HIV/AIDS and Earth Summit 2002 Stakeholder Viewpoints: The international partnership against AIDS in Africa (IPAA)

The vision of the International Partnership Against AIDS in Africa is that within the next decade African nations with the support of the international community will be implementing larger-scale, sustained and more effective multisectoral national responses to HIV/AIDS. Through collective efforts, promotion and protection of human rights and promotion of poverty alleviation, countries will:

·         Substantially reduce new HIV infections;

·         Provide a continuum of care for those infected and affected by HIV/AIDS;

·         Mobilize and support communities, NGOs and the private sector, and individuals to counteract the negative impact of the HIV/AIDS epidemic in Africa.

1. Context

An unprecedented crisis...

In a world where six thousand lives are lost due to AIDS each day, nearly 70% of the world’s deaths are to be found in a continent that is home to just 10% of the world’s population.  Infection levels are highest in the sub-Saharan region, where access to care is lowest, and social and economic safety nets that might help families cope with the epidemic have been grossly inadequate.

In 1999, the epidemic killed ten times as many people as died in armed conflict, and there are currently over 10 million young people orphaned by AIDS in sub-Saharan Africa. Life expectancy among sub-Saharan Africans, which had risen from 44 years in the 1950s to 59 years in the early 1990s, is now expected to drop to 45 years between 2005 and 2010. Other development indicators, such as education levels and economic development, have similarly been affected throughout the region.

An estimated 3.8 million Africans became infected with HIV during the year 2000, bringing the total number of people living there with HIV/AIDS to 25.3 million. With an average of ten years for HIV to reach fully blown AIDS, the epidemic has still not reached its maximum potential.

Needing an unprecedented response

In December 1999, the Secretary-General assembled representatives from the five constituencies for the first time and called on then to respond on a scale commensurate with the challenge of AIDS. He commented, “This unprecedented crisis requires an unprecedented response - a response from all of us, whoever and wherever we are. A response that makes humanity live up to its name. The epidemic is terrible, but we are not powerless against it. Already strong forces of hope and faith are showing us what can be done. In many cases, Africa itself is leading the counter-attack.”

The IPAA proceeds from the recognition that none of the partners – neither governments, nor civil society, nor the various national and international organisations working against AIDS in Africa – can mount an effective response to the epidemic in isolation. Rather, it takes a coalition approach to magnify the contribution of all partners, while giving a clear leadership role to African governments.

Following the meeting with UN Secretary-General, all partners agreed on a Framework for Action, which sets out a strategy for working together to address the AIDS epidemic. It has gone through a broad consultation process that ensured optimal participation and ownership by all the groups. The Framework is a living document that outlines the vision, the principles and the overall goal of the IPAA. It also sets out expected results and key milestones to be achieved in the next two years, and makes clear provision for activities at all levels as well as the roles and responsibilities of each constituency. The Framework is seen as the foundation for strengthening and monitoring the IPAA and it will be revisited every year. It has since been endorsed by the UNAIDS Programme Co-ordinating Board and acknowledged by the Heads of State Summit of the Organisation of African Unity (OAU) held in Lomé in July, which adopted the Ouagadougou Declaration by the OAU Ministers of Health.

2. Progress

Before the formal launch of the IPAA during the Africa Development Forum in Addis Ababa in December 2000, much has occurred to achieve the milestones which were identified in the fields of advocacy and political mobilisation, increasing financial resources, national capacity strengthening, intensified country level action and effective partnership mechanisms.

Advocacy and political mobilisation

The IPAA has mobilised unprecedented leadership and commitment of African leaders and organisations to intensify their response to HIV/AIDS. Many presidents have broken the silence that previously surrounded HIV/AIDS in their countries and have established high-powered commissions. Panafrican (OAU) and subregional institutions such as SADC, ECOWAS, ECA[1] have committed themselves to support the IPAA and the implementation of the Framework for Action. In January of 2000, the UN Security Council debated the AIDS pandemic, the first time that a development issue has achieved such attention. As a result HIV/AIDS strategies for countries in conflict, including issues related to the military and peacekeeping operations are being developed. AIDS has also been the focus of attention at major summits such as the G-8 2000 meeting in Japan, the Heads of State Summit of the OAU in Lomé, the 13^th International AIDS meeting in Durban and the Africa Development Forum in Addis Ababa this year. A Joint Advocacy Programme for the IPAA which is now being implemented in various countries intends to enlist both the political commitment and the financial support for HIV/AIDS programmes.

Mobilising financial resources

The growing commitment of African governments is resulting in a re-alignment of funding priorities at national level. Many governments are organising roundtables to mobilize funds for intensified action against AIDS. Cosponsors and donors are significantly increasing their financial and technical resources. Substantial grants have been made by private sector organisations such as the UN foundation and Gates Foundation among others. The pharmaceutical companies in collaboration with the UNAIDS Secretariat and the Cosponsors are exploring ways to accelerate and improve the provision of HIV/AIDS related care and treatment in developing countries. The UNAIDS Secretariat is also working closely with the World Bank, UNDP and UNICEF to maximize benefits for HIV/AIDS programmes in debt relief accords.

Strengthening national capacity

Emphasis is being placed on strengthening the managerial capacity within countries, while at the same time ensuring better coordination of external support and advice. Task teams have been formed to improve information systems (SAFCO[2], SAFAIDS[3]) and resource networks around specific themes (e.g. migration, young people, etc.). Cosponsors and donors have added regional technical posts. The UNAIDS Secretariat has developed a directory of technical expertise on AIDS in Africa, and is now finalising a common database for the use of all partners. Tools for prioritisation and costing of the national strategic plans against AIDS were also developed.

Intensified action in countries

The key focus of the Partnership is at country level, and the first principle of the Framework for Action is African ownership and leadership of the Partnership at all levels.

·         The IPAA reinforced the national strategic planning (NSP) process, a concept for HIV/AIDS which was started in 1997. It includes a dynamic and participatory process that involves all sectors and levels of government including NGOs, religious organisations and international development partners to produce a multisectoral and decentralised response to the epidemic. The IPAA has been instrumental in helping countries to formulate the NSP (Ghana and Burkina Faso) and revise costing and priorities of completed plans (Ethiopia, Malawi, Zambia and Mozambique). This has resulted in the formation of wider and more effective partnerships and has encouraged increased internal and external mobilization of financial and human resources.

·         Following the increased commitment of governments, high level national coordinating bodies were established and empowered. The IPAA has provided technical expertise to build the capacity of National AIDS Councils and their Secretariats in among others Mozambique, Nigeria, Botswana, Zambia, Uganda, Ethiopia and Tanzania. 

·         Through the District Response Initiative based on a broader community mobilization and participation, the Partnership has supported countries in strengthening the capacity of communities to respond to the epidemic in order to decentralise the response against AIDS. The decentralisation also creates linkages between health care providers and communities. Ghana, Tanzania, Burkina Faso, Malawi, Mali, Uganda, Zambia and Zimbabwe are receiving technical and financial support to scale up District Responses. Through implementation of community responses the organisational capacity of national community based organisations and non-governmental organisations is also being strengthened. More partners are now expressing their interest in contributing to increasing capacity at community level.   

·         In regard to resource mobilisation, the quality of the participatory, multisectoral and costed national strategic plan resulted in successful roundtables that will enable the implementation of the plan. The experiences and lessons learned in roundtables have been documented and are being disseminated to assist other countries in preparing their own roundtables. In the framework of the AIDS-for-Debt Initiative, UNAIDS is assisting African countries to place AIDS policies within such documents as the Poverty Reduction Strategy Papers (PRSP), as well as including their NSPs into the medium-term public expenditure frameworks (MTEPs). Over the past 12 months, more than a dozen countries in Africa have highlighted HIV/AIDS in their PRSPs as an important factor in reversing national and household poverty. A number of these countries have for the first time set aside funds from their own national budgets, as part of the HIPC debt relief process, to finance part of the national AIDS response. Burkina Faso, Cameroon, Malawi, Mali, Mozambique, Tanzania, and Uganda are each allocating $2-5 million of national resources liberated through debt relief to the fight against AIDS each year. Also as part of the debt relief process these countries are committing themselves to implementing concrete actions in such areas as AIDS prevention and care and support, that can be monitored in collaboration with civil society and international partners. 

·         One of the challenges in the response to HIV/AIDS in sub-Saharan Africa is the scaling up programmatic interventions to achieve national coverage. Partners have accelerated this process by providing financial, technical and material sources. Care and support programmes have been expanded in Swaziland, Mozambique, Uganda, Tanzania, Côte d'Ivoire and Ghana. Partners have worked together with countries in accelerating Mother-to-Child-Transmission in many countries.

Effective partnership mechanisms

UNAIDS Cosponsors and donors identified HIV/AIDS as a top priority and have started to expand and reorient their programmes substantially. Regional community networks such as AfriCASO, NAP+, SWAA[4] mobilised the community organisations to actively participate in the national response, and global NGOs are becoming more active within the IPAA. The private sector is also increasingly involved and has started broadening corporate responses, workplace policies and programmes. 

At international level, efforts have been made to give all partners access to the information they need through an information-sharing system which is being established and managed by the UNAIDS Secretariat. A communication strategy is gradually being implemented to enhance information dissemination among all partners at all levels. A regular electronic information bulletin on key activities of the African governments, UN agencies, donors, the private sector and the community sector is now sent out. A website with several types of background information and activities of countries on the international response has been established within the UNAIDS website. All major documents of the activities and decisions on the international response are widely distributed throughout all levels of the IPAA.

At country level, the IPAA also provides a forum for information exchange and planning. Based on national contexts and realities, mechanisms vary e.g. Expanded Theme Group in Ghana, Zambia, Ethiopia; Technical Working Group in Malawi; Task Force in Burkina Faso; Partnership Forum in Tanzania and South Africa.

3. Challenges

The IPAA is moving but much more needs to be done to address the magnitude of the impact of the epidemic on the individuals, the family, the society and the development of the sub-Saharan countries. To accomplish the objectives of the Partnership, stated in the Framework for Action, we need to intensify our effort, especially in the following areas: 

§         Many countries have now completed their national strategic plans, and others are in the process of doing so, but it can not be forgotten that the enormity of the epidemic makes it an emergency crisis, and programmes must move quickly from planning into practice. The cost of waiting to ensure a ‘perfect’ programme is a luxury that simply cannot be afforded. The plans that have been made already, and those being made, must be implemented with the shortest possible delay.

§         The establishment of clear and thorough mechanisms for resource mobilization and for channeling the funds directly to the communities will ensure that the limited resources reach where they are so desperately needed.

§         At present the resources are unable to keep pace with the epidemic. Many more resources are required in order to stem the devastation that has been caused by the epidemic throughout sub-Saharan Africa. It is of vital importance that all actors further intensify their contributions.

§         The co-ordination of the national response by the government is a key element for success. It is therefore essential that partners support the strengthening of the capacity of the national co-ordinating bodies.

§         Strengthening the leadership role of the community, especially traditional leaders, religious leaders, youth groups, women's groups and networks of PLWHA, so that they may build partnerships at national and local level will contribute effectively to the national response.

4. Conclusion

The IPAA comes at a critical moment in the continent’s development, a time when African solutions are needed to solve a serious problem stalking the continent. Though much has been done in a relatively short period, it is now the time to accelerate the implementation of all programmes. It is essential that all partners realise that the only means by which progress can be made against HIV/AIDS is by working in coalition, and the most appropriate mechanism we have for implementing is the International Partnership against AIDS in Africa.

Nelson Mandela in his address to the 13^th International AIDS Conference in Durban said “I come from a long tradition of collective leadership, consultative decision-making and joint action towards the common good. We have overcome much that many thought insurmountable through an adherence to those practices. In the face of the grave threat posed by HIV/AIDS, we have to rise above our differences and combine our efforts to save our people. History will judge us harshly if we fail to do so now, and right now.”

Web link to further information about the IPAA is at:

http://www.unaids.org/africapartnership/index.html  

HIV/AIDS and Earth Summit 2002 Stakeholder Viewpoints: The international partnership against AIDS in Africa (IPAA)