Inter Press Service - May 2, 2000
Jim Lobe

In particular, comprehensive debt relief should be provided to those countries which present a credible plan for fighting AIDS and other major social and health problems. If unchecked, AIDS by itself could destroy entire societies in the coming years, says Jeffrey Sachs, director of Harvard University's Center for International Development (CID).

Those countries now are forced to pay many times more to service their foreign debt than they spend on health care, leaving them without enough money to even begin to cope with what some observers believe may turn out to be the most deadly disease in recorded history.

Such plans should, however, be submitted to the World Health Organisation (WHO) or the World Bank for approval, rather than to the International Monetary Fund (IMF), the global agency which currently determines what conditions countries must meet in order to receive debt relief under the Highly-Indebted Poor Countries (HIPC) initiative, according to Sachs.

"Somehow, we've assigned this task to a financial institution whose expertise is ... balance of payments, but not the social emergency that the (debt) initiative was supposed to address," he told a telephone press conference Tuesday.

He called on the administration of President Bill Clinton to take the lead in removing HIPC from the IMF's control in the interest of expediting debt relief so that African governments could redirect their resources from debt service to health and related spending. If Clinton fails to do so, said Sachs, who recently served on a special Congressional commission on the IMF and the World Bank, the US Congress, which is more hostile to the IMF, should take action.

Sachs, who hosted a conference on assessing debt-relief initiatives to date in Boston Monday, spoke in the wake of published reports that Clinton's National Security Council (NSC) has formally designated the AIDS pandemic as a threat to US national security.

According to an estimate prepared by US intelligence agencies in January, some of the hardest-hit countries, especially in sub- Saharan Africa, will suffer "a demographic catastrophe" over the next 20 years due to the spread and lethality of HIV/AIDS.

"This will further impoverish the poor and often the middle class and produce a huge and impoverished orphan cohort unable to cope and vulnerable to exploitation and radicalisation," according to the classified estimate, a copy of which was obtained by the Washington Post. Sharp declines in life expectancy caused by the disease could well result in "revolutionary wars, ethnic wars, genocide, and disruptive regime transitions," it said.

More than 16 million people have died from AIDS since the 1980s, 14 million of them in Africa. By the end of 1999, some 33 million people - including about 23 million Africans - were infected with HIV, the virus that causes AIDS.

UN experts believe that the disease is now poised to spread swiftly through much of Asia, Eastern and Central Europe, and Latin America and the Caribbean. Indeed, the US intelligence estimate predicted that Asia was on track to surpass sub-Saharan Africa in the number of new HIV infections within 10 years.

But sub-Saharan Africa - particularly southern and eastern Africa - is especially hard hit. In some countries, more than one in five adults is infected with HIV, and the continent's health system, which was already battered by IMF- and World Bank-sponsored "structural adjustment programmes" (SAPS) - must deal with 5,000 new infections every day.

In the absence of exorbitantly expensive treatments available in the West, HIV/AIDS ordinarily kills its victims within 10 years of infection, causing not only sharp declines in life expectancy; but also huge economic losses, as most of the victims are cut down in their most economically productive years. Most societies would find it difficult, under the best of circumstances, to cope with such a scourge. But many of the worst-affected countries suffer a huge debt burden as well.

Zambia, for example, where two percent of the population is now HIV positive, spent more than 30 percent of its national budget on debt payments each year throughout the past decade. That left only 10 percent for basic social services, of which only a portion was devoted to health services.

Despite the seriousness of the AIDS threat, the international response to date has been "shockingly meagre, almost unbelievably so," according to Sachs. UN agencies estimate the costs of an effective AIDS prevention campaign in Africa at 2 billion dollars a year, and another 2 billion dollars for treatment.

While international agencies, including the World Bank, have increased their spending on HIV/AIDS, it still amounts to only a fraction of what is needed - about 300 million dollars per year. Even US officials who were part of the decision to designate AIDS as a national security threat have admitted that Washington is not yet prepared to spend nearly the amount of money that is required.

The United States provided about 125 million dollars a year for AIDS prevention over the last several years and almost doubled that amount for 2000. Clinton also has asked Congress to approve 1 billion dollars over 10 years to be used as a tax incentive for pharmaceutical companies to develop vaccines for HIV/AIDS and other infectious diseases which wrack Africa and other poor regions.

But a faster way to free up resources for the fight against HIV/AIDS and other diseases is through debt relief, according to Sachs. Indeed, the HIPC initiative calls explicitly for beneficiaries to use the money they save in debt relief for social purposes, especially health and education.

The problem, however, is that HIPC, for which some 40 countries are supposed to be eligible, has been far too slow in its implementation. Launched four years ago, the programme has required countries to faithfully implement SAPs before receiving any reduction in their debt, and, even then, the reductions have been so modest that the remaining debt continues to hamper the country's ability to tackle its health problems.

Tanzania, for example, was promised debt-service relief of 3 billion dollars of which the IMF portion was 152 million dollars, to be delivered over 10 years, and the World Bank's portion, 1.2 billion dollars spread over 20 years. But that translates into only 75 million dollars a year that will be available to the government to spend on social and health programmes.

"The difference between the publicly announced figures - which typically run into the billions - and the actual resource flow, in this case, 75 million dollars, is vast indeed," said Sachs, who noted even this much is only currently available to a small fraction of the potentially eligible HIPC countries.

Only one country, Uganda , has reached a "completion point" in the HIPC process, at which time debt is actually cancelled. But a final deal, which would free up more money for health spending, has been delayed because donors on the IMF's board have raised questions about the government's purchase of a plane for President Yoweri Museveni.

"I think it is farcical, to put it bluntly," said Sachs, noting that Uganda had been a model in using money saved from debt reduction for social purposes and that the plane had been agreed on by the Ugandan parliament. "The IMF should not be part of the micro-management of a debt-relief initiative," he added.

Worse, some of the conditions imposed through SAPs by the IMF and the World Bank actually undermine the ability of governments to provide health care, according to Sachs. Thus, Mozambique, which has also received some debt relief under HIPC, is being required to increase user charges for health-care services in a country where HIV/AIDS is spreading quickly. "These user fees exclude the poorest of the poor," according to Sachs.

"There has to be the institutional recognition by the IMF that (these) issues are really beyond its remit," he said. "It would be far more effective for the World Health Organisation to take the lead in mobilising debt cancellation in the interests of world public health. The leadership for this belongs in Geneva, not on 19th Street," which is the IMF's location in Washington.(END/IPS/HE/EF/jl/da/00)
000502
IP000502

Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2000. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .