To: The Rt. Hon. Tony Blair MP 10 Downing Street London SW1A 2AA 24/5/03
Dear Prime Minister,
We write to you as doctors committed to the prevention of HIV/AIDS and the care and treatment of patients with HIV/AIDS both in the UK and abroad. We know that you see Africa as a priority and of your determination to give leadership in the fight against HIV/AIDS. We respectfully submit eight recommendations based on sound public health principles, international law, and a moral commitment to save millions of lives.
First, we recommend that your plan include a major commitment to help scale up health infrastructure in AIDS-burdened countries. Poor health infrastructure has been used to justify negligible contributions for care and treatment, but the proper response to poor infrastructure is to invest heavily to improve it. We recommend you to start without delay a generous programme aimed at supporting doctors, nurses, and other health workers fighting the disease globally. Funding is needed to retain health professionals who emigrate in search of better opportunities; to enhance skills of health professionals and others for their role in treatment, care, and prevention; to purchase medication, supplies, and equipment for health facilities, and; to upgrade and expand health facilities. The health infrastructure your programme helps to generate will enhance countries' capacity to respond to other critical health issues, such as deaths in childbirth, diarrheal disease, and malaria, and will make a sustainable contribution to the health of the world.
Second, we recommend expansion of existing programmes that treat people with AIDS and establish additional ones. In April 2002, the World Health Organisation announced a goal of providing at least 3 million people in developing countries with anti-retroviral therapy by 2005. We consider that the UK, the first country to provide universal access to free healthcare in 1948, should take a lead in this global effort. In every country, health care systems already exist that could form the backbone of the infrastructure for a comprehensive approach to prevention, care, and treatment. For example, although Malawi is one of the worlds poorest countries, more than 90 percent of mothers receive ante natal care from a doctor, trained nurse, or midwife. Existing health systems make some treatment possible today in every country.
Third, the UK should encourage a massive scaling up of prevention programmes. A study published in the Lancet, found that if prevention is amply expanded, the annual incidence of new HIV infections in adults could be more than halved within five years (1). We recommend you to commit the UK to supporting this goal. This will require the significant scaling up of prevention interventions, including school-based and peer AIDS education, outreach programmes for commercial sex workers and men who have sex with men, access to condoms, treatment for sexually transmitted infections, voluntary and confidential counselling and testing, and mass media campaigns.
Fourth, we recommend the UK enhance assistance to people caring for children orphaned by AIDS and to achieve the goals laid out in the UN Declaration of Commitment on HIV/AIDS. These goals include ensuring that orphans and children infected with, and affected by, HIV/AIDS receive appropriate support, and are enrolled in school and have access to shelter, good nutrition, health care, and social services on an equal basis with other children. Orphans and vulnerable children should also be protected from abuse and exploitation.
Fifth, we recommend you advance your debt relief plans for impoverished countries which is so crucial to fighting the AIDS epidemic, both to free up countries own resources to spend on HIV/AIDS programmes and to enable them to significantly increase spending on health, education, agriculture, micro-credit, and other development programmes, all of which must be part of a comprehensive response to HIV/AIDS. Furthermore if poor, heavily-indebted countries spend their limited resources on HIV/AIDS and other health issues, education, and other social programmes rather than on servicing their debts, they should not be penalised.
Sixth, we recommend that your initiative encourage the judicial and legal infrastructure to address discrimination and subordination of women and girls. In the age of HIV/AIDS, prevention infrastructure must include robust programmes to prosecute rape and sexual violence, assist local womens groups who offer legal services to victims, educate the public on womens rights, and support civil society groups of women with AIDS. We recommend you fund initiatives that upgrade women and girls legal and economic status, enlarge women and girls access to health care (including reproductive health care), and assist governments in preventing and prosecuting sexual violence, including rape, sex trafficking, and child prostitution. We also recommend you to use all appropriate tools to pressure governments to combat discrimination against people with HIV/AIDS and high-risk groups.
Seventh, we recommend you significantly increase UK funding for international HIV/AIDS programmes, including for the Global Fund to Fight AIDS, Tuberculosis and Malaria. The WHO Commission on Macroeconomics and Health estimated that excluding research, about $14 billion is needed annually to fight the AIDS pandemic. The UK is obliged, under the International Covenant on Economic, Social and Cultural Rights ratified in 1976, to wherever possible provide the necessary aid. A report last year (2) estimates that the UK should be paying approximately £306m per year to the Global Fund to reach the level that experts agree it needs (if donations are assumed to come on an equitable basis). These funds should complement, not replace, current development and relief funds.
Finally we recommend you use your influence to persuade the policy makers within the EU, and within individual EU countries, to recognise that the threat that HIV/AIDS poses to global health, security and economy, requires that they assume an obligation to do whatever is necessary to help bring the epidemic under control.
Your premiership will be remembered as the time when the world became aware of the devastation that AIDS is causing. The question is, will it be remembered as the time that the world took the necessary action or the time when neglect made the epidemic worse. Even at the beginning of your second term as Prime Minister, experts grossly underestimated how quickly the pandemic would spread. Now we know that the disease threatens to explode in the worlds most populous nations. 50 to 75 million people could be infected by 2010 in China, India, Russia, Nigeria, and Ethiopia and continues to reach record levels in Southern Africa. In Botswana, nearly 40 percent of adults have HIV/AIDS. Now 14 million people in Southern Africa face the possibility of starvation because AIDS strikes people the most productive members of society, including farmers. Today only a tiny proportion of the 30 million Africans with the disease are receiving treatment.
The manner of the world’s response to the currently estimated 85 million people who will have been infected by HIV by 2010 will be a defining issue of the age. As you began your second term, the funding that the UK, the United States and other wealthy nations provided to combat HIV/AIDS was but a fraction of what was needed. Since then President Bush has committed to nearly tripling the U.S. contribution to the international fight. With the disease consuming entire communities the world over, we recommend a financial commitment that is proportionate to both the UK's economic status and to the threat to mankind posed by HIV/AIDS
Dr Peter Hall MBBS, MRCPI, DGM Chair, Physicians for Human Rights-UK
1. Can we reverse the HIV/AIDS pandemic with an expanded response? John Stover, Neff Walker, Geoff P Garnett, Joshua A Salomon, Karen A Stanecki, Peter D Ghys, Nicholas C Grassly, Roy M Anderson, Bernhard Schwartländer Lancet 2002; 360: 73-77
2. T France, G Ooms and B Rivers. The GFATM: Which countries owe, and how much? International Association of Physician's in AIDS Care Monthly Vol. 8, No. 5, May 2002