AIDS : the greatest leadership challenge

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United Nations

Economic Commission for Africa (ECA)

African Development Forum 2000

"AIDS: The Greatest Leadership Challenge"

3-7 December 2000

United Nations Conference Centre (UNCC)

DAILY REPORT

AFRICAN DEVELOPMENT FORUM 2000

Daily Report for December, 3 and 4, 2000.

This report covers the opening session on 3 December and the full day of 4 December, including reports of sessions that were received by the time this report was completed.

The key themes covered were Leadership on HIV/AIDS; Development and HIV/AIDS; and Country Reponses and Lessons Learned.

ADF 2000 opened on 3 December with a reading of a poem by Biruk G. Medhin, an Ethiopian community activist working on HIV/AIDS. Titled: The Birds are Singing, the poem featured a father in a hypothetical African village talking to his son about AIDS and symbolically trying to warn the citizen of Africa to be on the safe side. It spoke of the urgency of the AIDS scourge, the need to create awareness and the role of governments in implementing appropriate policy.

Welcoming Remarks by Mr K.Y. Amoako, Executive Secretary, UNECA

Mr Amoako stressed the role of ADF 2000 as a platform for renewed commitment, vigour and determination to take on the challenge of HIV/AIDS in Africa. There was not only a need for ideas and actions, but political progress as well. Noting that the HIV/AIDS had robbed Africa of its dreams, he felt there was need to stop and reassess the AIDS

pandemic. He said he was convinced that this need not be Africa's inevitable future. "This is not a policy issue: this is ourselves, our families, our communities, our hopes." Calling

for an African response, Mr Amoako said the pandemic continued to roll on in its 14th year,

greatly impacting on Africa's socio-economic development (a reduction of .7% of GDP/year now, projected to soon deepen to a loss of 2% per year).

The Executive Secretary emphasized the need for leadership at all levels, to do the right thing, at scale ~ in education, health care and economic support. "Each and every one of the leadership acts necessary to prevent HIV/AIDS and to help those burdened with HIV/AIDS, each of these leadership acts, without exception, are things we want anyway for a stronger, better developed Africa." But, it was even more important to get the

'sequence' right. Instead of stressing the role of donors to reduce the destruction of AIDS - such as 2.4 million HIV/AIDS deaths a year in Africa and a total of 12.1 million orphans today; or that the international response is about one tenth of what it should be - there was an even greater need to emphasize desperately needed leadership, "here....first."

Mr Amoako challenged participants to reflect on how they could personally be involved in this struggle and on how to scale up the best strategies, policies and programmes. The consensus from ADF 2000 would be directly taken to the African Heads of State Summit on AIDS and other infectious diseases in Nigeria in April.

Dr Salim Ahmed Salim, Secretary-General of the Organization of African Unity (OAU)

Mr Salim noted that Africa's political leaders had committed themselves to fighting the disease, citing the OAU Summits of Dakar (1992) and Tunis (1994). Regrettably, most of these commitments had not been translated into action. The Secretary General called for a massive scaling up of efforts. He likened the AIDS pandemic to an armed invasion -- a major catastrophe that required total and spontaneous mobilization of society on a war footing by the continent's leadership. "There is a dire need to reorient the concept of national security to transcend invasion of borders and threats to governments." Mr Salim pointed out that ADF 2000 would serve as an important contribution to the Extraordinary Summit of the OAU to be convened early 2001 in Abuja.

Ms Charlotte Mjele, Hopeworldwide Jabavu Clinic, Soweto and the Society for Women and AIDS in Africa, SWAA-South Africa spoke of living with HIV/AIDS as a young African woman.

She began by telling of her shock when she was confronted with the news of her HIV status and of being overwhelmed at the thought of a future with no prospects. Knowing however that she wanted to live, she confronted her fear of dying, of becoming a mere statistic and of being stigmatized. "As the days, weeks and months went by my knowl edge increased and my fear decreased." It was replaced by a determination to reclaim her self esteem and confidence in order to make a difference in the lives of other young

people.

Ms Mjele talked of the difficulty of finally breaking the silence to family, colleagues and friends. But the need to fight stigmatization helped her to come out in the open. She warned, however that many do not have the courage to do what she did, which is why she made a conscious effort to be a leader in showing that a HIV diagnosis is not the end of one's life. "We need to help them make the transition from victims to victors."

Ms Mjele threw a challenge to policy makers on the continent urging leaders to reach young people as allies in the fight against poverty, the breeding-ground of HIV/AIDS; to break their silence and disclose their HIV status; to take seriously the violation of rights of people living with HIV/AIDS; and to make available affordable treatments, particularly to HIV infected pregnant women and HIV related illnesses. "The life of an African with HIV should not be seen to be less than that of his or her counterpart in other parts of the world."

In response to Ms. Mjele's statement, the entire audience stood in solidarity with her.

H.E. Dr Negasso Gidada, President of the Federal Democratic Republic of Ethiopia The President expressed concern about the devastating toll of AIDS, in terms of jeopard izing economic growth, development prospects and political stability in the continent.

"Given the degree to which HIV/AIDS is undermining progress in development, it is no longer merely a health problem, but poses a major development crisis to the continent."

The empowerment of women and restoration of basic education services were crucial elements in the struggle.

As Chairman of the National Coordinating Council, President Negasso Gidada said that

u?w™CCepted the chaiIen9e of 0AU Secretary General Salim Ahmed Saiim to treat

HIV/AIDS as a national disaster that requires an even greater level of spontaneous mobilization of people and resources than that devoted to armed conflict He committed his government to lead such a mobilization.

Song, dance and poetry renditions by artists of the Ethiopian AIDS Orphans Group The opening session concluded with a moving portrayal of the devastation caused by HIV/AIDS on the African family. Through song and dance, the children portrayed the agony of children in a family as, first the father, the mother and then one child are claimed by masked agents of the virus. As the children cry for their parents a strong call is made for people to take responsibility for their actions and avoid immoral behaviour The skit ended with a positive message of hope as the agents of the virus are unmasked and the

virus is overcome.

The December 4 program began with a plenary entitled: Leadership and Public Policy 4 December 2000, chaired by Mr. K.Y, Amoako, Executive Secretary of ECA The Plenary speakers were Dr. Peter Piot Executive Director, UNAIDS, and Mr Mark

Mallock Brown, Administrator of UNDP.

The speakers emphasized that AIDS, which has become an unprecedented multidimen sional crisis, threatens the social fabric and the human security of the African continent The impact of HIV/AIDS goes far beyond reducing life expectancy; reversing all human development and poverty reduction efforts. . "HIV/AIDS Does to Society what it does to the human body," said Dr. Piot. Yet it is a challenge that can be overcome To meet this extraordinary challenge, more effective and innovative leadership, and action based on

openness, realism and hope, are required.

The magnitude of the epidemic requires that countries and agencies put themselves on a war footing. There is need for more resources, commensurate to the challenges These should include traditional and non-traditional sources from all actors (national government UN agencies, private sector, civil society, UN agencies and donor community) There is ' also a need for behavioral change translated into good governance.

Key principles of effective leadership and action emerging from the presentations and the discussions included: breaking the silence around norms and values that fuel the

epidemic, namely those which perpetuate gender inequalities and discrimination; fostering opportunity for improved social dialogue and peace building; allocating appropriate

resources through the national budget and developing a new resource agenda which combines all sources; integrating HIV/AIDS into sectors and development plans; and fully involving people living with HIV/AIDS placing them in the center of the response.

The following issues were raised by the participants in the open session of the plenary:

• How to develop a social vaccine;

• How to build on positive cultural values while reducing the negative ones when

• Implication of debt on HIV/AIDS;

• Relevance of poverty reduction strategies to HIV/AIDS control"

Implications of HIV/AIDS on international economic policies and practices;

Inclusion of antiretroviral drug in the essential drug list at affordable prices;

Morning breakout sessions

The following points were raised during these sessions:

Household Impact: AIDS has a profound impact which has social, psychological and economic effects. Major strategies outlined were increasing food security and increasing productivity. Women, children and traditional and religious leaders were identified as leaders in this area.

Impact and Response, Health Care Services: The reassessment of the place and role of the health system is essential. Demand for health services is increasing, but leaders are not responding at the required level. Leadership must work more with traditional African leadership. Research less dependent on external financing should be instituted.

Social and health training should be instituted. The HIV challenge provides opportunity to reform current health systems.

Afternoon Plenary: Leadership and Public Policy

The Plenary session focused on the issues of leadership and public policy. In her

introductory remarks, Ms. Vivian Lowery Derryck, Assistant Administrator for Africa, USAID, stressed the need to focus on five lessons: leadership on all levels, especially senior leadership; the need to involve Civil Society; the elimination of the stigma by empowering women and embracing men; target prevention with a special emphasis on youth; and creating multi-sectoral approaches.

His Excellency Justin Malewezi, Vice President of Malawi, stated that HIV/AIDS is an epidemic that has been described as a "catastrophe in slow motion." Unless we scale up

our responses, more people will die of AIDS in Africa than in all wars of the 20th Century."

He stressed the need to make long-term commitments and more importantly, the importance of preventing the transmission of HIV/AIDS as the centra! to any long term strategy. "Our hope lies with the uninfected youth less than 15 years of age. Keeping young people HIV negative is probably the greatest challenge to us African leaders." he said. Vice President Malewezi pointed out the need to change men's behavior. Men must be included in advocacy about sexual behaviour. He highlighted the need for more

inclusive programmes.

Another key lesson from Malawi in dealing with HIV/AIDS, is the importance of a compre hensive multi-sectoral programme that includes the following sectors: education; health, including home-based care; agriculture and rural development; private sector and labor policy; and military personnel are key factors that must be included

On the issues of international justice and human rights, he pointed out that, amongst others, the following issues are relevant to the fight against HIV/AIDS: African external debt, the unequal distribution of benefits from the international economic order, the need for greater access to health care and social services in Africa and conflict prevention.

In conclusion, he highlighted the need to strengthen leader's commitment in addressing HIV/AIDS in Africa and to scale-up the response as well as the recognition that we face an emergency. Leadership is not about power, or the delegation of authority. It is about taking responsibility to address the most important issues facing our people.

Almaz Amine from the African Development Bank informed the plenary that the Bank is developing a strategy on HiV/AIDS in its development work as well as a policy for HIV/AIDS in its other work.. They are mainstreaming the issue in their sectoral pro grammes, focusing on gender and multi-generational responses.

Salvator Nyonzimas from UNAIDS pointed out that stigma is related to fears, myths of the community and to the perceptions that people have. The bad news is that the stigma is out there. It is wide-spread. Despite guidelines and reports, it still exists and People Living With Aids (PWLA) experience it daily. The good news is that we can do something about it. PLWA have taken leadership to change this. In those countries where PLWA have given a living face to the disease, they are helping to remove the stigma but we still have a lotto do.

Ms. Sisonke Msimang, representing the Youth Forum, stressed that information is not enough. There is need to get underneath the issues and identify the keys to behaviour change. She said that young people have created the only real movement around HIV/AIDS. Young people are organising, challenging leaders and showing them how to address the real issues.

Highlights from Break Out Sessions, Afternoon

Leadership role in restoring and strengthening health and social systems and services

The breakout session first pointed out that the basic facts include the growing strain that HIV/AIDS cases are having on national health systems e.g. 30 % - 70 % of bed occu pancy rates. The resultant growing resource needs should be matched by growing budget allocations. And finally, the facts that there is an urgent need to strengthen and rehabili tate the majority of health systems on the continent.

The campaigns for prevention, care/treatment and support/counseling etc will only be effective as they become more decentralized and as more people at the local level

develop the skills to run them. Therefore, resources need to be concentrated at the local level.

PLWAs must be made part of the decision making process. It is important not to focus on structures and forget people. In addition, there is need to pay attention to the needs of health care workers; i.e.,'care for the carers'.

Finally, a lot of work needs to be done on making affordable Anti Retro Viral (ARV) drugs available and improving their delivery to where they are most needed.

Leadership roles for overcoming denial, stigmatization and discrimination; ethical and legal issues

This breakout session highlighted five main points.

• First was the fact that the invisibility of PLWA and ignorance on HIV/AIDS has driven the epidemic underground.

• Secondly, the issue is not 'What is to be done?1 because we know that. The real issue is 'Why is it not being implemented?1

• Thirdly, the discussion around religion and HIV/AIDS was the third point and it brought out contrasting points of view. Some see religion's way of describing pre-marital sex as "sin" as a way of labeling risky behaviour whilst others see the approach that relig ious organizations have taken on the issue as unfortunate.

• Fourthly there is need for the media to take a lead role.

And finally, the session stressed the need for involving PLWA in relevant policy making.

Leadership roles in mobilizing political support and sustaining responses to HIV/AIDS

The breakout session examined the role of political leaders in the prevention of HIV/AIDS in Africa. Three levels of involvement of political leadership were considered. Namely, the personal involvement of the Head of state, members of the government, parliamentarians as well as the involvement of religious leaders, the private sector, NGOs and associative bodies. The session stressed that the success of mobilization for a sustained response against H1V/A1DS should also focus on the decentralization of the management structures for national programmes, the multi-sectoral implementation of activities, co-ordination based on popular participation as well as an equitable allocation of resources to all

sectors.