Troby
PREVENTION
THE FINANCIAL PERSPECTIVE
What happens to a society when the majority of the population in the most productive working ages are living with HIV or have AIDS or have died as a result of AIDS? Who shall work and make the economy spin and develop (or at least maintain today’s situation), and who shall take care of, and educate the coming generations of children and who shall take care of the old and sick people?
The financial perspective contains all the type of obvious areas connected to health prevention, care and treatment. It also contains the vividly advocated issue taking place some years ago about pharmaceutical companies and their demand for high prices on the anti-retroviral medicines (ART). Should they (pharmaceutical companies) be able to profit too much on their R&D-medicines or should they take on a corporate social responsibility earning less, possible leading to a lesser eager to research and develop the next generations of more effective medicines to be developed?
With the access to financial assets, the opportunities for people in developing countries to take care of themselves and their families’ increases. Nevertheless, suffering from HIV often leads to a higher percentage of a person’s income must be spent on buying medicines, if the person has access to them. At the same time s/he has to have money to purchase the type of food (diet) needed for the medicine to have full effect.
For governments and NGOs the need of money is both to buy medicines and distribute them amongst the people who need it, as well as to spend funds on information about where to get tested, who to contact to find the medicines, how the medicines should be taken and, preferably, awareness information to the general public about the disease in order to reduce stigma. In this decision-making process, basic issues like water, electricity and other types of important infrastructure must also be addressed and taken into account when making priorities and there are a lot of different priorities to take into account in order to make the financial assets as effective as possible. This is extremely difficult when the resources are scarce.
Another dilemma is when different funders or stakeholders are supporting countries lacking resources to conduct their own HIV prevention and dictate how the money they bring should be spent. Such as PEPFAR and other funders which, as in the case of Uganda, do not want to contribute to activities involving distribution or use of condoms. According to my view, it is important for every country and community in the world to carry out prevention activities with cultural specific methods, and to adjust projects and ideas to fit their society. The risk is otherwise that the funders’ ideas of support (especially the Western countries’) are something being directly translated from their home country, without taking the cultural setting into account. Another dilemma is that some of the available funds are provided as loans, making poor countries able to work on prevention, care and treatment, but at the same time puts them in an awkward situation, since the money needs to be repaid. Again, this is where it is possible for countries like China and multi- or international companies to take opportunity to use this underdog-situation any country might have.
In Iraqi Kurdistan, where I am working (first contact was in 2006), they test everyone who enters Kurdistan from abroad and intend to stay longer than 15 days. The test includes Hepatitis B, C and HIV, and is only carried out for bearers of foreign passports, not Iraqi passports. (This is something I will go into detail in coming perspectives.) Based on available information and facts from the governorate of Sulemaniya, an estimate cost of 100,000 US$ is spend on testing procedures each month. The sum includes the materials, staff hours and on equipment used. This is a huge sum spent on a procedure that is not contributing to a serious and effective way of working on HIV prevention and which could have been spent on alternative activities. The priorities, when deciding about the division of funds, have probably been influenced by wrong information background and/or lack of knowledge about how to manage the HIV/AIDS work in general. Money is therefore no guarantee countries spend them in the most effectively way.
A related aspect of the financial perspective is the foreign trade market. China has, as an active player, an extensive trade in around 30 countries, not the least with African states, any of which are seriously affected by AIDS and the HIV epidemic. Some of these governments see China's trading interest as an opportunity to become more developed by receiving “new fresh money”, without any questions raised for increased democracy
or human rights, which is done by western countries Again, several of these countries, for example, Chad and Sudan are subjects to debt-relief by the international community. A related aspect of the financial perspective is the foreign trade market. China has, as an active player, an extensive trade in around 30 countries, not the least with African states, any of which are seriously affected by AIDS and the HIV epidemic. Some of these governments see China's trading interest as an opportunity to become more developed by receiving “new fresh money”, without any questions raised for increased democracy or human rights, which is done by western countries Again, several of these countries, for example, Chad and Sudan are subjects to debt-relief by the international community.
I believe another aspect of the financial perspective has been neglected, namely marketing. Marketing is one way for companies to get consumers to change their (purchasing) behaviour and create demands. They seek to make people adopt to a certain lifestyle, where they in this lifestyle should do specific things, wear and use certain products, and to go in a certain direction mind wise. How much has organisations and authorities benefitted from the knowledge contained in marketing, for the benefit of HIV prevention? Is it enough? I believe we have much more to learn from this in the strategies we create for dealing with prevention! And I believe corporations in general should take on a responsibility to support local and national work on HIV prevention with their knowledge in marketing and how this can be used for the benefit of the society. Some companies have done this more or less strategically, but from what I have found, NGOs and authorities have limited skills in this planning. It is more conducted by the companies, which also have another agenda – making profits.
Dealing with prevention needs resources, and I have seen a lot of these resources being spent on the medical side of societies’ efforts, even though the medical side is more focused on care and treatment, not prevention. Maybe this work is being funded more because of the higher status associated with this field, and that many people believe that a disease is best treated with doctors and medicines? If we take the issue of male circumcision, governments and health authorities (in non-Muslim, and non-Jewish countries) have shown a huge interest in this, and are willing to spend a lot of funds to develop this further. Maybe this is a quest for easy solutions? Male circumcision is expected to reduce the risk of being infected with HIV with up to 60 percent, but this is not 100 percent. Still there would be a need for condom use and resources on primary prevention, and still there are funds needed to develop the comprehensive approach to HIV prevention, meaning a need to further develop the methods connected to behavioural change. At the World AIDS Conference 2008 in Mexico City, there were a lot of voices raised saying the world has so far been unable to properly address the behavioural change activities and methods in HIV prevention. I believe we need to reflect on how and why we put so much hope on the medical perspective, and why we have so difficult to advocate for the social or behavioural side of the prevention work and activities, and supply it with enough funds. (This is something that I will get back to in some of the other perspectives in this series, from different angles.)