Wall Street Journal - June 27, 2001
Rachel Zimmerman and Gardiner Harris

NEW YORK -- As world leaders publicly spoke of the horrors of AIDS at a special United Nations session here Tuesday, delegates behind the scenes were struggling over the logistics of a global health fund created to fight the disease in poor countries.

On the second day of a historic U.N. general assembly on HIV/AIDS, myriad questions over the structure and governance of the fund were raised. Debate flared over who will sit on the fund's governing board; how the board will divvy up money, which is also to be used against tuberculosis and malaria; and even over how to bank the money raised and get the cash to countries, said people involved with the talks.

1U.N. AIDS Conference Is Hampered by Debate Over Groups' Participation (June 26)

Few answers emerged, and U.N. staffers monitoring the discussions said the exact makeup and goals of the new fund may not be fully formed until later this year. Even so, officials from the U.N., World Health Organization and World Bank continued to press wealthy nations and private organizations for money to support the fund. As of Tuesday, $811 million had been raised, with new contributions from Kenya, Nigeria, Norway, Sweden, Uganda, and Zimbabwe, according to the U.N.

The fund was launched earlier this year by U.N. Secretary-General Kofi Annan, who said a $7 billion to $10 billion "war chest" of additional money was needed to combat the virus. Contributions to date are far short of that target, and, officials said, donors are demanding clear goals and measurable results. Julia Cleves of UNAIDS, an agency shepherding the global response to the epidemic, Monday tried to ease fears that the money will be squandered, several times saying, "This is not a U.N. Fund."

Some of the fund's donors, particularly the U.S., which has committed $200 million to the global fund and has promised more later, want to resolve certain key questions about the fund this week. But other rich countries, notably Japan and several European nations, apparently want to wait until a meeting of the Group of Eight major industrial nations next month in Genoa, Italy.

Indeed, delegates continued to debate whether the bulk of the new funds should be spent on preventing the spread of the virus or to treat those already infected. Activists attending one of the U.N. meetings, chanting and shaking pill bottles filled with pennies, demanded that the fund go toward treating the 36 million people currently infected with the virus. "We believe it is unconscionable that we will prevent AIDS but not treat it," said Raymond C. Offenheiser, president of Oxfam, a charity based in the United Kingdom.

Andrew Cassels of the WHO said a new nonprofit may be created to accept donations to the fund. It is likely that the World Bank will be the fund's banker. In addition, the global AIDS and health fund will probably require countries to submit applications to its board in order to receive assistance. Meanwhile, health ministers from five European countries announced plans to set up associations between hospitals in Europe, Africa and South America. European doctors will be sent to hospitals in developing countries to create better conditions for treating patients, said Bernard Kouchner, the French health minister.

If the implementation of the fund is anything like the negotiations over an international declaration on AIDS that was supposed to be completed before the start of this week's U.N. summit, it won't be easy. A U.N. spokeswoman said an "agreement" for the text was finally reached late Tuesday. To soothe some Islamic countries' concerns, references to homosexuals and commercial-sex workers were deleted from a section of the document that deals with affected groups. Now, the declaration will mention "behaviors" that are unsafe without getting into details.

Separately in Washington, President Bush met with South African President Mbeki in the White House to discuss topics ranging from trade to AIDS. "The AIDS pandemic in Africa is terrible, and our nation intends to do something about it," Mr. Bush said, noting that the U.S. is the largest contributor to the new fund.

Mr. Mbeki cautioned, however, that AIDS is just one disease ravaging the continent, and Africa needs a comprehensive international strategy for addressing its problems. "If you're talking about an African recovery, you cannot but discuss AIDS and really confront it," he said. "Malaria, tuberculoses, all sorts of communicable diseases" and the poverty that accompanies them must also be addressed, he said.

Write to Rachel Zimmerman at rachel.zimmerman@wsj.com and Gardiner Harris at gardiner.harris@wsj.com

010627
WJ010620

Copyright © 2001 - The Wall Street Journal. Reproduction of this article (other than one copy for personal reference) must be cleared through the WSJ Permissions Desk.

ÆGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.

ÆGiS 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 ©1990, 2000. ÆGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on ÆGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS and the Sisters of Saint. Elizabeth of Hungary, or the party credited as the provider of the content.