- In July 2000, the United Nations Security Council (UNSC) adopted Resolution 1308, calling for “urgent and exceptional actions” to mitigate the threats posed by HIV/AIDS.
- As the first disease to be the subject of a UNSC resolution, the exceptional status of HIV/AIDS has brought about unprecedented levels of international funding allocated primarily in developing countries where responses to the disease have historically been scarce or non-existent.
Sword of funding cuts
- While the exceptional approach to HIV/AIDS was warranted in the earlier stages of responses at the national level, it has become increasingly ineffective over time.
- This is visible through duplicated/parallel health systems and unsustainable funding.
- The overdependence on international assistance, coupled with the overwhelming policy preference towards HIV/AIDS, has resulted in the marginalisation of other pressing health threats such as malnutrition, and maternal and child health care.
- Most importantly, there has been a stagnating and even declining trend of HIV/AIDS international financial assistance in recent years.
- Data show that most European donor governments have reduced their financial commitments since 2012.
- Moreover, in light of the continuous economic boom in India and China, international funding agencies now argue that these countries should be donors instead of recipients of international HIV/AIDS-specific grants and loans.
- Without renewed and increased commitment from international donors and recipient governments, the sustainability of future national HIV/AIDS programmes is in doubt.
- In response to the changing global health agenda, most of these countries are prioritising the integration of HIV/AIDS programmes into existing health-related systems.
- This shift implies that international funding organisations now exert a tremendous influence on the priority of health issues in the developing world.
- An integration of HIV/AIDS interventions and primary health-care systems has taken place in India from 2010 onwards.
- For instance, six components of the National AIDS Control Programme (NACP)-III merged with the National Rural Health Mission (NRHM) in 2010.
- The integration of HIV/AIDS responses under the umbrella health system is ongoing in the NACP-IV; where all the service delivery units except the targeted interventions (TIs) have been set up within the health-care system.
- At the 2016 high-level meeting at the UN General Assembly, India pledged to follow targets towards ending HIV/AIDS as a public health threat in the next five years, and ending the epidemic by 2030.
- India is now playing a larger role in funding its HIV/AIDS programmes — two-thirds of the budget for the NACP-IV is provided by the Government of India and comes from the domestic budget.
- Indian HIV/AIDS programmes have progressively become less dependent on foreign assistance considering that over 85% of the budgets in the first and second phases of the NACPs and 75% in the third phase were supported by international and bilateral funding mechanisms.
- But in order to ensure the sustainability of the HIV/AIDS interventions, continuous integration of HIV/AIDS programmes into a larger health system is required.
- However, despite rapid economic development over the past two decades, public expenditure on health care in India as a proportion of GDP is among the world’s lowest.
- India’s health-care expenditure is also comparatively less than other BRICS countries.
Awareness versus stigma
- A UN report showed that “India has the third largest number of people living with HIV/AIDS in the world and accounts for about 4 out of 10 people living with HIV/AIDS in the region”.
- If the goal of ending HIV/AIDS in India by 2030 is to become reality, there not only has to be an increase in budgetary allocation to public health care but also a more concentrated effort to increase AIDS awareness.
- Evidence suggests that many people suffering from HIV/AIDS in Asia lack the awareness that they test positive.
- Despite the prevailing advocacy of HIV/AIDS interventions in an integrative manner, there has been a consistent push to maintain the exceptional status of HIV/AIDS as a unique global health challenge.
- It is argued that certain levels of AIDS exceptionalism should be maintained when we perceive ending HIV/AIDS as a means to an end.
- If we can end HIV/AIDS, we can end other pressing developmental problems, where the costs of the disease and its care present a serious economic burden.
Source: The Hindu