UN fund for AIDS hides the real injustices

On the face of it, the setting-up by the UN of a new global fund for health and HIV/AIDS, malaria and TB seems entirely laudable. Sadly, it is not that simple. Why is another fund needed at all? There are already well-established channels for the distribution of aid, many of which are under resourced or in need of reform.

Why could governments not use these without the fanfare of pledges to a new fund? There is every danger that funding will become mired in another layer of bureaucracy, and that decisions will be taken even further away from the people most affected. The UN special session was unpleasantly reminiscent of the excesses of telethon fund-raising, where maximum publicity is garnered for minimum investment.

The US offered a paltry $200 million, which, as Christian Aid has pointed out, is one three-hundredth of the proposed spending on the so-called "Son of Star Wars" missile defence system. Britain pledged £125 million, but £75 million of that was from funds already earmarked for aid, not as a new and additional donation.

And Ireland? What did we pledge? Well, no one knows exactly. Bertie Ahern did promise to earmark $30 million for HIV/AIDS programmes. However, this is part of $100 million promised in the

Programme for Government, so it cannot be said to be new money. Nor were Government sources able to tell me what percentage would go to the UN fund and what would be channelled through existing mechanisms of aid to non-governmental organisations and government to government. If this is because they are waiting to see how successful this fund will be, it is a wise decision.

In his speech to the UN, Mr Ahern said: "My primary concern is to ensure that this extra money reaches communities most affected. We will channel funding to ensure efficient and effective delivery and impact at the country and local level."

Given these criteria, little or no money should be channelled through the UN. The most effective route is through locally based initiatives or through strengthening basic health and education systems through more effective bilateral aid. All of this can happen without a global fund.

I have no wish to criticise Bertie Ahern's excellent speech or our Government's decision to increase aid and to meet the now 30-year old UN target of donating 0.7 per cent of GDP by 2007. We have a proud tradition of voluntary giving to organisations such as Trocaire, and it is right that our government should match that.

After all, the US, the wealthiest country in the world, donates a mere 0.10 per cent of GDP to development. In that context, Ireland is doing remarkably well. Yet it is no more than what we should do.

HIV/AIDS is not just a health issue. It cannot be tackled without looking at dee per issues of poverty. The disease is not a disaster in wealthier countries where many people with the illness lead productive lives because they have access to treatment. When you combine extreme poverty with malnutrition, poor access to healthcare and education, and a lack of basic infrastructure, HIV/AIDS wreaks havoc, feeding on and causing further poverty.

Why are these countries where HIV/ AIDS thrives so poor in the first place? Corruption and war in some of these coun tries are no doubt a factor but they have also been crippled by debt and by draconian measures imposed by the IMF and the World Bank. As Christian Aid also points out, 23 countries have had some of their debt can celled, but those 23 are still repaying more than $2 billion every year. Together with many of the countries most affected by the HIV/AIDS crisis, they are able to spend only $1.4 billion per a year on healthcare. A UN fund of $1 billion, or even Kofi Annan's proposed $7-$10 billion, begins to look paltry indeed. Unlike a global fund, debt cancellation entails no new bureaucracy. It will be tragic if the UN fund allows richer countries to boast that they are doing something while these underlying injustices continue.

Why is the developed world so troubled by HIV/AIDS, albeit belatedly, and so untroubled by other tragedies? Every week the child death toll to malnutrition and illness is 250,000. In developing coun tries, 10 per cent of children under five still die from measles, mostly because malnutrition has weakened their defences. We do not see the same call to action to tackle these realities. Could it be because HIV/ AIDS also affects the developed world? Or worse, could it be that this tragic pandemic represents an opportunity for powerful pharmaceutical companies to make a fortune from human misery?

One interesting development was that words such as abstinence and fidelity found their way into the declaration made after the special session. Until this, the patronising Western assumption that Africans in particular were incapable of reforming their sexual behaviour held almost complete sway.

Nelson Mandela challenged the trend, declaring at a major conference on HIV/ AIDS last year that Uganda had made great strides in combating the disease through condoms and abstinence. To speak of condoms was predictable; speaking of abstinence caused shock waves.

Few in Ireland are aware that two Irish nuns have been credited with playing a part in the fight against the disease in Uganda. Sister Miriam Duggan and Sister Kay Lawlor have set up a network of youth clubs called Youth Alive, which use positive peer pressure to enable young people to examine and avoid risky sexual behaviour through promoting abstinence.

And it is working.

Much of the behaviour which spreads HIV/AIDS is abusive and exploitative of young people and of young girls in particular, who are also at greater risk of contracting the disease. That needs to be confronted and addressed. Simply handing out condoms does nothing to change such abusive trends. Rather like the way the UN global fund may allow governments off the hook for deeper structural injustices, focusing on condoms allows people to feel that something is being done.

Meanwhile, there is no equivalent energy dedicated to eradicating the poverty which makes HIV/AIDS such a disaster in the first place.