By JONATHAN MUNDELL (1)

At the beginning of last month, from June 3rd to June 7th, Uganda hosted the second global HIV & AIDS Implementers Meeting at the Imperial Royale Hotel in Kampala. The five-day meeting was held under the theme, ‘Scaling Up Through Partnerships: Overcoming Obstacles to Implementation’, and was co-sponsored by the US Presidents Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF), the World Bank, the World Health Organisation (WHO) and the Global Network for People Living with HIV/AIDS (GNP+). The meeting attracted over 1,700 participants from more than 70 countries around the world.

The primary objectives of the meeting were to widely disseminate the lessons learned over the past year, focussing specifically on: the scaling up of prevention, treatment and care programmes; the building of local capacity; quality; and improving coordination among partners. The meeting also aimed to have a direct impact on HIV & AIDS programme implementation over the next year, through encouraging open dialogue about the future directions of HIV & AIDS programmes, best practices, and the identification of critical barriers. Prior to the meeting, Jimmy Kolker, chief of the HIV section at UNICEF, summed up the objectives of the meeting, stating that, "Coming together to share best practices will move us closer to an AIDS-free generation. Kampala will reaffirm the priority that the global community must continue to give to the fight against AIDS".

PRESIDENT PAYS TRIBUTE TO PARTNERS, BUT CRITISISES DONOR REGULATIONS

During his opening address, Ugandan President Yoweri Museveni began by thanking global partners such as PEPFAR, the UN and the Global Fund, for their generous funding and support in the fight against HIV & AIDS, stating that “Without your support, we would not have reached where we are today". President Museveni paid special tribute to United States President George Bush for the recent increase in PEPFAR funding for Uganda, up from US$ 236 million to US$ 283 million. The President went on to assure donors that the previous mismanagement of funds would not be repeated. He was speaking specifically about the recent case of embezzlement by his former Health Minister, and said that, “mechanisms have been put in place to ensure proper use of the funds". Museveni also discussed recent challenges and progress made by Uganda, stressing that future programmes in HIV & AIDS prevention need to emphasise the importance of behaviour change and healthy living for all people, whether infected with HIV or not.

In contrast to his praise of the various donors at the meting, the Ugandan President also criticised the stringent regulations that have been set to guide the spending of funds, such as the inflexibility of drug procurement regulations. He said that while donors stress the importance of capacity building, they do not encourage the purchase of locally manufactured drugs, and this seems to be completely contradictory. Chief Medical Officer of PEPFAR, Dr. Thomas Kenyon, responded by saying that there are not strings attached to donor aid, but that donors will only provide funds for what the recipient countries need. During a press conference later in the meeting, Michel Kazatchkline, the executive director of the Global Fund, commented that, "What I am ready to fund is the cheapest drug available, which is of quality. It is okay if Uganda produces its own ARVs. The drug should be of approved quality and cheap. Otherwise, I will ask the Uganda Government to buy drugs elsewhere".

LOOKING FORWARD TO IMPORVED PROGRAMME IMPLEMENTATION

During the meeting, delegates discussed a number of strategies that could potentially improve future programme implementation. Governments and international partners were encouraged, for example, to refocus their HIV & AIDS strategies on the prevention of the epidemic. Although much of the funding for the fight against HIV & AIDS is focused on a cure and treatment for the disease, it was suggested that prevention still remains the most important way to conquer HIV infection. Janet Museveni, Ugandan First Lady, stated at the close of the meeting that, "Our chief weapon against AIDS has been and continues to be prevention. It is our only line of defence because the disease has no cure".

African countries were also reminded about their commitment in Abuja, Nigeria in 2001, of devoting 15% of their national budgets to the health care sector. It was also stressed that the inclusion of people infected and affected by HIV & AIDS could strengthen the effectiveness of HIV programmes. An example that was given is how the Aids Support Organisation (TASO) empowers people who are living with HIV & AIDS to enrich service delivery. By incorporating people who are living with the virus into their activities, TASO gains a deeper understanding on how to address HIV & AIDS issues.

ONE SIZE DOES NOT FIT ALL

In addition, Susan Kasedde, of the United States Agency for International Development (USAID) regional support team for East and Southern Africa, stated that emerging findings suggest that epidemics vary between countries and within countries and because of the variations, ‘one-size fits all HIV programmes’ are inadequate in the global response. She commented that, “poor analysis of evolving epidemics leads to poor strategic focus and continued misallocation of resources”. In order to predict where the next infections are likely arise and to address gaps in current programmes, Kasedde said it is critical to investigate trends in the general public as well as specific groups within the general population.

The Great Lakes Initiative on HIV/AIDS (GLIA), funded by the World Bank, reported that its member countries Burundi, Democratic Republic of Congo, Kenya, Rwanda, Tanzania and Uganda have failed to protect some of the groups most at risk from the pandemic. As national epidemics evolve, programmes developed to address them must also change, especially when a specific group or groups have been identified as the key driver of the epidemic. Flavia Kyomukama, from the National Forum for People Living with HIV & AIDS, also urged programme implementers to include the face of the child in their programmes and campaigns, as data reveals that children’s programmes were grossly under-funded.

A NEED FOR SIMPLIFICATION AND COORDINATION

While there was much progress made in conceptualising new strategies for HIV & AIDS programme implementation, the disappointments of the past were also highlighted, and it is these lessons that will assist in improving future efforts. A challenge that was most pertinent for the meeting, noted by Michel Sidibe, UNAIDS Deputy Director, is the “uncoordinated manner” in which HIV & AIDS efforts have been undertaken in the past. He suggested that it is critical for implementers to “simplify and coordinate aid money” in the future. In closing, Deputy Director of the Global Fund, Helen Evans, commented that this challenge could potentially be addressed through such meetings, facilitating “better understanding and coordination among all partners”.

So as we now look forward to the International AIDS Conference in Mexico City, in August later this year, we hope that the lessons learned and suggestions made during the Implementers Meeting have not fallen of deaf ears.