Shifting paradigms: enabling accountable governance in African HIV/AIDs interventions/Renversement des paradigmes: permettre une gouvernance responsable dans les interventions Africaines dans le domaine du VIH/SIDA.

• Author: Butegwa, Christine

Next to malaria, HIV/AIDS continues to be the single biggest killer of humankind in the new century. Although, sub-Saharan Africa has just over 10% of the world's population, it has been most affected by the epidemic with close to 25 million people living with HIV. That is close to two-thirds of all people living with HIV (3). It is widely acknowledged that the two major trends of the pandemic are feminization and globalization. HIV/AIDS is not only an issue for sub-Saharan Africa, but is now a global issue. At the same time, the face of HIV/AIDS is unmistakably female due to gender-based violence, the feminization of poverty, women's lack of control over resources, the gendered disproportional burden of home-based care, denial of women's sexual and reproductive rights, and their vulnerability to the virus due to their biological composition. In sub-Saharan Africa, the feminization of the epidemic is apparent where 57% of adults infected are women, and 75% of young people infected are women and girls (4).

Despite the urgency of the pandemic, expenditure on health by governments continues to be an issue of concern. Doubtless, funding allocations to HIV/AIDS programmes and research have increased from the mid 1990s. However, an analysis of national budgets of African countries reveals that few governments have allocated 10% of their budgets to health. By 2002, most of Africa's expenditure on health fell at between 3-5% of the Gross Domestic Product (GDP) (5). For example, both Mozambique and Uganda were only spending $9 per person per year on health by 2002. The implementation of Structural Adjustment Programmes (SAPs) by governments from the late 1980s at the recommendation of the Bretton Woods institutions takes a fair share of the blame for the dismal level of money that is allocated to the health sector in African countries. SAPs were applied to more than 90 countries over the last two decades and were aimed at, among other things, cutting government expenditures and privatizing state-owned companies. Governments were therefore put under pressure to reduce spending.

Unfortunately, the effects of downscaling government spending were felt in the social services sectors of health and education. Thus, where just after independence, most African countries had succeeded in reducing infant and maternal mortality, these gains were eroded by the SAPS. By the time the HIV/AIDS epidemic struck, health institutions in Africa were reeling from inadequate medical staff, lack of infrastructure, equipment and medicine/drugs. To compound the situation, governments continue to spend more in foreign debt servicing than on health. African civil society organizations are now advocating for debt cancellation in order for government resources to be channeled back to social services. This is one of the agendas of such campaigns as the Global Call to Action Against Poverty (GCAP) in the run-up to the July 2005 G-8 Summit and the United Nations Summit on Millennium +5 review.

Gender, HIV/AIDS and the Millennium Development Goals (MDGs)--

MDG Goal 5 seeks to combat HIV/AIDs, malaria and other diseases with the target of halving and reversing the spread of the pandemic by 2015. This target will not be achieved unless interventions are premised on the right to health for all that is guaranteed in the Universal Declaration of Human Rights, the Convention on Economic, Social and Cultural Rights and the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women. Economic and social rights such as the right to health are progressive rights, which mean that governments are meant to progressively move towards protecting those rights within their resources. For African governments, this means that the achievement of goal 5 cannot be looked at in isolation. Governments need to be committed to applying gender sensitive strategies at national, regional and international levels that deal with HIV/AIDs in relation to the other 7 goals, specifically goal 8 on developing a global partnership for...