From the Executive Director's Desk...
Improving Global HIV/AIDS Care

November 27, 2006
By Rev. John L. McCullough, Executive Director and CEO, Church World Service

Basic advances in human health are fundamental to improving the quality of life and economic conditions in developing countries. December 1 World AIDS Day offers us the opportunity to reflect on the next steps needed in addressing one of the most pressing global development challenges – the HIV/AIDS pandemic.

Biblical Inspiration

“Do not withhold good from those to whom it is due, when it is in your power to do it. Do not say to your neighbor, ‘Go, and come again, tomorrow I will give it’ when you have it with you.”

Proverbs 3:27-28

There is a virtual paralysis in the global community on providing life-saving treatment to people with HIV/AIDS. This does not have to be. In the face of such a devastating pandemic, the world community has the ability to get help to those who need it. One of the most important and effective actions we can take to overcome the treatment paralysis is to ensure the existence of an adequate number of community health care workers.

A Good Beginning

Five years ago, leaders from 189 nations, including the U.S., made a bold commitment to use their nations’ resources on behalf of neighbors who are in desperate need of life-saving help. They set impressive goals for dealing with the global AIDS crisis. The leaders’ most immediate pledge was to provide universal treatment, care, and support for everyone with the disease by 2010.

These commitments spurred greater giving and various experiments in targeting foreign assistance. From the limitations of these experiments, we know that one of the most effective strategies to reach this critical treatment goal would be to increase the number of community health workers in developing countries. Now is the time for us to scale-up our assistance in this area and make our generosity meaningful and tangible today.

Treatment Report Card

Last year, 39 million people were HIV positive, and three million people died from AIDS, according to UNAIDS and the World Health Organization (WHO). The vast majority of those deaths were unnecessary – because people were not getting needed medicine. WHO reports that at least 80 percent of those in clinical need of anti-retroviral treatment are not receiving it.

Recent data from UNAIDS indicates that in Asia only about one in six people in need of antiretroviral treatment are now receiving it. More than seventy percent of the treatment need of Asia is in India, where treatment coverage is below ten percent. In China total infections number approximately 650,000.

In Eastern Europe and Central Asia HIV infection has increased twenty fold in less than a decade. Though access to antiretroviral treatment has expanded in some parts of the Caribbean, AIDS is the leading cause of death among adults. In Latin America the most intense epidemics are in smaller countries like Belize and Honduras. According to UNAIDS, “the poorest countries of Central America and those in the Andean region of South America are struggling to expand treatment access in the face of affordability barriers.”

Nearly two-thirds of those living with and dying from the disease are in Sub-Saharan Africa, creating a heavy social and economic toll. UNAIDs reports that the AIDS epidemic in Sub-Saharan Africa “has erased decades of public health gains.” African Bishops have noted that poverty not only magnifies the suffering and death, but also itself is worsened by the pandemic, because AIDS is ravaging the labor force and national health budgets in many nations. The productive core of countries and the few safety nets that exist are being shredded.

At this point, one of the chief roadblocks to achieving universal treatment is the lack of trained health workers. In 2003, WHO called the treatment gap a “global public health emergency.” Not much has changed since then. WHO’s 2006 Annual Report found severe health workforce shortages in 57 nations, most of them in Sub-Saharan Africa. Africa needs to more than double the numbers of health providers in order to meet AIDS and other global health goals.

Improving Access to Treatment

Fortunately, we know how to address this roadblock. In response to the global goals on AIDS set in 2001, President Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR). In spite of its serious shortcomings and limited reach, PEPFAR has demonstrated that the training and equipping of community health workers is an affordable, effective and efficient way of dramatically scaling-up health care even in remote, rural areas of very resource-poor nations.

On-the-ground health workers can be trained and mobilized quickly and be dispersed throughout the country, providing coverage in areas where existing health care is thin or non-existent. They offer a range of much-needed services such as initial diagnoses, referrals to more highly-skilled health care providers, education, and support to ensure people who need medicine follow the recommended treatment regime. Moreover, governments have found that increasing community health workers had positive multiplier effects in relation to other health goals as well, such as boosting childhood immunization rates and reducing maternal and infant mortality rates.

We need to take these lessons and multiply them. The U.S. share of WHO estimates to train, retain, and sustain the number of doctors, nurses and community workers needed to meet international health targets is $8 billion over five years. A minimum of $650 million is needed in the coming year. This will be a legislative advocacy priority for Church World Service when the new Congress convenes in January.

Comprehensive strategies for improving treatment will also need to look at factors spurring high turnover of medical professionals. Overburdened staff face major burnout caused by having to cope with severe caseloads and crumbling health systems where shortages of medicines and equipment are common. Low pay and poor workplace conditions make offers from foreign recruiters and private contractors a more attractive employment option, which also contributes to the decimation of public health care in developing countries.

Vital Policy Changes

Finally, some policy changes may be necessary in Washington as well as in some developing nations. Some countries impose fees to use public health care, making AIDS treatment financially impossible. In Nigeria, for example, out-of-pocket AIDS treatment costs can be $300 annually. This is a country where 91 percent of the households live on less than $2 a day. Sometimes these fees are charged because governments have been pressured by the International Monetary Fund (IMF) and World Bank to reduce public spending as a condition to receive loans.

The IMF and World Bank also recommend that countries set low inflation targets and limit wages. These measures have the unintended consequence of curbing nations’ ability to invest in public health by hiring medical personnel. As a key stakeholder in these institutions, the U.S. could prod a needed reassessment of these approaches. The new Congress can investigate this in collaboration with the U.S. Treasury Department .

Doing Good to Our Neighbors

Expanding the number of community health workers will enable treatment for AIDS to reach the millions of women, children and men who need it. Fully providing our share of the cost to train, equip and support them is not only the right thing to do, it is a wise investment for the future of our world.

It is within our power as nations to overcome the treatment paralysis and do tremendous good to our neighbors in need. The passage from Proverbs reminds us that now is not the time to hang back.