors,and stabilizing daily life will do far more than the "aid" we give now, too often merely fostering secret deals and relationships with the main people in power who may not be in power the next day. We won't get rid of skinny AIDS until we wipe out fat AIDS, but getting rid of fat AIDS is unfortunately not a priority of the fat cats who allocate the budgets and carry out the plans.
Being a responsible global citizen and caring about each other are not sufficient motivators to stop this cycle. Thanks to BdM I am reminded that if bringing HIV under control is a true priority and worthy goal, it must appeal to the incentives of those in power, or those that elect and ensure the political survival of those in power.
On that conclusive note...Happy Super Tuesday! Get out there and vote and make sure your candidate does support goals that you feel are worthy of our time and funds.
It is ultimately we as the citizens of rich, democratic nations, that will have the opportunity to respond to "what about it?" Speak up!
Tuesday, January 22, 2008
A Messy Intersection
Flipping through television programs, lamenting over filing taxes, or mediating post-holiday-meal banter between family members, we all eventually end up on the topic. "Foreign Aid" inevitably weaves its way through many of our personal conversations about domestic affairs and national spending, because at the end of the day, it's our taxpayer dollars that are being sent overseas, and it is our business as Americans to make sure the investments are wise and productive. Whether you're watching Bono duke it out with G8 leaders in televised arenas, or calming granpda down as he criticizes 'those damn [Democrats/Republicans]', the issue of foreign aid is anything but foreign to Americans.
We are undisputably one of the richest nations in the world, fluctuating among the top ten highest GDP/capita nations. Only $2,200 in assets puts you in the top half of the world's wealthiest people, and with $61,000 in assets, you shoot up to joining the 2% of the world's wealthiest. CRAZY.
America is exponentially better off than the 53% who live on less than $2/day (yes even fathers and mothers with families to raise) and certainly luxurious living compared to the 20% of our global neighbors living on less than $1/day. Let that SOAK IN for a minute. That's reality.
As a non-isolationist nation we have a responsibility to attend to the needs of our fellow global citizens. Not only would neglect be inhumane, unjust, and heartless, but more pragmatically, it is foolish to discount the potential benefits one would reap from giving stability, security, and health to billions of our global neighbors. Productivity and innovation would increase, not to mention basic human dignity.
Few would realistically argue that the U.S. should not provide foreign aid. However, contentions abound when the discussion begins on how best to give foreign aid: to whom? for what programs? in what amounts? on what conditions?
In 2006, the U.S. gave 0.17% of her national budget to foreign aid. Fabulous folks like Bono and Jeff Sachs are pressuring for at least 1%, but how do we know that more is better? Is .17% a cowardly shame or a wise decision? What's our track record? Has our foreign aid in the past been effective at all in sparking economic growth in recipient nations?
Research on aid effectiveness to date has primarily analyzed the macroeconomic impacts of aid on recipient country economic growth, savings, and investment, and has consistently yielded inconclusive results. Aid-efficacy studies relate economic growth as a dependent variable to many causal independent variables including foreign aid - these other variables include everything from economic measures to human development indicators (infant mortality, primary school ratios, life expectancy). Researchers continue to try and find a relationship between aid and growth - what is is about some countries that aid is effective? Why has is been ineffective in so many places?
Among many significant contributions to the literature, one notable discovery of how aid can be effective was authored by Craig Burnside and David Dollar in 2000,(click here and scroll to bottom to download free from SSRN). They concluded contrary to common conclusions that aid actually could impact macroeconomic growth, but only when recipient nations endorse specific ‘good’ policies. They found that aid has a positive impact on growth in developing countries with good fiscal, monetary, and trade policies, but has no effect on growth in countries with poor policies. Most significantly, they introduced the idea that policies and institutions of the recipient nation matter if aid is to improve and not hamper development.
However the theory has been challenged, with particular efficacy by William Easterly et al (click and scroll again to DL) , who determined with the same model and expanded data (countries and years) that not even in countries with deemed ‘good policies’ could aid be proven to promote economic growth.
After all the running of regressions and number crunching and data analysis...the effects of foreign aid on a recipient country's economic growth presently remain inconclusive. But if we don't know how to give effectively, why should we keep dumping billions of our taxpayer dollars into the foreign aid system?
[As I have mentioned, my thesis falls out of the overarching foreign aid conundrum, focusing specifically on the relationship between AIDS-specific foreign aid and HIV rates (in parallel to general foreign aid and rates of economic growth). The same questions arise in this sub-section, as there is abundant speculation over the billions presently being spent on HIV/AIDS. Do we not give enough, or give too much? Are we spending it effectively?]
Funny how we get ahead of ourselves, though it feels quite natural to want to act urgently when the allocation of resources and wealth in the world is disproportionate to the point of disorientation. There is an enormous desire to tip the scale just for dignity's sake. But compassion is rarely what tips the scale and approves the budget requests. Strategic interests and need for political concessions predominantly determines who receives aid. So naturally, when aid is received by leaders who have made bilateral deals and arrangements, leaders who run systems where accountability to the general public is neither practiced nor enforced, the aid spills into personal accounts, and rarely reaches the people in need.
The intersection of power and resources, without a traffic light of coordination, quickly becomes a scene of collisions, destruction, and chaos. Especially when the police aren't enforcing, and when the drivers speed through, feeling accountable to no one else on the road. It's no surprise to see the gridlock and people waiting. Accidents and people dying. Frustration and people fighting.
Some people conclude that ineffective aid means we should stop giving. But many people continue to demand governments like the US give more, because we can. Personally, I am infuriated to my core watching people wait for promised aid who know in their hearts they are waiting for nothing (a clinic with no doctor, a line with no food at the end, a well queue with no clean water at the bottom). To suggest stopping aid seems as unjust as continuing our current, corrupted system: a guarantee that the poor will always be waiting, suffering, bearing injustice.
Rather, a diligently monitored and sufficiently financed reform effort of foreign aid systems seems to be a worthy global agenda item. In a world as rich as ours there is absolutely no reason, beyond pure human greed and insecurity, that anyone should have to raise a family on less than $1/day. And I don't believe it's a matter of not caring...if it didn't somehow effect the safety and security of Bono or grandpa, they wouldn't be bickering about it.
Whether this issue tears at your heart, concerns your reputation, or simply matters to your wallet, I encourage you to learn more about US Foreign Aid in the many links within this article. The situation is far from hopeless, but like most major issues, is merely a matter of political will and coordination of actors. If we want to help poor people, we should not give money to national governments. But if we want national governments to become less corrupt and likely to steal foreign aid, we need to seriously reverse our current track record of supporting corruption.
At the risk of concluding on useless vaguery, an example of reform's potential for progress:
We are undisputably one of the richest nations in the world, fluctuating among the top ten highest GDP/capita nations. Only $2,200 in assets puts you in the top half of the world's wealthiest people, and with $61,000 in assets, you shoot up to joining the 2% of the world's wealthiest. CRAZY.
America is exponentially better off than the 53% who live on less than $2/day (yes even fathers and mothers with families to raise) and certainly luxurious living compared to the 20% of our global neighbors living on less than $1/day. Let that SOAK IN for a minute. That's reality.
As a non-isolationist nation we have a responsibility to attend to the needs of our fellow global citizens. Not only would neglect be inhumane, unjust, and heartless, but more pragmatically, it is foolish to discount the potential benefits one would reap from giving stability, security, and health to billions of our global neighbors. Productivity and innovation would increase, not to mention basic human dignity.
Few would realistically argue that the U.S. should not provide foreign aid. However, contentions abound when the discussion begins on how best to give foreign aid: to whom? for what programs? in what amounts? on what conditions?
In 2006, the U.S. gave 0.17% of her national budget to foreign aid. Fabulous folks like Bono and Jeff Sachs are pressuring for at least 1%, but how do we know that more is better? Is .17% a cowardly shame or a wise decision? What's our track record? Has our foreign aid in the past been effective at all in sparking economic growth in recipient nations?
Research on aid effectiveness to date has primarily analyzed the macroeconomic impacts of aid on recipient country economic growth, savings, and investment, and has consistently yielded inconclusive results. Aid-efficacy studies relate economic growth as a dependent variable to many causal independent variables including foreign aid - these other variables include everything from economic measures to human development indicators (infant mortality, primary school ratios, life expectancy). Researchers continue to try and find a relationship between aid and growth - what is is about some countries that aid is effective? Why has is been ineffective in so many places?
Among many significant contributions to the literature, one notable discovery of how aid can be effective was authored by Craig Burnside and David Dollar in 2000,(click here and scroll to bottom to download free from SSRN). They concluded contrary to common conclusions that aid actually could impact macroeconomic growth, but only when recipient nations endorse specific ‘good’ policies. They found that aid has a positive impact on growth in developing countries with good fiscal, monetary, and trade policies, but has no effect on growth in countries with poor policies. Most significantly, they introduced the idea that policies and institutions of the recipient nation matter if aid is to improve and not hamper development.
However the theory has been challenged, with particular efficacy by William Easterly et al (click and scroll again to DL) , who determined with the same model and expanded data (countries and years) that not even in countries with deemed ‘good policies’ could aid be proven to promote economic growth.
After all the running of regressions and number crunching and data analysis...the effects of foreign aid on a recipient country's economic growth presently remain inconclusive. But if we don't know how to give effectively, why should we keep dumping billions of our taxpayer dollars into the foreign aid system?
[As I have mentioned, my thesis falls out of the overarching foreign aid conundrum, focusing specifically on the relationship between AIDS-specific foreign aid and HIV rates (in parallel to general foreign aid and rates of economic growth). The same questions arise in this sub-section, as there is abundant speculation over the billions presently being spent on HIV/AIDS. Do we not give enough, or give too much? Are we spending it effectively?]
Funny how we get ahead of ourselves, though it feels quite natural to want to act urgently when the allocation of resources and wealth in the world is disproportionate to the point of disorientation. There is an enormous desire to tip the scale just for dignity's sake. But compassion is rarely what tips the scale and approves the budget requests. Strategic interests and need for political concessions predominantly determines who receives aid. So naturally, when aid is received by leaders who have made bilateral deals and arrangements, leaders who run systems where accountability to the general public is neither practiced nor enforced, the aid spills into personal accounts, and rarely reaches the people in need.
The intersection of power and resources, without a traffic light of coordination, quickly becomes a scene of collisions, destruction, and chaos. Especially when the police aren't enforcing, and when the drivers speed through, feeling accountable to no one else on the road. It's no surprise to see the gridlock and people waiting. Accidents and people dying. Frustration and people fighting.
Some people conclude that ineffective aid means we should stop giving. But many people continue to demand governments like the US give more, because we can. Personally, I am infuriated to my core watching people wait for promised aid who know in their hearts they are waiting for nothing (a clinic with no doctor, a line with no food at the end, a well queue with no clean water at the bottom). To suggest stopping aid seems as unjust as continuing our current, corrupted system: a guarantee that the poor will always be waiting, suffering, bearing injustice.
Rather, a diligently monitored and sufficiently financed reform effort of foreign aid systems seems to be a worthy global agenda item. In a world as rich as ours there is absolutely no reason, beyond pure human greed and insecurity, that anyone should have to raise a family on less than $1/day. And I don't believe it's a matter of not caring...if it didn't somehow effect the safety and security of Bono or grandpa, they wouldn't be bickering about it.
Whether this issue tears at your heart, concerns your reputation, or simply matters to your wallet, I encourage you to learn more about US Foreign Aid in the many links within this article. The situation is far from hopeless, but like most major issues, is merely a matter of political will and coordination of actors. If we want to help poor people, we should not give money to national governments. But if we want national governments to become less corrupt and likely to steal foreign aid, we need to seriously reverse our current track record of supporting corruption.
At the risk of concluding on useless vaguery, an example of reform's potential for progress:
The antiretroviral drug Nevirapine has been clinically proven to half the chance of an infected mother passing HIV to her child during pregnancy, birth, or breastfeeding. Nevirapine is an incredibly hopeful advance in the prevention of new cases of HIV in resource poor settings, because it is so simple that even mothers in rural areas, where many women give birth with just a midwife and no doctor, can easily receive the pill. Nevirapine is certainly not without its controversies and imperfections, but widely agreed upon as the best option for prevention of mother-child transmission in resource poor settings.
Imagine if we were able to prevent ALL mother to child transmission? No children born with AIDS! We wold need to responsibly 1. make the drug the safest it can be and 2. mass distribute. The simplicity of a single pill is easy enough to supply to doctors and midwives all over the world (or rather, simpler than complicated drug regimens that are difficult to adhere to or require refrigeration). Researching, perfecting, and producing the drug is possible. But the logistics of distribution are complicated. Dollars earmarked for HIV-prevention don't just transform into Nevirapine. In this example we need professional doctors to give the drug, hospitals and clinics at which woman can give birth and get the drug, clean water with which to take the drug. It's great to give a magic pill but it's cruel to give that if the surrounding necessities are not in place.
Nevirapine's potential to end the transmission from mother to child - a revolutionary advance - demonstrates the need for coordinated actors and shared responsibility. The pharmaceutical industry needs to recognize the emergency and the potential of the drug to respond, and invest more time and resources into AIDS drug research - make the drugs the best and easiest to take that they can be. Rich countries need to monitor massive aid to build hospitals and hire doctors in poor countries. Smaller organizations, social entrepreneurs, and innovative projects and programs can supplement this national-level reform that is not achievable by non-governmental actors. Effective, specific efforts would ensure and increase use of improved health systems: sponsoring patients at hospitals and clinics for their medication, providing cars to rural communities or district hospitals to allow drugs to be delivered (although the roads are often unnavigable!), or training community members to serve as health-care workers to do simple tasks like giving Nevirapine that don't require an M.D.
What emerges is a tier of primary and secondary concerns that we hate to admit exists, because it seems inhumane to categorize the provision of lifesaving drugs to be 'secondary'. But pragmatically, the drugs won't work without doctors and clinics and food and water. However we absolutely cannot wait until primary concerns are solved - they will never wholly be - before we attack the secondary. Rather we must agree internationally on who will conquer what, how, and when.
Imagine if we were able to prevent ALL mother to child transmission? No children born with AIDS! We wold need to responsibly 1. make the drug the safest it can be and 2. mass distribute. The simplicity of a single pill is easy enough to supply to doctors and midwives all over the world (or rather, simpler than complicated drug regimens that are difficult to adhere to or require refrigeration). Researching, perfecting, and producing the drug is possible. But the logistics of distribution are complicated. Dollars earmarked for HIV-prevention don't just transform into Nevirapine. In this example we need professional doctors to give the drug, hospitals and clinics at which woman can give birth and get the drug, clean water with which to take the drug. It's great to give a magic pill but it's cruel to give that if the surrounding necessities are not in place.
Nevirapine's potential to end the transmission from mother to child - a revolutionary advance - demonstrates the need for coordinated actors and shared responsibility. The pharmaceutical industry needs to recognize the emergency and the potential of the drug to respond, and invest more time and resources into AIDS drug research - make the drugs the best and easiest to take that they can be. Rich countries need to monitor massive aid to build hospitals and hire doctors in poor countries. Smaller organizations, social entrepreneurs, and innovative projects and programs can supplement this national-level reform that is not achievable by non-governmental actors. Effective, specific efforts would ensure and increase use of improved health systems: sponsoring patients at hospitals and clinics for their medication, providing cars to rural communities or district hospitals to allow drugs to be delivered (although the roads are often unnavigable!), or training community members to serve as health-care workers to do simple tasks like giving Nevirapine that don't require an M.D.
What emerges is a tier of primary and secondary concerns that we hate to admit exists, because it seems inhumane to categorize the provision of lifesaving drugs to be 'secondary'. But pragmatically, the drugs won't work without doctors and clinics and food and water. However we absolutely cannot wait until primary concerns are solved - they will never wholly be - before we attack the secondary. Rather we must agree internationally on who will conquer what, how, and when.
We need coordination - a much better traffic light - because even though our cars our bigger and safer and virtually indestructible, we are all driving on the same road. At the end of our American day, certainly our national security and economic stability are top concerns, and these are two major reasons that dictate who we give to and in what amounts. But the well-being and humane treatment of our global neighbors is not mutually exclusive. It's not one or the other. And if we can be innovative and visionary enough, we can design a system where each perpetuates the other.
And to give this our best most responsible effort, we need data, to be informed! Next time, further focus on HIV/AIDS: how is the disease progressing and has AIDS-specific foreign aid been effective?
All questions and comments are greatly appreciated!
And to give this our best most responsible effort, we need data, to be informed! Next time, further focus on HIV/AIDS: how is the disease progressing and has AIDS-specific foreign aid been effective?
All questions and comments are greatly appreciated!
Sunday, January 20, 2008
Responsible Local Media!
Many thanks to The Valley Breeze, who recently published a letter I wrote in response to the passing of Joe Swanson. On local and global levels there truly are ways we can each invest our time, efforts, and money to alleviate the effects of AIDS...and The Breeze are doing their part to raise awareness on a local level!
http://www.valleybreeze.com/Free/7255807335172.php
http://www.valleybreeze.com
Sunday, January 13, 2008
Welcome to the Green Monstah
Welcome! The Green Monstah, as most know her, is the infamous 37-foot left field wall at Fenway Park, home of my beloved Boston Red Sox. In an effort to share my current research into global financing of the HIV/AIDS pandemic, I introduce to you another Green Monstah:
As many of you know, despite our existing medical technologies and abundant resources, HIV/AIDS continues to ravage our world, particularly in resource-poor communities where social and medical services are disturbingly absent.
The rich of our world have certainly been contributing to financing and end to AIDS. The most impressive contributions have come from bilateral aid, particularly through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Multi-lateral donors like the Global Fund to Fight AIDS, Malaria, and Tuberculosis (Global Fund), and UN agencies, particularly the World Bank, have also contributed significantly.
But HIV - preventable and treatable - continues to infect and kill, and in many places, at increasing rates. Are we not spending enough, or are we spending on the wrong things? Why are we not reversing bad investments, trivial spending, poor monitoring and evaluation? Is AIDS really too difficult to defeat? Or are we just using too many dollars and not enough sense?
In my work in Ghana, Tanzania, and South Africa I have witnessed many successful localized programs that are eliminating AIDS against intimidating odds. For example, Keep a Child Alive funds the "Blue Roof Clinic", in alarmingly 41% infected Wentworth, Durban. KCA funds top-quality, comprehensive care for FREE including voluntary counseling and testing (VCT), anti-retroviral (ARV) treatment, adherence counseling for medications, home-based care, alcohol and drug abuse counseling, psychosocial support, nutritional counseling and food assistance. With 1,340 patients on file and 358 patients on comprehensive ARV treatment in one year, the success and popularity of the Blue Roof model is forecasting an additional 200 patients per quarter in 2008.
Not quite 'saving the world', but making significant progress in one community. Is scaling grassroots efforts up and out a more sensible option than 8-figure donations to national governments?
Many successful programs I have witnessed do not receive PEPFAR and Global Fund money, which are often (or exclusively, for PEPFAR) channelled through recipient national governments before disbursement, rather than given straight to actors on the ground. I will reference and reflect on more experiences as I work my way into new territory - exploring the origins, direction, and use of massive AIDS aid.
Many infected and affected people I have met in Africa and America have referred to AIDS as an absolute "monster". However I am tempted to think it is not AIDS that is the monster, but rather our foreign aid system; a Green Monstah that keeps our potential home-run efforts from making it over the wall.
I aim to follow 'the green' to figure out how to best use our resources to end AIDS. How can we break down the paradox of more aid not resulting in less AIDS. Should we be giving more money or less? To which countries? For what purposes? Where have we found success and where have we failed? Can my Millenial generation really end this pandemic? How?
I invite you to join me on my journey. I encourage you to respond to posts with questions and comments, to share relevant articles and research, and to take action in some way to participate in a solution.
Thanks for joining in - and Happy 2008!
As many of you know, despite our existing medical technologies and abundant resources, HIV/AIDS continues to ravage our world, particularly in resource-poor communities where social and medical services are disturbingly absent.
The rich of our world have certainly been contributing to financing and end to AIDS. The most impressive contributions have come from bilateral aid, particularly through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Multi-lateral donors like the Global Fund to Fight AIDS, Malaria, and Tuberculosis (Global Fund), and UN agencies, particularly the World Bank, have also contributed significantly.
But HIV - preventable and treatable - continues to infect and kill, and in many places, at increasing rates. Are we not spending enough, or are we spending on the wrong things? Why are we not reversing bad investments, trivial spending, poor monitoring and evaluation? Is AIDS really too difficult to defeat? Or are we just using too many dollars and not enough sense?
In my work in Ghana, Tanzania, and South Africa I have witnessed many successful localized programs that are eliminating AIDS against intimidating odds. For example, Keep a Child Alive funds the "Blue Roof Clinic", in alarmingly 41% infected Wentworth, Durban. KCA funds top-quality, comprehensive care for FREE including voluntary counseling and testing (VCT), anti-retroviral (ARV) treatment, adherence counseling for medications, home-based care, alcohol and drug abuse counseling, psychosocial support, nutritional counseling and food assistance. With 1,340 patients on file and 358 patients on comprehensive ARV treatment in one year, the success and popularity of the Blue Roof model is forecasting an additional 200 patients per quarter in 2008.
Not quite 'saving the world', but making significant progress in one community. Is scaling grassroots efforts up and out a more sensible option than 8-figure donations to national governments?
Many successful programs I have witnessed do not receive PEPFAR and Global Fund money, which are often (or exclusively, for PEPFAR) channelled through recipient national governments before disbursement, rather than given straight to actors on the ground. I will reference and reflect on more experiences as I work my way into new territory - exploring the origins, direction, and use of massive AIDS aid.
Many infected and affected people I have met in Africa and America have referred to AIDS as an absolute "monster". However I am tempted to think it is not AIDS that is the monster, but rather our foreign aid system; a Green Monstah that keeps our potential home-run efforts from making it over the wall.
I aim to follow 'the green' to figure out how to best use our resources to end AIDS. How can we break down the paradox of more aid not resulting in less AIDS. Should we be giving more money or less? To which countries? For what purposes? Where have we found success and where have we failed? Can my Millenial generation really end this pandemic? How?
I invite you to join me on my journey. I encourage you to respond to posts with questions and comments, to share relevant articles and research, and to take action in some way to participate in a solution.
Thanks for joining in - and Happy 2008!
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