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Without significant debt relief, there is little money for prevention, education, research, and medication for HIV/AIDS. And, without the means to raise awareness and work for prevention, the AIDS epidemic, far from declining, has been increasing exponentially.
It is no coincidence that the AIDS crisis has exploded most dramatically in highly indebted countries. The impact of the debt over the last two decades in systematically diverting resources from health and education towards unproductive debt servicing has had devastating results. The fall in expenditures for education and health has undermined the basic preventative measures needed to address the scale of the disease – such as health education. A fragile health care system has thus been unable to cope with the ensuing spread of infection. The sudden influx of patients has brought many hospitals in indebted countries to the brink of collapse.
Broader and deeper debt cancellation needed
Faith-based groups and others engaged in both debt and AIDS advocacy have recently been urging this administration to press the international financial institutions – the World Bank and the International Monetary Fund – to go further in canceling the international debts of impoverished countries, both by granting deeper debt cancellation and by including more countries, and directing the savings to poverty reduction and critical development needs. Debt relief advocates have suggested that our government consider two methods for deeper and broader debt cancellation:
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Canceling 100 percent of the multilateral debt of impoverished countries (as the major donors, led by the U.S., have cancelled their bilateral debt); and
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reducing debt stock sufficient to reduce the annual payments on an impoverished country’s public and publicly guaranteed debt to not more than 10 percent of the amount of the annual current revenues received by that country from internal resources. In the case of a country suffering a severe health crisis, such as an HIV/AIDS adult infection rate of 4 percent or more, not more than 5 percent of such annual current revenues should go for debt payments.
In addition, advocates have urged that multilateral debt cancellation not be made contingent on the adoption or implementation of policies that hurt the poor, such as “user fees” for health care.
Funds freed from debt service can be used for AIDS prevention and treatment
Advocates have affirmed the link between poverty and AIDS, and have therefore accepted the view that debt cancellation, as an aspect of poverty alleviation, should also be linked to the effort to combat AIDS. This has brought us into the difficult waters of “conditions” – the strings attached to any arrangement.
Conditionality – to use an awkward but common version of the term – refers to any number of concerns, ranging from specific economic policy reforms to advocating that funds freed up by debt relief be dedicated to certain programmatic allocation, be it poverty eradication or something more specific still, like HIV/AIDS. Many in advocacy, such as the Washington Office on Africa, find comfort in saying that debt relief permits the allocation of funds to health care, while urging – but not mandating – that African nations direct substantial funds secured through debt relief to HIV/AIDS prevention and treatment.
It is a grim picture, a continent where millions live on less than a dollar a day, and where 84% of all AIDS deaths worldwide occur. Yet, many African countries are clearly ready to make a commitment to fight HIV/AIDS with broad-scale preventative education initiatives as well as treatment, provided resources are available. Heads of African states at the OAU Summit on HIV/AIDS in April 2001 committed themselves to spend 15 percent of their GNP on health.
