Meeting the Challenge: Canada's Foreign Policy on HIV/AIDS - With a Particular Focus on Africa

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Section 8.0 - Conclusion

This report puts forward a case for Canadian leadership in the international response to HIV/AIDS. It argues that Canada is well-placed to demonstrate leadership and voice. It looks forward to the development of a comprehensive international strategy. It calls for enhanced leadership by DFAIT in international theatres, but also in engaging the full cooperation of other relevant departments and agencies in Canada.

In line with the request for the report, the focus is on Africa, specifically sub-Saharan Africa Although there are distinct signs of hope in Africa, the epidemic has not reached a plateau in many of the most seriously-affected countries. Furthermore, a recent World Bank study on the long-run economic costs of AIDS in South Africa indicates that the country, a leader and a key economy in Africa as a whole, is threatened with progressive economic collapse.¹⁷⁴ As the World Bank study attests: "What are the lessons for public policy? Where the prevalence rate is still low...it is of the utmost importance to contain the disease at once: for the economic system as well as for individuals, an ounce of prevention is worth far more than a pound of cure."¹⁷⁵ In situations like that of South Africa or of countries with fewer resources, the study admits that the answers are much more complex and will "require a large and determined fiscal effort."¹⁷⁶

However, the extent of support for such a large fiscal effort remains inadequate, tragically low. The urgent need for a massive scaling-up of the response, including multiplying the resources, is clear. As Stephen Lewis, United Nations Special Envoy for HIV/AIDS for Africa, states, "The question of resources remains central to everything else, and I have no illusions that that struggle over money is yet joined."¹⁷⁷

With the prices of HIV-related medications finally dropping to the point where they may become affordable for national governments (with assistance from donors), a massive scaling up of access to treatment is a concrete possibility. Affordability is essentially a question for donor nations because for the majority of the most seriously affected, unless treatment is provided free of charge it will not be accessible. The reinforcement of public health systems to make treatment sustainable and to simultaneously strengthen prevention and care services is similarly possible, given adequate resources.

The failure to rapidly remove legal obstacles to affordable access to medicines, including generics, in the light of claims of the right to health and the right to life, is a failure of global governance, not merely a difficulty with trade negotiations. Action is overdue to make effective the claims of human rights, particularly the right to health, upon trade and intellectual property policies and agreements.

The engagement of community-level resources, and the participation of the most-seriously affected and of other elements of civil society in mobilizing response and in developing appropriate policies, priorities and legislation, whether nationally or multilaterally, is essential to success.

By these means the stress on governance and the cycle of infection-insecurity-conflict-transmission may be reduced.

Africa is most seriously affected. The response to HIV/AIDS in Africa has an immediate priority in humanitarian, economic and security terms. But the "arc of infection" is not, by any means restricted to Africa. Eastern Europe and Central Asia have sharply escalating rates of infection. China, India and Russia could soon have epidemics that will see greater numbers of HIV infections than we have witnessed in Africa. Thus, as the World Bank study attests, in the countries that have a relatively low HIV prevalence rate, but an increasing HIV incidence rate, action must be taken now to contain and reverse the contagion.

Again, the situation is not all bleak. The Brazilian initiative in treatment is a beacon of hope, as are an increasing number of responses of governments in Africa and Asia. The development of a strategy for support of prevention as well as care and treatment in areas of greatest risk should be part of the ongoing development of Canadian leadership in confronting the epidemic.

Canada and Canadians will be unable to sustain the sort of high-intensity response to the global challenge of HIV/AIDS without a clear sense of the shared risk of living in a globalized world, and the necessity of shared responses for shared survival. In the words of Tony Barnett, a leading academic in development studies with extensive expertise in HIV and development issues, "We cannot act as though we were inhabitants of a medieval city-state and exclude those who are sick and/or poor. There is no longer any quarantine, we cannot avoid contagion."¹⁷⁸

For the moment, there is no greater argument than that of simple human decency put forward by Stephen Lewis, who said:

"What is wrong with the world? People are dying in numbers that are the stuff of science fiction. Millions of human beings are at risk. Communities, families, mothers, father, children are like shards of humanity caught in a maelstrom of destruction. They're flesh and blood human beings, for God's sake; is that not enough to ignite the conscience of the world? "¹⁷⁹

Notes

174. Stephen Lewis commented as follows on the World Bank study: "What it says about the prospects for South Africa is nothing less than apocalyptic. I remind you that the Bank is given to sober appraisal...For the Bank to predict the possibility of a failed state of South Africa within three generations, based on the socio-economic fall-out from HIV?AIDS, is astonishingly uncharacteristic. It must therefore be taken seriously." From Lewis, Speech. 3 August 2003: p. 10.
175. Bell. The Long-run. 2003: p. 95.
176. Ibid.
177. Lewis. Speech. 2003: p. 11.
178. Barnett. What can. 2002: p. 16.
179. Lewis. Speech. 2003: p. 10.

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