Viewpoint

Interview with Christoph Benn


10/2003		  

[ Interview with Christoph Benn ]

The fight against AIDS must not be put off

The Global Fund to Fight AIDS, Tuberculosis and Malaria still needs more than US$ 2 billion by the end of 2004 to be able to fulfil its tasks properly. But the donors are holding back on pledges. At the same time, the World Bank and the University of Heidelberg warn in a joint study that the impacts of the AIDS pandemic could be even worse than assumed so far. We asked physician Dr Christoph Benn, the former Deputy Director of the German Institute for Medical Mission (DIFAEM), in Tübingen, and since October Director for External Relations at the Global Fund in Geneva, about the state of the international fight against AIDS.


Dr Benn, at the G8 Summit in Evian in June, US President George W. Bush announced that his country would pay one billion dollars per year into the Global Fund to 2008 provided that the European Union would provide the same amount. At an international meeting in Paris on July 16 in support of the Fund the Europeans were unable to make that pledge (see p. 359 of this issue). Are the donors not taking the problem seriously enough?
First of all, the mere fact that the Fund exists and that since its founding in June 2001 some 160 programmes have been promoted with a total of 1.5 billion US dollars is a success. On the other hand, we have to note that the donors’ vigour has slackened. That has also to do with September 11 and the concentration on combating terrorism. When the Fund was founded the supporting countries signed a covenant which says that by 2005 at least seven to ten billion dollars is to be raised for the worldwide fight against AIDS. The willingness to provide funds to combat AIDS is now nowhere near as marked as it is required by this covenant. And this development is reflected in the announcements of Jacques Chirac and European Commission President Romano Prodi at the meeting on July 16. Both declared, in fact, that Europe aimed to raise the one billion dollars for 2004, but they could not say where the money was to come from. At present, the pledges of the EU and its member countries total 440 million dollars. That is not a small sum, but it is less than promised originally and less than the Fund needs to meet the expectations aroused by its founding.

Is it right to regard the EU as the brakeman? German Development Minister Heidemarie Wieczorek-Zeul has pointed out that compared with total spending, Europe is the biggest donor in the fight against AIDS and that the promises of the US government must be taken with caution as long as Congress has not approved the money.
The objection is justified. Compared with the money paid in to the Fund so far – not just what has been pledged – Europe’s 650 million dollars puts it even slightly ahead of the USA with its 620 million dollars. However, there are big differences within the EU in willingness to support the Fund. France and Italy are the largest donors. France has increased its contribution for 2004 from 50 million euros to 150 million, meeting exactly its share necessary to help reach one billion dollars. Unfortunately, other countries have not followed this example, and we hear time and again that in the European context Germany tends to be one of the brakemen.

Is that due only to budgetary reasons, or are there in Germany also reservations about the Global Fund in terms of its substance?
Both. Certainly, Germany is in a difficult budgetary situation, but so is France. I think that what lies behind the German reserve is also a debate on substance with the Development Ministry (BMZ) on how the Global Fund is to be assessed. In the BMZ there is a view that they should first wait until the Fund has built up organisational structures; after all, they do not know yet if it works. I cannot understand these reservations. The structures are in place, the Fund promotes 160 programmes, the money has flowed in – and that only 18 months after its founding.

There is much talk about which donors allocate most money to fighting AIDS. In the debate, do questions of substance, such as on promising concepts, not get the attention they deserve?
Superficially that may appear so. On the other hand, we look back on 20 years of fighting AIDS and know the successful examples in Uganda, Thailand, Zambia, Brazil and Senegal. There are concepts that work, that have been scientifically covered and tested in practice. UNAIDS says we have a set of 25 different interventions that have been proved to work. So we know what has to be done, but implementation fails often due to a lack of financing. That is why the political debate focuses on the financial aspect.

The World Bank and the University of Heidelberg write in their joint study that AIDS could cause entire national economies to collapse (see p. 391 of this issue). Is this scenario too gloomy?
No, I don’t think so. The study confirms what other economic analyses have shown. But it goes still further in that it takes into account not only the direct economic impacts caused by the death of working people, but also the indirect costs incurred due to the death of parents and potential parents who are very important for the upbringing, education and qualification of following generations. This aspect has been ignored so far. If you travel through countries that are badly affected by AIDS you see how many households are run by adolescents, and you notice that huge social problems are arising here. Who integrates these children? Who gives them an outlook for the future? People who expect nothing of the future also do not invest in the future.

What can be done against that?
We must make a start at several points at the same time – in both the preventive and the therapeutic area. Earlier, we gave too much thought to single measures, but in the meantime we have come to the conclusion that prevention and therapy belong together. Prevention works better if the people have the prospect of being treated in case they get infected.

In the debate, therapeutic measures and the problems associated with them, such as access to medicines, are often in the foreground. Is prevention in the fight against AIDS not being paid the attention it deserves?
No, this impression is wrong, but it can be understood. I have been involved in the fight against AIDS for 15 years and have worked in Africa for many years, long before there was a possibility of therapy. In all these years we have focused entirely on prevention and the care of those affected. After all, the option of also applying therapy has existed for only a few years. That is why therapy is discussed most at present, but in practice prevention still plays the more important role – and, by the way, in the payments of the Global Fund. Some critics claim that most of the money goes into treating AIDS, but that is wrong.

The fight against AIDS is 20 years-old, but success in the developing countries has so far been meagre. Why?
The quick answer to that is: we need more time. Take the example of Uganda, where the foundations for successful prevention were laid very early on. The President declared the combating of AIDS to be a government priority back in 1986. A self-help movement formed quickly, the people were encouraged to break the taboo on the disease and speak about it openly, and test centres were established which people made full use of. But even under these good conditions – and that is soon forgotten – it took eight years until the infection rates in Uganda declined. The Ugandan model is in principle transferable to other countries, although many governments have faced up to the problem only with great delay, some of them not until the end of the 1990s. You cannot expect the same successes there overnight. AIDS is a disease that so strongly penetrates societies and has such long-term impacts that the fight against it cannot deliver fast results. That, at the same time, means a lot of money must be invested in the fight now, otherwise the problem will become ever bigger.

So it is crucial that the governments open themselves to the subject and take the initiative in fighting the disease?
Yes. That does not mean that governments must implement everything. They must open the way for civil society, they must promote cooperation among the NGOs and between them and the government. The atmosphere in the affected countries must change, openness must be engendered, and that is very hard to accomplish against the will of a government.

What can development cooperation contribute to the fight against AIDS? Is the practice on the right track?
Some things can be improved, and it is not least for this reason that the Global Fund was created. We must ask ourselves how effective the fight against AIDS within the framework of development cooperation, including the German, has been to date. Government and non-governmental organisations have promoted a great number of projects, but they have never been able to go beyond that and exercise influence at national and regional level. That is exactly what the Global Fund aims to do, by applying successful concepts at a higher level so that more people will be reached. What is new is that, instead of implementing single projects, upon a country’s application for funds, in which government, civil society and the private sector must participate, a close look will be taken at the country as a whole in order to decide what nationwide measures promise to deliver the greatest impacts.

I believe this instrument is superior to bilateral approaches.

Questions by Tillmann Elliesen.