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What Effect Does Reducing Foreign Aid Have On HIV?
Sustainable development. Community development. Economic development. In my line of work, I have heard these phrases thrown around quite a bit.
But what is development?
The Merriam-Webster Dictionary describes development as the process in which “the government encourages the establishment of new industries particularly in order to increase industrial diversification and stability.” Although this definition implies the creation of local health systems, development most often is preceded by the receipt of foreign aid. The money is meant to increase production and to strengthen the local government. It also has a humanitarian aspect, where funds are used to alleviate poverty and to strengthen national health infrastructures.
In the past few years, the nature of development has shifted dramatically. The global economic crisis, the emergence of new challenges, and the complexity of existing obstacles has changed the nature of foreign aid. It was no surprise to me that global AIDS expert, Dr. Bernhard Schwartländer, discussed how to stretch funding at the recent International AIDS Conference in Washington, DC. It is also not surprising that, during an international economic crisis, he discussed moving away from a culture of charity.
“We should abandon the concepts of dependency and charity, as well as habitual ways of thinking and acting,” said Dr Schwartländer. "We should explore new possibilities for collaboration, activism, and financing."
For me, the most interesting aspect of Dr. Schwartländer’s presentation was the use of development language in speaking about HIV. As wealth grows in low- and middle-income nations, governments will have to find steady, internal sources of revenue and redirect funds towards their national health systems. This shift is extremely important. In countries like Kenya and Bolivia, where foreign aid almost entirely funds health care for HIV, this task is herculean.
Still, the shift offers a great deal of potential. It may serve to create more local interventions that are culturally appropriate to the various locations, which could result in stronger national health systems.
While the possibilities are endless, I worry that people will be left without health care as the United States government rushes to scale back funding. Take young people in Latin America and the Caribbean, for example. This region has one of the highest gaps between the rich and the poor. It is the region where health care users pay the highest out-of-pocket expenses in the world. Rates of poverty among young people remain high—in Honduras, for example, nearly 70% of youth between 15 and 19 live in poverty.
What will happen to these young people if aid funding is cut even more? In the current context, 3,000 young people around the world are newly infected with HIV each day. These rates will only increase without safety nets for young people and other poor and marginalized communities; these are the people who suffer the most when their nations are left hanging.
Where do we draw the line of responsibility in assisting nations transition smoothly? What about the increasing rich-poor divide within these nations, a gap that shows no sign of diminishing in many countries? As global rates begin to decline, we are no longer in an emergency crisis to combat HIV. Yet, we cannot stop funding because rates will rise again. These shifts in international policy raise questions about how the changes will impact HIV transmission and care globally.
“Let us not take the pressure off the world’s richest countries to meet their commitments and obligations," Dr. Schwartländer concluded. "It would be exactly the wrong moment for international donors to cut back funding, now that the dynamic is going the right way."
Photo credit: UNAIDS