ADF IV HIV/AIDS AND GOVERNANCE FOCUS GROUP

ISSUES PAPER

Introduction

Given the fact that an estimated 30 million individuals on the continent live with HIV/AIDS, the worst effects of the epidemic will be felt by future generations. These effects are felt through losses in the development achievements of the past in many areas, chief among which are the education and health sectors.

In the interface between the agendas of overcoming the HIV/AIDS epidemic and promoting good governance in Africa, there are two key challenges. The first is to fully understand the nature, magnitude and urgency of the threats to governance posed by the HIV/AIDS epidemic and its wider impacts. The serious and sustained loss of human resources across all sectors jeopardises the institutional capacity of government departments, the business sector, NGOs and society at large.

The second challenge is to undertake the biggest service delivery operation ever undertaken in Africa, namely extending anti-retroviral treatment (ART) to the millions of people on this continent living with HIV and AIDS. Achieving this requires not only mobilising financial resources, but also putting in place the human and physical infrastructure and institutional arrangements necessary for sustained delivery of this life-prolonging treatment.

Objective of the Focus Group

The purpose of the HIV/AIDS and Governance Focus Group is to discuss the challenges the pandemic presents to the maintenance of state structures given the serious loss of human resources across all sectors, including the health sector. Such an understanding can lay the foundation for effective policies and programmes to mitigate these threats, and ensure that essential governance functions are retained and services delivered.

Key Issues

Evidently, progress in Africa will not be possible while the HIV/AIDS epidemic continues unchecked. This is now universally accepted, with key commitments undertaken by African governments and international partners at the April 1991 Abuja Summit, the UN General Assembly Special Session (UNGASS), etc. In this context, the Focus Group must move beyond repeating already well-rehearsed calls for HIV/AIDS to be a `priority', for there to be `mobilisation", and for there to be `leadership at all levels'. The Focus Group should move towards specifying frameworks for action in each of the following areas of governance:

1) Economic management and institutional effectiveness

Rising morbidity and mortality will directly affect macroeconomic indicators. Rising morbidity will reduce productivity (due to workers' time off for sick leave or to look after a sick family member, and lower productivity while at work due to illness or worry); increase expenditure on health care (by individuals, firms and governments), training (by individuals, firms and governments), and sick pay (firms and governments); reduce savings - at least part of the additional expenditure will be taken from income that would otherwise be saved; and reduce investment (both public and private).

Rising mortality will have demographic impacts: smaller population and workforce; and changing age structure of the population and workforce (with implications for experience, productivity and the availability of skills).

• How does the Focus Group see these impacts playing out over the coming years?

• What measures should be undertaken to minimise the damage to service delivery and the functioning of basic state structures and social institutions?

• What should be the nature of some sector-specific measures by key social actors to retain our vitally needed human capital?

• How should societies work toward minimizing the damages resulting to social progress and stability from the alarming growth in the orphan population?

• What does the epidemic imply for the viability of the private sector, and what role should business play in combating HIV/AIDS?

2) Effectiveness of scaled-up ARV delivery

Although ART has been shown to dramatically reduce HIV-related morbidity and mortality, to date only about 50,000 people in Africa have access to these treatments, coverage of only 1 percent whilst over 4 million people are in need. The debate on anti-retrovirals has until recently focused on the cost of these drugs and on making them available more cheaply. The cost has already fallen, and it is widely assumed that it will fall further in the future. However, even the cheaper drugs currently remain way beyond the means of the majority of Africans. If access is to be widened, then the cost both of providing the drugs and of creating the necessary infrastructure for their delivery will need to be carefully calibrated for African states. Some issues to consider include:

· To what extent is scaled-up ART a solution to the disastrous erosion of human capital?

· How can African health systems be strengthened to administer ARVs and to also provide adequate health care in general?

· How are the crucial public policy choices surrounding the roll-out of ARVs to be made in a transparent manner in which all stakeholders are represented? Which sectors should be regarded as a priority for governments' limited resources?

· How should the budgetary strains of financing the necessary measures for ART scale-up be handled?

· What forms of international partnership will be needed?

3) Political representation

One of the ways in which people have predicted that HIV/AIDS will shape democracy is by affecting elections and voters. In particular, AIDS could reduce the capacity to hold free, fair and legitimate elections; could limit participation, particularly by those infected or affected by HIV/AIDS; and could shift power and affect electoral outcomes.

It is important to also consider the impact of AIDS directly on political institutions, such as parliaments (MPs and staff) as well as the response of these institutions to the epidemic, and their potential to serve as positive agents in the fight against the epidemic. Likely impacts on representative institutions include the loss of expertise and effectiveness, and a potential undermining of public faith in governance.

• How does the Focus Group see HIV/AIDS impacting upon electoral processes and democratic accountability?

• What is the impact of AIDS on legislatures? Can it be mitigated?

• How can we ensure that all relevant stakeholders are able to participate in debating government's AIDS-related priorities, programmes, and budgets?

• How are the interests of people living with HIV/AIDS to be mediated through the democratic process?

• How can the interests of women, who are especially impacted by HIV/AIDS and its wider effects, be best represented?

Conclusion

These are some of the issues that the focus group will need to consider before the ADF IV in October 2004. The group's agreement on key areas of concern, and consensus on recommended actions, is intended to guide the plenary deliberations, with other stakeholders and selected heads of State, at the Forum itself.